Treatment for Seizures, Epilepsy, and Spasticity Flashcards
what is the definition of seizures?
brief episodes of abnormal electrical activity in nerve cells of the brain that may or may not be accompanied by visible changes in appearance or behavior
what is the definition of epilepsy?
one or more seizures not caused by a reversible medical condition
what is spasticity?
increase in muscle tone or contraction
- stiff or awkward movements
- associated with brain/nerve damage related to the spinal cord
what are partial seizures?
begins focally in the cerebral cortex with limited spread to adjacent cortical areas
- simple or complex
what is a simple partial seizure?
- no memory loss
- no loss of consciousness
- muscle rigidity, spasms, jerking movements
what is a complex partial seizure?
- memory loss
- loss of conciousness
- lip-smacking, chewing, impaired coordination
what is a generalized seizure?
seizure activity is conducted widely throughout both hemispheres
- often lose consciousness
- typically 1-3 minutes
what is the prodromal period?
before the seizure - can be triggered by stress, overstimulation, mood changes, infection
what is the aura?
trigger or feeling prior to seizure
what are the possible triggers for seizures?
- infection
- depression
- stress
- lights
- over stimulation
what is the ictal period?
during the seizure event - this is what you time
what is the post-ictal period?
the period after seizure activity
- headache
- tired
what is tonic?
contraction of skeletal muscle
what is clonic?
rhythmic, jerking movements
what are the 4 stages of a seizure?
- prodromal
- aura
- ictal
- postictal
what is the part of the seizure that you time?
ictal
what is seen with tonic-clonic seizures?
stiffness and shaking
what is seen with absence seizures?
- staring spells and spacing out
what is seen with atonic seizures?
- loss of muscle tone
- drop to the ground or head starts bobbing
what is seen with myoclonic seizures?
- shakey and jerky
- short in duration
- specific limb
what are the possible causes of seizures?
- idiopathic
- fever
- hypoglycemia
- electrolyte imbalance
- drug overdoses
- withdrawal from alcohol of sedative-hypnotics
- developmental defects
- birth injury
- eclampsia
- alzheimer’s
- head injury
- stroke
- brain tumor
what health history would be taken while diagnosing seizures?
- TBI
- drug use
- history of CVA or brain tumor
- brain swelling
what IMAGING studies would be used while diagnosing seizures? why?
looking for scaring or abnormalities
- CT scan
- MRIs
what is the most important test for diagnosing seizures?
electroencephalograms (EEGS)
- outpatient or inpatient
- detect seizures via electrical brain activity
- shows the specific area of seizure
what is the goal with antiepileptic drugs (AEDs)?
- reduce seizures (not a cure)
- improve quality
what are the different actions of AEDs?
- suppress sodium influx
- suppress calcium influx
- antagonism of glutamate
- potentiation of GABA (increase)
is glutamate excitatory?
yes (we want to decrease)
provide examples of traditional AEDs
- phenytoin (Dilantin)
- carbamazepine (Tegretol)
- phenobarbital (Luminal)
- diazepam (Valium)
- clonazepam (Klonopin)
- lorazepam (Ativan)
what is the action of phenytoin (Dilantin)?
delay influx of sodium into neurons thus preventing excitability (calms down nerves)
what are the adverse effects of phenytoin (Dilantin)?
- toxicity
- gingival hyperplasia (overgrowth of gums)
- rash - steven johnson’s syndrome
- CV: arrhythmias and hypotension
- GI: nausea and vomiting (take with food)
what teaching is needed with phenytoin (Dilantin)?
- monitor for levels of toxicity (should be 10-20, more than 20 is toxic, and less than than 10 is not therapeutic)
- increase dental exams
is phenytoin (Dilantin) safe for pregnancy?
no, and it decreases the effectiveness of birth control
- would need to use two forms of birth control
what are the signs and symptoms of toxicity with phenytoin (Dilantin)?
- unsteady walk
- trembling hands
- can’t speak well
- serum level greater than 20
what is a common but severe side effect of AEDs?
steven johnson syndrome
what is the action of carbamazepine (Tegretol)?
inhibits sodium uptake
what black box warning is seen with carbamazepine (Tegretol)?
agranulocytosis (decrease WBCs, increased risk for infection)
what side effects are seen with carbamazepine (Tegretol)?
- agranulocytosis
- steven johnson syndrome
- aplastic anemia
what is the action of valproic acid (Depakene)?
increase GABA
what side effects are seen with valproic acid (Depakene)?
- teratogenic (toxic to fetuses)
- PCOS in women of childbearing age
is valolporic acid (Depakene) safe for pregnancy?
no, it is teratogenic
what kind of medication is phenobarbital (Luminal)?
barbiturate - AED
what black box warning is seen with phenobarbital (Luminal)?
increased suicide ideation - don’t use if the patient is depressed because they can commit suicide by overdosing
what are the signs of overdose with phenobarbital (Luminal)?
- decreased respirations
- constricted pupils
- bradycardia
- coma (decreased level of consciousness)
what side effects are seen with phenobarbital (Luminal)?
- steven johnson syndrome
- increased suicide ideation
provide examples of newer AEDs?
- lamotrigine (Lamictal)
- gabapentin (Neurontin)
- levetiracetam (Keppra)
- topiramate (Topamax)
what side effect is seen with newer AEDs?
steven johnson syndrome
what is one benefit to newer AEDs?
helps regulate and calm mood because there are fewer neurons firing
what is the action of lamotrigine (Lamictal)?
decreases release of glutamate
what drug would require drug level monitoring?
Dilantin (10-20)
what newer AED can not be crushed?
levetiracetam (Keppra)
what is glutamate?
an excitable neurotransmitter (we want to decrease in patients with seizures)
what does Gabapentin (Neurontin) treat?
seizure, restless leg syndrome, hot flashes, alcohol withdrawal, peripheral neuropathy, deep nerve pain.
what happens if a patient does not take their AED regularly?
increased seizure activity
how to stop AEDs?
don’t stop abruptly
what drug creates a higher risk for suicide?
phenobarbital (Luminal) - black box warning
what are some nondrug therapies for seizures?
- neurosurgery
- vagal nerve stimulation
- ketogenic diet
- marijuana treatment????
what kind of diet is good for seizure patients? why?
ketogenic diet because it is high in fat, fat breaks down into ketones, and ketones decrease risk of seizures
what is vagal nerve stimulation?
kind of like a pacemaker that stimulates the vagal nerve to increase the stimulation of norepinephrine
- takes weeks or a year to be effective
- patient still needs to be on meds especially till it starts working
can service alert dogs help?
yes
what is status epilepticus?
the most dangerous and extreme type of surgery
- TONIC CLONIC seizure that lasts longer than 5 minutes or frequent events closer together
what is there a high risk of with status epilepticus?
permanent brain damage
- loss of oxygen/perfusion to the brain
what are the possible causes of status epilepticus?
- brain trauma
- cerebral damage
- systemic infection
- drug overdose
- alcohol withdrawal
- abrupt discontinuation of AEDs
- brain tumor
- epilepsy syndrome
- electrolyte abnormalities
- encephalitis
how common is status epilepticus? what is the treatment?
15% of epileptic pt’s will experience status epilepticus
- treatment includes: oxygen, neuro exam, IV Ativan (benzodiazepine)
what should a nurse do when taking care of a patient who is seizing?
- turn on their side, head support, nothing in mouth
- oxygen therapy or suctioning if needed
- time the event
- administer Ativan for prolonged seizures
- monitor for possible loss of consciousness
what are anti-spasmotic drugs used for?
muscle spasms
what is the action of carisoprodol (Soma)?
inhibits multineuronal spinal reflexes
what is carisoprodol (Soma) used for?
relieve pain caused by MS conditions
what are the side effects of carisoprodol (Soma)?
- dizziness
- vertigo
- ataxia
- tremor
- agitation
- irritability
- idiosyncratic reactions
what are examples of idiosyncratic reactions caused by carisoprodol (Soma)?
drug reactions not related to the chemical makeup of the drugs itself after multiple doses
- rashes
- decreased WBC
- anemia
- kidney damage
- jaundice
what are concerns with carisoprodol (Soma)?
- avoid operating heavy machinery
- don’t stop abruptly
- high levels of abuse
- should not be taken for more than 3 weeks
what is baclofen used for?
decrease muscle spams, spasticity, and rigidity
- spasms from multiple sclerosis
what is the action of baclofen?
- inhibits impulse transmissions from the spinal cord
- increases GABA
what form can baclofen come in?
a pump that continuously delivers baclofen to the spinal cord
what are the side effects seen with baclofen?
- drowsiness
- fatigue
- weakness
- confusion
- headache
- insomnia
- hypotension
- urinary frequency
what does dantrolene sodium do and what is it used for?
decreases spasticity
- multiple sclerosis, cerebral palsy, spinal cord injury, CVA
relaxes skeletal muscle
what side effects are seen with dantrolene sodium?
- drowsiness, dizziness, diarrhea, fatigue, and hepatitis
what needs to be monitored with dantrolene sodium?
may need to monitor liver function - black box warning
what else is dantrolene sodium used for?
malignant hypothermia
- increased carbon dioxide (hypocarbia)
- metabolic acidosis - rigidity of skeletal muscles
what is cyclobenzaprine (Flexeril) used for?
short term therapy
- relieves spasms by relaxing skeletal muscles
- commonly given post-op for spine or joint surgery
what are the side effects seen with cyclobenzaprine (Flexeril)?
- drowsiness
- dizziness
- anticholinergic
what teaching is needed with cyclobenzaprine (Flexeril)?
avoid alcohol use because of CNS depression
what is tizanidine (Zanaflex) used for?
given for spasms due to increased muscle tone
what is the action of tizanidine (Zanaflex)?
disrupts excitatory actions from the spinal interneurons
what is the absorption like for tizanidine (Zanaflex)?
rapid absorption via GI tract
what side effects are seen with tizanidine (Zanaflex)?
- drowsiness
- dizziness
- constipation
- dry mouth
- hypotension
- hallucinations
- anticholinergic
