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Seizures

3 min read

References:

  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (pp. 2017)
  2. Lecturer (VJVS)

Seizures are an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in alteration of consciousness, motor, or sensory ability, and/or behavior. Epilepsy is a chronic disorder characterized by recurrent, unprovoked seizure activity, in which 75% of cases are idiopathic.

Clinical Manifestations

Generalized Seizures

  1. Grand Mal; Major Motor Seizures: may be preceded by an “aura”. These have tonic and clonic phases, and are the most dramatic form of seizures.
    • Tonic phase involves stiffening, eye-rolling, and glottis closure. Incontinence and loss of consciousness may occur. 20 to 40 seconds.
    • Clonic phase involves jerking movements that taper off. Mucus production is increased.
    • Postictal period includes confusion and drowsiness.
  2. Akinetic Seizure: organic brain damage results in sudden loss of postural tone and loss of consciousness.
  3. Myoclonic Seizure: brain damage, may be precipitated by tactile or visual sensations. Brief flexor muscle spasm and myoclonic jerks occur.
  4. Petit Mal; Absence Seizure: nonorganic brain damage; similar to daydreaming. Sudden onset, with twitching or rolling of eyes. Lasts a few seconds and is frequent. Common in preschoolers.
  5. Febrile Seizure: most common in children, usually not resulting in brain damage. Also tonic-clonic, similar to grand mal seizures. Seizure abates when temperature is controlled.
  6. Status Epilepticus: prolonged seizures with minimal postictal stages or without regaining consciousness.

Partial/Focal Seizures

  1. Simple Partial Seizure: limitation to one hemisphere of the brain, with no loss of consciousness. This may be motor, sensory, or autonomy.
  2. Complex Partial Seizure: begins in the anterior temporal lobe, then spreading to both hemispheres. This impairs consciousness and may be preceded by an “aura”.

Diagnostic Examination

Diagnostic examination for seizures is focused on ruling out other causes.

  • Blood studies: rule out lead poisoning, hypoglycemia, infection, or electrolyte imbalances.
  • Lumbar Puncture: rule out infection or trauma
  • Imaging (Skull X-rays, CT Scan, Head Ultrasound, Brain Scan, Arteriogram) to detect pathologic defects
  • EEG to detect abnormal wave patterns that can specify a type of seizure.

Medical Management

  • Surgery: if caused by a tumor, hematoma, or epileptic focus.
  • Phenytoin (Dilantin) is the drug of choice for generalized tonic-clonic (grand mal, febrile) and partial seizures.
    • Side effects include gum hyperplasia (swollen, tender), growth of facial and body hair, enlarged or rough facial features, acne, and skin.
    • Pregnancy Drug Category D: risk to the baby, but with benefits may outweigh the risk.
    • May be taken with a potentiator: phenobarbital. Seizure thresholds and spread/electrical discharge is inhibited.
  • Carbamazepine is used for some seizures. It reduces abnormal excitement in the brain.
  • Benzodiazepines: Diazepam (Valium) slows the CNS and reduces muscle spasms and convulsions.

Nursing Management

  • Protect from injury: use side rails, loosen tight clothing, positioning
  • Keep airway open: side-lying, suction excess mucous production
  • Documentation: preictal aura, nature of ictal phase (symmetry, responses to stimuli, LOC, respiratory pattern), and postictal response (amount of time to orient to time and place; sleepiness).

First Aid

Do not restrict the patient. Loosen neckwear, remove anything in their mouth, and turn them on their side. Cushion the patient’s head.

Graph View