1. Seizure Disorders Tiara Lintoco Batch 8

2. Seizure Disorders Seizures are symptoms of an abnormality in the nerve centers of the brain. Also known as convulsions, is an episode of abnormal motor, sensory, cognitive and psychic activity caused by erratic and abnormal electrical charges of brain cells. Repeated episodes of seizures are called seizure disorders.

3. Seizure Disorders Most seizures are self limiting and benign. Lasting a few seconds to a few minutes. Many individuals may manifest different types of seizures at different times. If the seizures are chronic, and recurrent, the patient is diagnosed as having epilepsy.

4. Seizure Disorders In most cases, the cause of seizure is unknown. Some known causes includes: Birth trauma, head injuries Genetic predisposition Some types of brain infections and toxicity Fever, metabolic and nutritional disorders Tumors or brain malformations

5. Seizure Disorders Epilepsy is the most common of all neurologic disorders. It is not a single disease but several different disorders that have one common characteristics: A sudden discharge of excessive electrical energy from nerve cells in the brain.

6. Classification of Seizures Partial or Focal Seizures – usually results in no loss of consciousness. Jacksonian – rhythmic jerking movements start in one muscle group & spread. Adversive – person may become combative. Sensory – person has unpleasant hallucinations, talks unintelligibly, or experiences vertigo.

7. Classification of Seizures A partial complex seizure results in impaired consciousness: person may be motionless or have repetitive movements. General Seizures – involves both hemispheres of the brain. Tonic-clonic seizures (grand mal) Absence seizures (petit mal) Tonic seizures – similar to tonic-clonic but with tonic contractions only.

8. Classification of Seizures Atonic seizures – the muscles become momentarily flaccid and the individual drops to the floor. Infantile spasms – characterized in infants by clusters or rapid-like spasm movements of the extremities, with hip flexion and arm extension. Myoclonic seizures – quick, often repetitive muscle jerks of a single group of muscles involving the extremities and facial muscles or the entire body. The patient may fall but doen not lose consciousness.

9. Classification of Seizures Unclassified Epileptic Seizures Includes all seizures that can not be classified due to inadequate or incomplete data. Adapted from Epilepsy foundation Status Epilepticus Is a medical emergency to prevent death from brain damage resulting from prolonged hypoxia and exhaustion.

10. Drug Therapy for Seizure Disorders The goals of anticonvulsant therapy are to reduce the frequency of seizure activity and minimize the adverse effects of the medicine. Therapeutic outcome must be individualized for each patient. The selection of medicine depends on the type of seizure, the age & gender of the patient, other medical conditions present and the potential adverse effects of the individual medicine.

11. Drug Therapy for Seizure Disorders In general, anticonvulsants increase the seizure threshold and regulate neuronal firing by either inhibiting excitatory processes or enhancing inhibitory processes. The medicine can also prevent the seizure from to adjacent neurons. Phenytoin, carbamazapine, lamotrigine, zonisamide, and valproic acid act on sodium and calcium channels to stabilize the neuronal membrane and may decrease the release of excitatory neurotransmitters.

12. Drug Therapy for Seizure Disorders Barbiturates, benzodiazepines, tiagabine, and gabapentin, enhance the inhibitory effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that counter balancesthe effect of excitatory neurotransmitters.

13. Nursing Process for Anticonvulsant Therapy Assessment History of seizure activity Seizure description Postictal behavior Diagnosis Risk for injury Disturbed body image Impaired gas exchange Disturbed sensory perception

14. Nursing Process for Anticonvulsant Therapy Planning Seizure activity – identify the need for precautions, have the equipment & supplies needed for care ready and order periodic laboratory test. Psychosocial assessment – discuss concern with patient, family or significant others and arrange for social workers to intervene with care. Emergency equipment – know the location of equiptment and have the drugs ready to treat status epilepticus.

15. Nursing Process for Anticonvulsant Therapy Implementation Management of seizure activity – assist the patient during and after seizure. Psychological implications Encourage maintenance of normal lifestyle Allow patient to express feelings Acceptance by peers specially school-age children Be alert for signs of denial of the disease Determine the patients current medication schedule.

16. Nursing Process for Anticonvulsant Therapy Status epilepticus Provide patient protection & summon assistance for transportation to an emergency facility. Administer oxygen, have suction & resuscitation equipment available. Establish IV lines and have available drugs for treatment. Monitor vital signs & neurologic status. Insert a nasogastric tube if patient is vomiting.