COLLGE OF NURSING GIMS ,GREATER NOIDA

SUBJECT : ADULT HEALTH NURSING

UNIT – VI

TOPIC:SEIZURES AND EPILEPSY

Lecture No:08 Presented By :

Mr. PRASIDH N PATHAK
Date: 11/11/24
Nursing Tutor
 COURSE MAPPING
GENERL OBJECTIVE OUTCOME PO, CO, LO EVALUATION
MAPPING

At the end of the Unit, the At the end of the course,

students will be able to students will be able to know
:Know about the disease about disease condition their P5,CO4,L1 Essay
condition and their symptoms diagnostic for Short answers
management evaluation of disease and Long answers
complete management.
SPECIFIC OBJECTIVES OF THE SESSION
At the end of the class, the students will be able to:
1. Brief description about Seizures & Epilepsy .
2. Etiological Factor
3. Symptoms
4. Diagnostic evaluation
5. Management.
INTRODUCTION :-
 The brain is the center that controls and regulates all voluntary
and involuntary responses in the body.
 It consists of nerve cells that normally communicate with each

other through electrical activity.

 A seizure is a sudden, uncontrolled electrical disturbance in the

brain, results in changes in behaviour, movements ,feelings,

and in levels of consciousness.
 If the person has two or more seizures or a tendency to have

recurrent seizures, than it is called as epilepsy.

 Most seizures last from 30 seconds to 2 minutes.

A seizure that lasts longer than 5 minutes is a

medical emergency.
 DEFINITION:-
 A Seizure is a paroxysmal, uncontrolled
electrical discharges of neurons in the brain that
interrupts normal function results in episodes of
abnormal motor, sensory, autonomic or psychic
activity (or a combination of these).

 Seizureare sudden, abnormal electrical

discharges from the brain that results changes in
sensation, behaviour, movements, perceptions or
consciousness.
 CONVULSION:- Seizure associated with motor
component results in sudden, abnormal, irregular, involuntary
contraction of the muscles of the body and thus results in
uncontrolled shaking of the body.
The term convulsion is sometimes used as a synonym
for seizure.

EPILEPSY:-
The word epilepsy derived from Greek Word
‘Epilepsia’ which means ‘Seizure’.
 Epilepsy is a group of syndromes characterized by

unprovoked, recurring seizure/convulsions, over time.

 Epilepsy is a 2 or more unprovoked seizures and convulsions

in more than 24 hours apart.

 TYPES
OF
SEIZURE
 PARTIAL/ FOCAL GENERALIZED
(Seizure activity UNKNOWN
(Seizure activity
involves one area involves both
of the brain) hemispheres of the
brain)

COMPLEX
SIMPLE PARTIAL Other
PARTIAL (altered epileptic
(alert) consciousness) spasm
EVOLVE TO
BILATERAL
CONVULSION

ABSENCE TONIC MYOCLONIC TONIC CLONIC ATONIC

OR CLONIC
PETIT MAL
SEIZURE
PARTIAL / FOCAL SEIZURE:
 Partial seizures takes place when abnormal electrical brain
function occurs in one or more areas of one side of the brain.
 One third of the person with partial seizures may experience

an aura before seizure occurs. An aura is a strange feeling

either consisting of visual changes, hearing abnormalities or
changes in the sense of smell.
 Partial seizure is divided into 2 categories.

1. Simple Partial Seizure

2. Complex Partial Seizure
1. SIMPLE PARTIAL SEIZURE :
 The seizure typically last less than 1 minute.
 These seizure do not result in loss of consciousness.

Symptoms include:
 Sudden and unexplained feeling of joy, anger,

sadness.
 Involuntary jerking of the part of the body such as an

arm, leg.
 Spontaneous sensory symptoms such as tingling,

vertigo, and flashing lights.

 Person also may hear, smell, taste, see or feel things

that are not real.

 The person may also experience sweating, nausea,

or become pale.
2. COMPLEX PARTIAL SEIZURE :-
 In this type of seizure the person has a change in
or loss of consciousness for a period of time.
 Commonly occur in the temporal lobe of the brain.

Symptoms include:
 Non purposeful movements such as hand rubbing,

chewing, swallowing, gagging , lip smacking,

screaming, crying, laughing, running, walking in
circle, .
 Repetitious movement such as blinking, twitching,

mouth movement etc.

 When the person regains consciousness the

person may complains of being tired or sleepy

after seizure.
GENERALIZED SEIZURE :-
 Generalized seizures involve both sides of the
brain and are characterized by bilateral
synchronous epileptic discharges in the brain from
the onset of the seizure.
 There is loss of consciousness.

 There is no warning or aura.

Types of generalized seizures include the following:

1. Absence or Petit mal seizure.

2. Tonic clonic seizure or Grand mal seizure.

3. Myoclonic Seizure.

4. Tonic seizure.

5. Clonic seizure.

6. Atonic seizure.
 1. ABSENCE OR PETIT MAL SEIZURE

 These seizures are characterized by an altered state of

consciousness and staring episodes.
 Typically, the person's posture is maintained during the seizure.
 The mouth or face may move or the eyes may blink.
 The seizure usually lasts no longer than 30 seconds.
 When the seizure is over, the person may not recall what just
occurred and acting as though nothing happened.
 This type of seizure is sometimes mistaken for a learning problem
or behavioral problem.
 Absence seizures are uncommon before the age of 5 and occur
more often in girls and in children.
 The EEG demonstrates 3 Hz spike in brain wave pattern.
 When untreated the seizure may occur upto 100 times a day.
2. TONIC-CLONIC SEIZURES :-
 Also called as Grand Mal Seizures.
 This seizure is characterized by 5 distinct phases that
occur.
1. The body, arms, and legs will flex (contract) for 30-40
seconds.
2. Extend (straighten out)
3. Tremor (shake)
4. Clonic period (contraction and relaxation of the
muscles) . Cyanosis, excessive salivation, tongue or
cheek biting, and incontinence may accompany.
5. Post ictal period. The patient usually has muscle
soreness.
 During the post ictal period, the person may be sleepy,
have problems with vision or speech, and may have a
bad headache, fatigue, or body aches.
3. MYOCLONIC SEIZURE :-
 This type of seizure refers to quick movements or
sudden jerking of a group of muscles or twitches
of the upper body, arms, or legs.
 These seizures tend to occur in clusters, meaning

that they may occur several times a day, or for

several days in a row.

4. TONIC SEIZURE :-
Tonic seizures causes stiffening of the muscles,
generally those in back, arms, legs, and may
cause the person to fall to the ground.
5. CLONIC SEIZURE :-
 These type of seizures are begins with loss of
consciousness and sudden loss of muscle tone
followed by limb jerking that may or may not be
symmetric .
 Symptoms include rhythmic , jerking muscle

contractions usually affecting the arms, neck and

face.

6. ATONIC SEIZURE:-
 Also known as ‘Drop Attack’.

 Seizure involves either a tonic episode or a

paroxysmal loss of muscle tone and begins

suddenly with the person falling to the ground.
 Conscious usually returns once the person hits in
PHASES OF SEIZURE:

1. Prodomal phase.
2. The aural phase.
3. The ictal phase.
4. The post ictal phase.
 ETIOLOGY :-
The exact cause of the seizure may not be known, the more
common seizures are caused by the following:
 In newborns and infants:

 birth trauma
 congenital (present at birth) problems
 fever
 metabolic or chemical imbalances in the body
 Genetic influence.
 In children, adolescents, and adults:

 alcohol or drugs
 head trauma
 infection
 Developmental disorder such as autism, down syndrome.
 unknown reasons
 Other possible causes of seizures may include the
following:
 brain tumor

 neurological problems

 drug withdrawal

 Overdose of antidepressants and other medications .

 Stroke or Transient Ischemic Attack.

 Dementia such as Alzheimers diseases.

 Traumatic brain injury.

 Infections including Brain abscess, meningitis,

encephalitis, AIDS.
 Abnormal blood vessels in the brain.

 Exposure to led , carbon monoxide, and many other

poison.
PATHOPHYSIOLOGY
CLINICAL FEAURES:-
The person may have varying degrees of
symptoms depending upon the type of seizure.
The following are general symptoms of a seizure
or warning signs of seizures. Symptoms or
warning signs may include:
 staring

 jerking movements of the arms and legs

 stiffening of the body

 loss of consciousness

 breathing problems or breathing stops

 loss of bowel or bladder control

 falling suddenly for no apparent reason

 not responding to noise or words for brief periods
 appearing confused or in a haze

 sleepiness and irritable upon waking in the morning

 nodding the head

 periods of rapid eye blinking and staring

 During the seizure, the person's lips may become bluish and

breathing may not be normal.

 The movements are often followed by a period of sleep or

disorientation.
DIAGNOSTIC EVALUATION :-
 History collection.
 Physical examination.

 Neurological examination.

 Blood tests, Serum chemicals, urine analysis,

studies of liver and kidney function- to rule out

metabolic disorders.
 Electroencephalogram (EEG) - a procedure that

records the brain's continuous, electrical activity by

means of electrodes attached to the scalp.
 Magnetic resonance imaging (MRI) - a diagnostic

procedure that uses a combination of large magnets,

radiofrequencies, and a computer to produce detailed
images of organs and structures within the body.
 Computed tomography scan (Also called
a CT or CAT scan.) - a diagnostic imaging
procedure that uses a combination of x-rays
and computer technology to produce cross-
sectional images (often called slices), both
horizontally and vertically, of the body.

 lumbar puncture (spinal tap) - a special

needle is placed into the lower back, into the
spinal canal. This is the area around the
spinal cord. The pressure in the spinal canal
and brain can then be measured. A small
amount of cerebral spinal fluid (CSF) can be
removed and sent for testing to determine if
there is an infection or other problems. CSF is
the fluid that bathes the brain and spinal
cord.
MANAGEMENT
SURGICAL MANAGEMENT:-
 Surgery is most commonly done when tests show
that seizure originate in a small well defined area
of brain that does not interfere with vital functions
like speech, language, hearing.
 Some surgery include-

 Resective and palliative surgery. Such as

resectioning of epileptogenic tissue in case of

complex partial seizure of temporal lobe origin.
 Sectioning of corpus callosum in drop attack

seizure.
 Hemispherectomy , callosotomy in case of multi

focal seizure.
VAGUS NERVE STIMULATION (VNS)
 Some people, whose seizures are not being well-controlled with seizure
medications, may benefit from a procedure called vagus nerve stimulation
(VNS).
 VNS is used for persons over the age of 12 who have partial seizures that are
not controlled by other methods.
 VNS attempts to control seizures by sending small pulses of energy to the
brain from the vagus nerve, which is a large nerve in the neck.
 This is done by surgically placing a small battery into the chest wall. Small
wires are then attached to the battery and placed under the skin and around the
vagus nerve. The battery is then programmed to send energy impulses every
few minutes to the brain. When the person feels a seizure coming on, he/she
may activate the impulses by holding a small magnet over the battery. In many
cases, this will help to stop the seizure.
 There are some side effects that may occur with the use of VNS. These may
include,
 hoarseness
 pain or discomfort in the throat
NURSING MANAGEMENT
 Move harmful object out of the way.
 Cushion the head

 Protect the person from falling.

 Side rails of bed should be padded to prevent

injury , if the patient’s extremity hits against them.

 Loosen ties and tight fitting clothing.

 Do not put anything in the patient’s mouth.

 The individual should not be restrained because

they may increase the risk of injury.

 If the person started to vomiting turn the person

on his /her left side to protect the airway and to

help drain away any mouth secretions.
 Suction the airway and make it clear and patent.
But do not force an airway in once the seizure has
begun.
 If the person is not breathing start the rescue

breathing and seek immediate medical attention.

 Observe the length of seizure, the movements

involved, direction of head and eye movements

and the time it takes to return to full
consciousness and alertness. And the information
should be reported to the medical profession.
PSYCHOLOGICAL TREATMENT:-
It include-
 Psychosocial counselling.

 Relaxation therapy.

 Cognitive behaviour therapy.

COMPLICATION :-
Status epilepticus-
It is a acute prolonged seizure activity that occur
full recovery of consciousness between attacks.
 Last 30 minutes without impairment of

consciousness.
 Vigorous muscular contraction may interfere with

respiration and may cause hypoxia to the brain and

leads to brain damage.
 Treatment-

 Adequate oxygenation.

 IV Diazepam, Lorazepam,

 Phenytoin and phenobarbital are administered later

to maintain a seizure free state.