SEIZURE PATHOPHYSIOLOGY

Etiology:
-Idiopathic
-Familial incidence
-Physical stimuli (head trauma, loud
noises or bright lights)
-Biochemical stimuli (stress, CNS infection,
brain tumor, high fever, hypertension,
metabolic and toxic conditions, drug and
alcohol withdrawal, excessive
premenstrual fluid retention, etc.)

Altered permeability of
neuronal membrane

Reduced inhibitory for

control of neurons

Lower threshold for

stimulation

Hyperexcitable
epileptogenic focus

Sudden, spontaneous, uncontrolled

depolarization of neurons

Depolarization spreads through focal

cells stimulating the surrounding
cells via cortical synapses

Neurotransmitter
imbalance

SEIZURE PATHOPHYSIOLOGY

Depolarization spreads through

intrahemospheric tracts to
contralateral cortex, basal ganglia,
thalamus and brainstem

Spread of depolarization
to the spinal cord

Abnormal motor or
sensory activity

Inhibitory neurons in
cortex, anterior
thalamus and basal
ganglia begin to inhibit
cortical excitation

Cerebral
hypoxia

SIGNS AND SYMPTOMS

TONIC PHASE:
-loss of consciousness
-muscle contraction and brief flexion
-extension of limbs and rigid trunk
-abdominal and thoracic muscle contract forcing air out of
the lungs, then jaws are clenched tightly and respiration
ceases
-AUTONOMIC SYMPTOMS: increase blood pressure, heart
rate and bladder pressure, flushing, sweating, increased
salivation and bronchial secretion, and apnea
CLONIC PHASE:
-Alternate muscle contraction and relaxation
-forceful rhythmic jerky movements
-increased salivation
-biting of tongue, cheek or lip
-bowel and bladder incontinence
POST-ICTAL PHASE:
-confusion, fatigue, aching muscle
-may fall into deep sleep

Seizure

Status Epilepticus

Increased cerebral blood flow,

Increased oxygen and glucose
consumption

Complications:
-severe hypoxia
-hypoglycemia
-acidosis
-injury

Cerebral
hypoglycemia

Metabolic
acidosis

Brain damage and

mental retardation

Reference:
Gould, B. E. (2007). Pathophysiology for the health professions. Elsevier Singapore PTE LTD.
Smeltzer, S. C., Brenda, B. G., Hinkle, J. L., & Cheever, K. H. (2008). Brunner & suddarth's textbook of medical-surgical
nursing. Philadephia: Lippincott Williams & Wilkins.