DAYANANDA SAGAR UNIVERSITY

INTRODUCTION
Seizures are symptoms of a brain problem. They
happen because of sudden, abnormal electrical
activity in the brain. When people think of seizures,
they often think of convulsions in which a person's
body shakes rapidly and uncontrollably. Not all
seizures cause convulsions. There are many types
of seizures and some have mild symptoms. Seizures
fall into two main groups. Focal seizures, also called
partial seizures, happen in just one part of the brain.
Generalized seizures are a result of abnormal
activity on both sides of the brain.

Most seizures last from 30 seconds to 2 minutes and

do not cause lasting harm. However, it is a medical
emergency if seizures last longer than 5 minutes or
if a person has many seizures and does not wake up
between them. Seizures can have many causes,
including medicines, high fevers, head injuries and
certain diseases. People who have recurring
seizures due to a brain disorder have epilepsy
Definition
seizure is a sudden, uncontrolled
electrical disturbance in the brain.
It can cause changes in your
behaviour, movements or feelings,
and in levels of consciousness. If
you have two or more seizures or a
tendency to have recurrent
seizures, you have epilepsy.
There are many types of seizures,
which range in severity. Seizure
types vary by where and how they
begin in the brain. Most seizures
last from 30 seconds to two
minutes. A seizure that lasts longer
than five minutes is a medical
emergency.
Seizures are more common than
you might think. Seizures can
happen after a stroke, a closed
head injury, an infection such as
meningitis or another illness. Many
times, though, the cause of a
seizure is unknown.
Most seizure disorders can be
controlled with medication, but
management of seizures can still
have a significant impact on your
daily life. The good news is you
can work with your health care
professional to balance seizure
control and medication side
effects.
Incidence
The incidence of acute
symptomatic seizures is 29-39 per 100,000
per year. ... The incidence of single
unprovoked seizures is 23-61 per 100,000
person-years. As with epilepsy, single
unprovoked seizures predominate in men
and in patients less than 12 months and
older than 65 years.

Pathophysiology
When the integrity of the neuronal
cell membrane is altered, the cell
begins firing with increased
frequency and amplitude. When
the intensity of the discharges
reaches the threshold, the
neuronal firing spreads to adjacent
neurons, ultimately resulting in a
seizure. Normally, excitatory
messages from a single
hypersensitive neuron in the
cerebral cortex are modulated by
deeper structures (e.g., thalamus
and brain stem) In epilepsy, these
bursts of electrical activity from
the cortex are not modulated.
Eventually, inhibitory neurons in
the cortex, anterior thalamus, and
basal ganglia slow neuronal firing.
Once inhibitory processes develop
or the epileptogenic neurons are
exhausted, the seizure stops.
These later events depress CNS
activity and impair consciousness.
This period of impaired
consciousness after a seizure,
called a postictal state, may be
manifested as sleep, confusion, or
fatigue. Seizure activity increases
cerebral oxygen consumption and
the need for adenosine
triphosphate (ATP). Supplies of
oxygen and glucose are rapidly
consumed. To meet these
demands, cerebral blood flow
increases during a seizure. If the
seizure is ongoing (as in status
epilepticus), severe hypoxia and
lactic acidosis occur and may
result in brain tissue destruction.

Etiology
Nerve cells (neurons) in the brain
create, send and receive electrical
impulses, which allow the brain's
nerve cells to communicate.
Anything that disrupts these
communication pathways can lead
to a seizure.
The most common cause of
seizures is epilepsy. But not every
person who has a seizure has
epilepsy. Sometimes seizures
happen because of:
 High fever, which can be
associated with an infection
such as meningitis
 Lack of sleep
 Low blood sodium
(hyponatremia), which can
happen with diuretic therapy
 Medications, such as certain
pain relievers, antidepressants
 or smoking cessation therapies,
that lower the seizure threshold
 Head trauma that causes an
area of bleeding in the brain
 Stroke
 Brain tumour
 Illegal or recreational drugs,
such as amphetamines or
cocaine
 Alcohol abuse, during times of
withdrawal or extreme
intoxication
Classification &symptoms

Partial Seizures with No Loss of

Consciousness
Partial seizures are the most
Common type of epilepsy The first
clinical and
electroencephalographic changes
indicate initial activation of
neurons in One part of the Cerebral
hemisphere. They are further
classified according to whether or
not consciousness is impaired.
There are four types of simple
partial Seizures that do | impair
consciousness. These include
Seizures with motor
manifestations, those with
Somatosensory or special Senses
"manifestations, those with
autonomic manifestations, and
those with psychic manifestations,
Motor Manifestations. Partial
seizures with motor manifestations
arise from a focus in the motor
Cortex the
resulting motor activity (Seizure)
occurs in the body innervated by
motor neurons originating in the
fected region of the Cortex,
Because the hand and fingers have
the largest cortical representation,
many focal motor seizure’s begin
with Convulsive movement in the
upper extremity. Involuntary
movements may spread centrally
and involve the entire limb,
including One sile of the face and
lower extremity. This progression
of Spread is known as the
Jacksonian march, "The client also
may exhibit changes in posture Or
Spoken utterances,
Somatosensory Manifestations.
If the epileptogenic
Somatosensory Manifestation is in
the parietal region Manifestations,
If the epileptogenic focus parietal
region, the client experiences
sensor What phenomena such as
numbness and tingling rea If the
focus is in the occipital region, the
may experience bright, flashing
lights in the field vision opposite
the side of the FOCUIS, Likewise.
the client can have changes in
speech or taste with involvement
of the posterior temporal area of
the dominant hemisphere.
Seizures of the autonomic and Tan
Autonomic M c sensations all
system product epigastric
Sensations flushing piloerection
(goose flesh. Our tachycardia and
Tachypnea sweating Psychic
Manifestations
subjective sensation that helps
localize the focus, An aura may be
a strange smell, noise, or
Sensation preceding a Seizure, or a
sense of rising or “welling up" in
the epi - gastric region. Visual
distortions and feelings such as
Deja Vu are common.
Complex Partial Seizures

Complex Partial Seizures With

Automatisms
The most characteristic features
of a Complex partial seizure are
the accompanying automatism.
These automatic behaviours
include purposeless repetitive
activities such as lip - stacking,
chewing patting a part of the body
of picking at clothes while in a
dreamy state. Inappropriate Of
antisocial behaviour may also
occur during the seizure, This
unusual
may also Cur This unusual
behaviour may cause the client to
be viewed as psychotics or
otherwise mentally disturbed.
However abnormalities may be
subtle and detected only by a
trained observer
Complex partial seizures with
automatisms usually last 2 to 3
minutes but can last up to 15
minutes. The client is usually
unaware of any activity during the
seizure and may be confused or
drowsy postically.
Partial Seizures Evolving to
Secondary Generalized Seizures.
These Seizures start from a
particular focus, and then the
electrical discharges spread
throughout the brain. Clinically,
the client first shows focal
manifestations; for example, one
side of the face moves, and then
the whole body becomes involved.
Consciousness is lost if the
discharges spread throughout the
brain.

Doctors generally classify seizures

as either focal or generalized,
based on how and where abnormal
brain activity begins. Seizures may
also be classified as unknown
onset, if how the seizure began
isn't known.
Focal seizures
Focal seizures result from
abnormal electrical activity in one
area of your brain. Focal seizures
can occur with or without loss of
consciousness:
 Focal seizures with impaired
awareness. These seizures
involve a change or loss of
consciousness or awareness.
You may stare into space and
not respond normally to your
environment or perform
repetitive movements, such as
hand rubbing, chewing,
swallowing or walking in circles.
Generalized seizures
Seizures that appear to involve all
areas of the brain are called
generalized seizures. Different
types of generalized seizures
include:
 Absence seizures. Absence
seizures, previously known as
petit mal seizures, often occur in
children and are characterized
by staring into space or by subtle
body movements, such as eye
blinking or lip smacking. These
seizures may occur in clusters
and cause a brief loss of
awareness.
 Tonic seizures. Tonic seizures
cause stiffening of your muscles.
These seizures usually affect
 muscles in the back, arms and
legs and may cause falling to the
ground.
 Atonic seizures. Atonic
seizures, also known as drop
seizures, cause a loss of muscle
control, which may cause
suddenly collapse or fall down.
 Colonic seizures. Colonic
seizures are associated with
repeated or rhythmic, jerking
muscle movements. These
seizures usually affect the neck,
face and arms.
 Myoclonic seizures. Myoclonic
seizures usually appear as
sudden brief jerks or twitches of
your arms and legs.
 Tonic-colonic seizures. Tonic-
colonic seizures, previously
known as grand mal seizures, are
the most dramatic type of
epileptic seizure and can cause
an abrupt loss of consciousness,
body stiffening and shaking, and
sometimes loss of bladder
control or biting your tongue.
Symptoms
With a seizure, signs and
symptoms can range from mild to
severe and vary depending on the
type of seizure. Seizure signs and
symptoms may include:
 Temporary confusion
 A staring spell
 Uncontrollable jerking
movements of the arms and legs
 Loss of consciousness or
awareness
 Cognitive or emotional
symptoms, such as fear, anxiety
or Deja vu

When to see a doctor

Seek immediate medical help if any
of the following occurs:
 The seizure lasts more than five
minutes.
 Breathing or consciousness
doesn't return after the seizure
stops.
 A second seizure follows
immediately.
 You have a high fever.
 You're experiencing heat
exhaustion.
 You're pregnant.
 You have diabetes.
 You've injured yourself during
the seizure.
If you experience a seizure for the
first time, seek medical advice.
Diagnostic test
Lumbar puncture. If your doctor
suspects an infection as the cause
of a seizure, you may need to have
a sample of cerebrospinal fluid
removed for testing.
An electroencephalogram
(EEG). In this test, doctors attach
electrodes to your scalp with a
paste-like substance. The
electrodes record the electrical
activity of your brain, which shows
up as wavy lines on an EEG
recording. The EEG may reveal a
pattern that tells doctors whether
a seizure is likely to occur again.
EEG testing may also help your
doctor exclude other conditions
that mimic epilepsy as a reason for
your seizure. Depending on the
details of your seizures, this test
may be done as an outpatient in
the clinic, overnight at home with
an ambulatory device or over a few
nights in the hospital.
Computerized tomography (CT). A
CT scan uses X-rays to obtain
cross-sectional images of your
brain. CT scans can reveal
abnormalities in your brain that
might cause a seizure, such as
tumours, bleeding and cysts.
Magnetic resonance imaging
(MRI). An MRI scan uses powerful
magnets and radio waves to create
a detailed view of your brain. Your
doctor may be able to detect
lesions or abnormalities in your
brain that could lead to seizures.
Positron emission tomography
(PET). A PET scan uses a small
amount of low-dose radioactive
material that's injected into a vein
to help visualize active areas of
the brain and detect abnormalities.
Single-photon emission
computerized tomography
(SPECT). A SPECT test uses a
small amount of low-dose
radioactive material that's injected
into a vein to create a detailed, 3-D
map of the blood flow activity in
your brain that happens during a
seizure.
Blood tests. may take a blood
sample to check for signs of
infections, genetic conditions,
blood sugar levels or electrolyte
imbalances.
Treatment
 When a seizure occurs, the main
goal is to protect the person from
injury. Try to prevent a fall by
laying the person on the ground in
a safe area. The area should be
cleared of furniture or other sharp
objects.
 Cushion the person's head.
 Loosen tight clothing, especially
around the neck.
 Stay with the person until the seizure
ends and he or she is fully awake. After
it ends, help the person sit in a safe
place. Once they are alert and able to
communicate, tell them what happened
in very simple terms.
 Comfort the person and speak calmly.
  Check to see if the person is wearing a
medical bracelet or other emergency
information.
 Keep yourself and other people calm.
 Offer to call a taxi or another person to
make sure the person gets home safely
 Ease the person to the floor.
 Turn the person gently onto one side.
This will help the person breathe.
 Clear the area around the person of
anything hard or sharp. This can prevent
injury.
 Put something soft and flat, like a folded
jacket, under his or her head.
 Remove eyeglasses.
 Loosen ties or anything around the neck
that may make it hard to breathe.
 Time the seizure. Call 911 if the seizure
lasts longer than 5 minutes.
Never do any of the following things
 Do not hold the person down or try to
stop his or her movements.
 Do not put anything in the person’s
mouth. This can injure teeth or the jaw.
A person having a seizure cannot
swallow his or her tongue.
 Do not try to give mouth-to-mouth
breaths (like CPR). People usually start
breathing again on their own after a
seizure.
 Do not offer the person water or food

Surgical management
palliative surgery was anterior callostomy .
This is still performed , but rarely . Several
curative surgery possible , including
lobectomy and lesionectomy Thorough
assessment is necessary before surgery
determine the epileptogenic focus is located
in the is dispensable areas of the cerebral
cortex Dispensable are those for which
there is a duplicative area in the cortex A
 variety of neurologic tests are used ,
including video EEG , SPECT , OF PET ,
Intelligence quotient ( IQ ) testing

injection of armilairbital Sodium ( Amytal

sodium is given directly into the left
internal carotid artery angiogram
testing and psychological assessments
are usually per formed, Deep LEG
electrolyse may be surgically place this is
one when surface electrodes are not
sensitive
Selective amygdalalohippocampectory:
In this procedure the two structures within
the temporal or that are commonly the
genesis of Seizure activity are removed, n
Temporal lobectomy:
Focal resection of part of the temporal
lobe, usually on the right side, is
performed If the dominant temporal lobe
 is removed, the client may experience
language defects for a few week Visual
defects from loss of visual projection
fibres at Compensated for quickly. Other
areas of the cortex may also be resected.
Sub - pail resection:
Fine cuts are made into the motor areas of
the brain that do not control motor function,
but lo prevent the spread of the seizure
Resection: A Cyst or lesion Causing the
May removed.
Hemispherectomy: An entire damaged side
of the brain is removed; this procedure is
performed treat very severe epilepsy
Corpus callosotomy:
Fibres that connect the two halves of the
brain are cut; this procedure is also done
for treatment of severe epilepsy
Vagal nerve stimulator implantation. The
implantation of a vagal nerve stimulator
(VNS) offers clients another treatment
modality.

Nursing management
Assessment
Diagnosis
Outcome
Intervention

Assessment.
 History, including prenatal, birth,
and developmental history; Family
history; age at seizure onset:his
tory of all illnesses and trauma;
 previous brain Surgery or stroke;
complete description of seizures,
including precipitating factors and
presence of an aura
 Medication use and postictal
(period of time following a seizure)
manifestations Psychosocial
 assessment, including mental
status examination

1.Risk for Injury. The diagnosis Risk for

you related to uncontrolled movement and /
or loss of airway patency during a seizure
Outcomes.
The client will have reduced risk of injury
and maintain a patent airway during a
seizure a
evicienced by showing no bruises Or
bumps following a seizure and by being
able to regain adequate Oxygenation
following the seizure.
Intervention
 seizure precaution should be
implemented in all clients with a
history of epilepsy and seizures. No
oral temperatures should be take use
axillary or rectal routes. The bedrails
should be padded and up when the
client is in bed, Seizure precautions
also include inserting an intravenous
needle for medication administration,
and keeping oxygen with a nasal
cannula and suction equipment,
including suction catheters, at the
beside, Fall risk precautions are also
needed.
 See earlier discussion about
assessments and how to maintain the
airway during a seizure. After the
seizure is completed, place the client
in a lateral position and assess oxygen
status
2.Ineffective Health Maintenance

Outcomes.
The client will have improved health
maintenance as evidenced by
maintaining routine losing, Consulting
a physician whenever there is a
problem, and wearing a medical alert
identification tag or bracelet .

Interventions.
Provide the client with verbal
information and written reinforcement
about (1) how AEDs prevent
Seizures, (2) the importance of taking
prescribed medication regularly, and
(3) care during seizures, Consult With
the client to plan Ways to make talking
medication part of daily activities.
Also, help the client to identify factors
 that precipitate seizures and ways of
avoiding these factors. Such factors
include increased stress, lack of sleep,
emotional upset, and alcohol use. The
Client Education Guide On p, 1818
lists other important client teaching
information.

Complications
Having a seizure at certain times
can lead to circumstances that are
dangerous for you or others. You
might be at risk of:
 Falling. If you fall during a
seizure, you can injure your head
or break a bone.
 Drowning. If you have a seizure
while swimming or bathing,
you're at risk of accidental
drowning.
 Car accidents. A seizure that
causes either loss of awareness
or control can be dangerous if
you're driving a car or operating
other equipment.
 Pregnancy
complications. Seizures during
pregnancy pose dangers to both
mother and baby, and certain
anti-epileptic medications
increase the risk of birth defects.
If you have epilepsy and plan to
 become pregnant, work with
your doctor so that he or she can
adjust your medications and
monitor your pregnancy, as
needed.
 Emotional health issues. People
with seizures are more likely to
have psychological problems,
such as depression and anxiety.
Problems may be a result of
difficulties dealing with the
condition itself as well as
medication side effects
Client Education

 Take prescribed dosages of medications to

maintain your blood levels.
 Consult your physician if you are unable to
take medication because of illness.
 Observe for side effects of antiepileptic
drugs. Do not stop taking medications
because of annoying side effects; this is
very dangerou5. Consult your physician
first.
 Notify the physician if seizures are not
controlled.
 Provide specific descriptions of the seizure
activity.
 Do not take any over-the-counter
medications without consulting your
physician ..
 Obtain a medical alert identification card (or
bracelet or tag) with the name of the drug,
dosage, and frequency; and your
physician's name and phone number. Carry
this identification with you at all times.
conclusion
The major gals in managing a client with
epilepsy are to establish and protect the
airway, to control the seizure, and to
monitor for adverse Outcomes The airway
is maintained and aspiration prevented by
placing the client in a side - lying position ,
suctioning the airway, and providing
oxygen, Oxygen offers no nothing a client
who is apneic therefore intubation may be
necessary to ventilate and oxygenate the
client.
AEDs are given to terminate seizures and to
prevent exhaustion.
Once status epilepticus has been controlled
the client may be unresponsive for a period
of time. Clients may be a postictal state or
experiencing subclinical seizures After the
seizures have been controlled maintenance
AEDs are prescribed. It is especially difficult
for significant others to watch clients
experiencing status epilepticus. The family
needs Support and information. Always
explain to family members the treatment
being given