Seizure Disorders

• Seizures are uncontrollable electrical discharge neurons in the brain that has to happen at least 2 times and more than 24 hours apart without a secondary reason to be termed seizure disorder
• Clinical Manifestations

  • Prodromal: person feels sick hours or days before seizure
  • Aural: person gets numbness, smells something burning, vision problems just before a seizure
  • Ictal: person experiences a seizure
  • Posictal: person feels exhausted after a seizure
• Tonic-Clonic Seizures

  • In the tonic phase, body stiffens
  • In the clonic phase, body jerks
  • person can experience cyanosis, cheek or tongue biting, incontinence and excessive salivation
• Non motor seizures

  • Typical Absence: occurs in children only. The person stares off into space for <10 seconds. Person can grow out of it
  • Atypical Absence: occurs in adults. The person has a staring spell with eye blinking and jerking of the lips for >10 seconds
• Focal-onset Seizures (lasts less than one minute)

  • affects sensory, motor, cognitive, and emotional areas of the brain.
  • Focal Awareness
  • person is aware of the seizure and has sudden feelings of anger or joy, and may hear, smell, see taste or feel things that are not real
  • Focal-Impaired
  • person has loss of consciousness and has no memory of their activities after the seizure
• Complications of seizures

  • Status Epilepticus
  • a very bad form of a seizure lasting more than 5 minutes or occurring so close together that the person cannot recover. Might cause permanent brain damage
  • Convulsive status epilepticus
  • prolonged or repeated tonic-clonic seizures
  • Nonconvulsive status epilepticus: prolonged focal impaired awareness seizures
  • Refractory status epilepticus: continuous seizure activity after 1st or 2nd line drug therapy
• Drug therapy

  • Phenytoin
  • normal therapeutic level is 10-20
  • Do not mix IV med with dextrose solution. Mix with normal saline
  • Drug toxicity cause nystagmus, loss in cognitive function
  • Carbamazepine: do not drink grapefruit juice
  • Anticonvulsant
  • levetiracetam, clonazepam, lamotrigine, valproic acid
  • Side effects of these meds include feeling tired, ataxia, diplopia, and decreased liver function
  • Avoid alcohol and check liver function when taking these medications
• Emergency treatment of Status Epilepticus

  • Ensure patent airway
  • Establish IV access
  • Record time of seizure
  • Put patient in lateral position
  • Do not restrain patient
• Most important vital sign to check in a patient having a seizure in oxygen saturation
• Best diet for seizure patients is a ketogenic diet where they have high fat and low carb diet
• EEG is the gold standard test to evaluate electrical activity in the brain