Seizures

• Assessing antiseizure medication effectiveness

  1. Does the seizure stop?

  2. Serum drug levels/ therapeutic range

  3. Side effects/Adverse effects
• Priority assessment for a patient having a seizure

  1. Ensure Safety

  2. Time the seizure

  3. Assess ABC's

  4. Evaluate consciousness and Neurological Status

  5. Vital signs
• Hydantoins


  Phenytoin (phenyTOXIC)
• Phenytoin


  • Inhibits sodium influx
  • Stabilized nerve cells to keep them from getting excited
• Phenytoin side effects


  • CNS: nystagmus, Paresthesia, ataxia
  • CV: brady/tachycardia, hypotension
  • Gingival hyperplasia (expected)
  • Other: suicidal ideation, skin rash (steven johnson syndrome)
• Signs of phenytoin toxicity

  • Incoordination
  • Onset of slurred speech
  • Arm & hand tremors
• Succinimide


  Ethosuximide (Zarontin)
• Succinimide

  • Suppress abnormal electrical activity in the brain
  • Decreases calcium influx through the t-type calcium channel
• Succinimide (Ethosuximide) side effects

  • CNS: drowsiness, lethargy, dizziness, mood changes
  • GI: N/V, anorexia → children!!
• Succinimide (Ethosuximide) adverse effects

  • Blood: Rash, dyscrasias
  • Rash: Steven-Johnson, Lupus
  • Psychosis
  • Suicidal Ideation
• Iminostilbene MOA

  • Stabilize neuronal membranes and limits seizure activity
• Iminostilbene (Carbamazepine) side effects/adverse effects

  • Hematologic: occasional hematologic toxicity occurs
  • CNS: D/D, HA, blurred vision
  • GI: distress
  • Possible toxic interaction w/ grapefruit juice
• Valproate


  Reduces abnormal electrical activity in the brain and may also increase GABA activity at inhibitory receptors
• Valproate side effects


  • CNS: D/D, insomnia, diplopia, weakness
  • GI: distress
  • Hematology: thrombocytopenia
  • Other: Suicidal ideation
  • Rarely: liver toxicity → NO alcohol
• Myasthenia Gravis


  • Discuss the pathophysiology of MG and identify priority assessment
• Pathophysiology of Myasthenia Gravis

  Antibodies attach ACH receptors resulting in decreased amount of receptors sites at the neuromuscular junction, this prevents ACH molecules from attaching to the receptor and stimulates normal muscular contraction. This results in skeletal muscle weakness that increases with use
• Most Frequent Affected Sites in Myasthenia Gravis

  • Eye & eyelids movement
  • Facial Expression
  • Chewing & swallowing
  • Respiratory paralysis → priority assessment
• Priority Assessment for Myasthenia Gravis

  1. Respiratory assessment (ABC's)

  2. Safety

  3. Monitor drug effectiveness

  4. Observe pt for s/s of cholinergic crisis

  5. Administer dose on time

  6. Take drugs before meals
• Myasthenic crisis


  • Muscle Weakness involving diaphragm & intercostal muscles resulting in respiratory failure
  • Triggers: Inadequate/underdosing, Emotional stress, Infection , surgery, trauma
  • Treatment: Neostigmine (fast-acting)
• Cholinergic crisis


  • Overdosing with acetylcholinesterase inhibitors
  • Triggers: Overdosing
  • Treatment: Antidote → Atropine
• The most common seizure type is the generalized tonic-clonic (grand mal) seizure
• Treatment of epilepsy includes anticonvulsant medication, surgery to remove the focus of abnormal electrical activity, vagus nerve stimulation and dietary therapy such as ketogenic diets.