Seizures

• Seizure is a temporary alteration in behavior or consciousness caused by abnormal electrical activity of one or more groups of neurons in brain

  • Believed to be the result of neuronal membrane permeability & structural lesion/metabolic derangement
  • Inc. membrane permeability to Na & K ions enhances ability of neurons to depolarize & emit electrical charge - can result in seizure activity
• Seizures are caused by multiple factors: stroke, head trauma, toxins, hypoxia, hypoperfusion, hypoglycemia, infection, brain tumor/abscess, eclampsia, metabolic abnormalities
• Seizures are either generalized (affecting large portions of the brain) or partial (affecting limited area of the brain)
• Types of Generalized Seizures: tonic-clonic (grand mal) & absence (petit-mal)
• Pseudoseizures: (psychogenic non epileptic seizures) a generalized neurologic event

  • Psychiatric origin - pt may not be intentionally causing this behavior
  • LOC, side to side head movement, weeping, stuttering, legs like riding bicylcle
• Partial Seizures: affect a limited portion of the brain - can be in one spot or can start in one sport & spread to other locations

  • Simple partial seizures & complex partial seizures
• Jacksonian Seizure: partial seizure activity that spreads in an orderly fashion to surrounding areas
• Assessment


  Monitor & protect pt from injuring themselves

  Assessment should include a thorough history & physical exam is possible

  • Compliance with prescribed medication
  • Description of seizure
  • Typical or atypical pattern of seizure - presence of aura
  • Generalized or focal
  • Head trauma
  • Medical history: diabetes, stroke, heart disease
• Physical Examination


  Alert to signs of trauma - head/neck trauma, tongue injury, oral lacerations

  Fever?

  Apneic, cyanotic, vomiting?

  Cranial nerve evaluation - pupillary findings

  Bowel or bladder incontinence
• Syncope


  Usually starts at a standing position

  Warning of lightheadedness

  Bradycardia caused inc. vagal tone

  Regains consciousness immediately on becoming supine

  H/A, confusion - last less than 15 min

  Causes may be cardiac or not

  • Bradycardia, pacemaker malfunction, VT, SVT, MI, cardiac medications
  • Dehydration, Hypoglycemia, Vasovagal response, Pulmonary embolism
• Management


  Determine if there was trauma - if so perform c-spine precautions

  Do not retrain or try to stop the seizing movement - prevent pt from injuring themselves

  Do not place anything in pt's mouth

  O2 & ventilatory support

  Place IV - correct hypoglycemia with glucose is needed

  Administer diazepam (Valium), lorazepam (ativan) or midazolam (versed)