Seizures

• Mannitol (OSMITROL)

  Osmotic diuretic = ↑osmotic pressure w/in Glomerular filtrate→↓reabsorption of water and e- (Excretion of h20, Na, K, Cl, P, Mg, (electrolytes), Urea, uric acid
• Lorazepam (ATIVAN, benzo)


  Potentates GABA
• Phenobarbital (ANCALIXIR), barbiturates

  Produces all levels of CNS depression, inhibits impulse transmission in the CNS and raises seizure threshold. Binds to GABA receptors→receptors respond ↑to GABA
• Gabapentin (NEURONTIN)


  Unknown MOA, Thought to ↑GABA
• Carbamazepine (TEGRETOL)


  has minimal adverse effects and minimal effects on cognitive function MOA = ↓Na channels =↓synaptic transmission in CNS
• Phenytoin (DILANTIN)


  ↓Na channels =↓synaptic transmission in CNS
• Valproic Acid (DEPAKENE)


  MOA =↓Na, ↓Ca, ↑GABA
• Topiramate (TOPAMAX)


  ↑GABA, ↓Na, Ca, Glutamate receptors FOR ADJUNCTIVE THERAPY
• Levetiracetam (KEPPRA)


  Unknown MOA SEIZURES
• Glutamate

  Excitatory
• GABA

  Inhibitory
• Metabolic changes that cause seizures

  • Hypoglycemia
  • Hypoxia
  • Dehydration
  • Alcohol
  • Electrolyte imbalance
  • Too much water
  • Barbiturates withdrawal
  • Acidosis
• Risk factors for seizures

  • Less than 6 months (Severe birth injury, congenital defects, infections)
  • 2-20 years (Birth injury, infection, head injury, genetics)
  • 20-30 years (Head injury, brain tumors, vascular disease)
  • Over 50 (Stroke, metastatic brain tumors)
• Types of seizures

  • Generalized seizures
  • Focal onset seizures
  • Unclassified
• Generalized seizures

  • Affect both sides of the brain
  • May have no warning signs or aura
  • Often the patient loses consciousness for a few seconds to minutes
• Tonic-clonic seizures

  1. Aura as a warning sign

  2. Tonic phase (10-20 seconds stiffening of the muscles)

  3. Clonic phase (rhythmic jerking of extremities for 30-40 seconds)

  4. Last about 2-5 minutes

  5. Exhaustion up to an hour after
• Tonic seizure


  • Abrupt increase in muscle tone or rigidity
  • Loss of consciousness
  • Autonomic changes
  • Lasts from 30 seconds to several minutes
• Clonic seizure


  • Lasts several minutes
  • Cause muscle contraction and relaxation
• Absence seizures

  • Person is blank and unresponsive for 5-10 seconds
  • Can occur up to hundreds of times per day
  • Sudden staring with impaired consciousness
  • Last 5-10 seconds
  • Only in children
• Myoclonic seizure


  • Brief jerking or stiffening of extremities
  • Often occur after going to bed or right after waking up
  • Can drop things
• Atonic seizure


  • Sudden loss of muscle tone (lasting for seconds)
  • Followed by postictal confusion
  • Often leads to falls
• Focal onset seizure

  • Caused by electrical activity in a focal part of the brain
  • Manifestations will be unilateral, affecting the area of the brain with abnormal excitation
  • May begin as focal and eventually convert into the entire brain being involved
• Manifestations of focal onset seizure

  • Sensory (visual distortion, taste, hearing, smell and tingling)
  • Autonomic (HR, abdominal cramps, nausea and vomiting, and sweating)
  • Motor (Opposite side, and jerking movements)
  • Emotional (Hallucinations, deja vu, and fear)
• Focal awareness

  Patient is awake and can talk, lasts less than a minute, classified as an aura (sign of bigger seizure waiting to happen)
• Automatism


  Semi-coordinated repetitive motor activities during a focal impaired awareness seizure, such as mouth chewing, picking at shirt, walking aimlessly, and mumbling
• Focal impaired awareness seizure (FIAS)

  Patient is awake but can't interact with the environment, may look intoxicated
• Seizure triggers

  • Strong emotions
  • Intense exercise
  • Loud music
  • Flashing lights
  • Fever
  • Menstrual period
  • Lack of sleep
• Seizure stages and manifestations

  • Prodrome phase (Change in mood, different sleep, and focus, lightheadedness)
  • Aura phase (Nausea, headache, weird smell, taste and sound)
  • Ictal phase (Odd smell, taste, sound, different speaking, confusion and repeated movements)
  • Postictal phase (Exhaustion, headache, shame and confusion)
• Consequences of seizures

  • Aspiration
  • Impaired gas exchange
  • Injury
  • Quality of life
  • Mental health (depression, anxiety)
• Status epilepticus


  State of continuous seizure activity for more than 5 minutes or repeated seizures over 30 minutes - Medical Emergency!!! Brain is in a hypermetabolic state – demand is greater than supply which can lead to hypoxemia, acidosis, hyperthermia, respiratory failure, and cardiac arrest
• Status epilepticus can also cause muscle to break down causing myoglobin accumulation in kidneys, leading to renal failure (rhabdomyolysis)
• Seizure > 10 minutes can cause death
• Common causes of status epilepticus

  • Infection
  • Sudden withdrawal from seizure meds
  • Acute alcohol and drug withdrawal
  • Head trauma
  • Cerebral edema & metabolic disturbances
• Mannitol (OSMITROL)


  Osmotic diuretic that increases osmotic pressure within the glomerular filtrate, leading to decreased reabsorption of water and electrolytes
• Indications for mannitol

  • Increased intracranial pressure
  • Renal failure
  • Edema
• Contraindications for mannitol

  • Anuria
  • Dehydration
  • Pulmonary edema
• Therapeutic effect of mannitol

  Decreases intracranial pressure, increases urine output to at least 30-50 cc/hr
• Adverse effects of mannitol

  • Pulmonary edema
  • Electrolyte imbalances
  • Dehydration
• Nursing considerations for mannitol

  Monitor vital signs, urine output (for dehydration/fluid overload), and electrolyte imbalances
• Lorazepam (ATIVAN)


  Benzodiazepine that potentiates GABA