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What is a seizure?
- Episode of excessive & abnormal electrical activity of all or part of brain
- Abnormal activity is manifested by disturbances in skeletal motor activity, sensation,behavior, consciousness, autonomic dysfunction of viscera
- From acute febrile state, head injury, infection, metabolic/endocrine disorders, exposure to toxins
- Seizures recurring within min, days, yrs, diagnosis of epilepsy is given
Etiology & patho
- Initiating factor is unknown
- Metabolic needs, o2 requirements, metabolic by-products, cerebral blood flow increase dramatically
- AS long as cerebral blood flow can meet demands of seizure, brain is protected from cellular exhaustion and destruction
- Partial seizures: begin in one area of the cortex
- Generalized seizures: involve both hemispheres and deeper brain structures
What is a simple partial seizure?
- Limited to 1 hemisphere
- Manifestations- alterations in motor function, sensory signs, autonomic/psychic symptoms
What is a complex partial seizure?
- Originate in temporal lobe
- May be preceded by an aura
- Impaired LOC
- Repetitive nonpurposeful mvmnts noted
- Amnesia is common
What is a generalized partial seizure?
Partial seizure that has spread to both hemispheres and deeper structures of brain
What is an abscence seizure?
- Generalized seizure that lasts 5-30sec
- Sudden, brief cessation of motor activity and a blank stare
- Seizures may be occasional or up to 100/day
- May be accompanied by eyelid fluttering or automatisms
- More common in children than adults
What is a Tonic-Clonic seizure?
- "Grand mal"
- May be preceded by aura but are often w/o warning
- Starts c loss of consciousness and sharp muscle contractions
- May have bowel/bladder incontinence
- Tonic phase: Breathing ceases and cyanosis develops- 15sec-1min
- Clonic phase: alternating muscle contraction/relaxation in all extremities, hyperventilation, eyes rolled back in head- 60-90sec
- Postictal period: relaxed c quiet breathing, unconcious/unresponsive, confusion and disorientation, head and muscle aches, fatigue, may sleep several hours
- Amnesia of seizure/events just prior to seizure
- Done to confirm diagnosis and determine treatable causes and precipitating factors
- Complete neurological exam
- Electroencephalogram (EEG)
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomographt (PET) scan
- Lumbar puncture c CSF analysis
- Blood studies
- Pt on bed or recliner in very quiet room
- 16-24 electrodes attached to pt scalp
- Pt must lie still with eyes closed during initial recording
- Rest of test engages pt in activities such as hyperventilation, photic stimulation & sleep
- Test takes 40-60 min, pt closely watched, any mvmnt recorded
Electroencephalogram pt care.
- Explain procedure/test not dangerous
- If to be sleep deprived, wake at 2 am
- Avoid CNS depressants or stimulants
- Withhold anticonvulsants only if ordered
- Avoid caffeine on day of test
- Wash hair/no sprays or oils
- Remove hairpins, accessories
- Wash hair p test to remove glue
What is a CT scan?
- With the aid of a computer, pictures are taken in many diff "slices" of the brain
- Accurate, quick, easy, noninvasive, painless, least expensive way to diagnose neurologic problems.
CT pt care
- Assess for allergies to shellfish
- Assess for pre-existing renal disease, diabetic neuropathy, HF, dehydration
- Assess for drugs that interfere c renal perfusion
- Remove hairpins, accessories
What is magnetic resonance imaging?
- Use magnetic fields to produce images that are better than CT scan.
- Images may be enhanced using gadolinium, a noniodine-based contrast
- NO metal may enter the MRI room
- Contraindicated for pt c pacemakers, implanted pumps/devices and ion-containing metal aneurysm clips
- Contraindicated for confused/combative pts, unstabble VS, continuous life support, or have old tattoos (lead)
What is Postitron Emission Tomography (PET) scan?
Provides info about the function of the brain, specifically glucose and oxygen metabolism and cerebral blood flow.
PET scan procedure
- Pt is injected c IV deoxyglucose, which is tagged to an isotope. The isotope emits activity in the form of positrons, which are scanned and converted into a color image by a computer. The more active a given part of the brain, the greater the glucose uptake.
- Pt may be asked to perform mental functions to activate diff areas of brain
PET scan pt care
- Withhold caffeine, alcohol, tobacco for 24 hours prior to test
- NPO 4-12 hrs prior to procedure
- No insulin given prior to test
- Do not give glucose solution AND anything else that alters glucose metabolism
- Insert 2 IV lines
- p procedure increase fluids to flush out radioisotopes
- Med therapy is mainstay of controlling seizure activity
- Then surgery for exicion of tissue involved in seizure activity
- Vagal Nerve Stimulation
- Electrodes surgically implanted into brain
- Partial Corpus Callostomy
What is vagal nerve stimulation?
- Controls partial seizures
- Device is implanted in L chest wall and electrode is attached to L vagus nerve and then to a generator
- Generator can be activated when experiencing an aura, and stop the seizure
Electrodes surgically implanted into brain
- Close observation/continuous EEG recording to identify area of seizure
- Electrodes are surgically imlanted in brain
- Additional EEG, if vital areas of brain not involved, the area is surgical removed
What is a partial corpus callostomy?
- Treats tonic-clonic or atonic seizures
- Anterior two thirds of corpus callosom is sectioned, preventing neuronal discharges from passing btwn two hemispheres
Planning & implementation
- Maintain airway patency
- Reduce risk of injury during seizure
- Document seizure activity promptly & report as appropriate
- Maintain low stimulus environment during recovery