Nursing 4 Lecture 8 Seizures & Epilepsy
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Abnormal sudden excessive uncontrolled electrical discharge of neurons with in the brain tat my result in change of LOC, motor or sensory ability, and/or behavior
Neurological disorder characterized by abnormal electrical activity in the brain
A change in senosorium consciousness or behavior due to an alteration in electrical conduction in the brain
- -Two or more seizures experienced by a person
- -Chronic disorder
- -Imbalanced neurotransmitters esp GABA
- -Can develop anytime in life (especially in childhood <2 and elderly >65)
- -Affects 2.5 million Americans
- -10% of the population will have a seizure sometime in their life
- -45,000 children <15/year; Males>Females
- -Greater incidence in African Americans
- -In 70% of the cases there is no apparent cause
Special Populations at Risk:
- -10% of children with mental retardation
- -10% of children with CP
- -50% of children with all disabilities
- -10% of Alzheimer patients
- -22% of stroke patients
Common Causes in Newborns:
BIRTH RELATED ANOXIA= MOST COMMON
- -Brain malformations
- -Lack of O2 during birth
- -Low levels of blood sugar, blood calcium, blood magnesium or other electrolyte disturbances
- -Inborn errors of metabolism
- -Intracranial hemorrhage
- -Maternal drug use
Common Causes in Infants and Children:
- -Fever (febrile seizures)
- -Brain tumor (rarely)
Common Causes in Older Children and Adults:
- -Congenital conditions (Downs syndrome, neurofibromatosis)
- -Genetic factors
- -Head trauma
- -Drug induces
Common Causes in the Elderly:
-In most right handed people the left frontal lobe (behind the forehead) controls speech while the left temporal lobe (above the ear) controls understanding of spoken and written language
-The occipital lobes, at the back of the head, control vision. Neuronal discharge in the occipital lobes could make objects appear larger or smaller than they are, or produce distorted visual images.
-The left and right parietal lobes each control muscles of the leg, hip, trunk, arm, hand, face, tongue, and vocal chords on the (opposite) right and left sides of the body. A seizure that affects this part of the brain might produce just the twitch of a hand or facial muscles, of might progress to involve the whole o one side of the body.
-The limbic cortex (incorporating deep, central portions of the frontal and temporal lobes) controls emotions and memory. This area is frequently the site where partial seizures begin.
-The hippocampus, an area of the brain just below the temporal lobes, plays a key rold in memory, especially recent memory.
Classification of Seizures:
- Generalized Seizures:
- -Tonic clonic (gran mal)
Generalized: affects entire body
Partial (focal): affects on focus part
- Partial (focal) Seizures:
- -Simple partial
- -Complex partial
-Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure
-Produces a loss of consciousness, but does not mean they are comatose!
-Also called Drop Attacks, Astatic, or Akinetic Seizure
BIGGEST RX: Patients will hurt themselves on the way down
- -Produces a sudden loss of muscle tone
- -Manifested by head drop, loss of posture, or sudden collapse
- -Occur witout any warning
- -People fall and suffer traumatic injury to the head and face
Atonic Seizures: What to do?
No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the child should be given a thorough medical evaluation.
-Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy
-Sudden loss of muscle tone lasting for seconds followed by postictal (after the seizure) confusion.
-Most cases patient falls which puts them at risk for injury, this type is most resistent to drug therapy.
- -Seizure with muscle twitching, usually bilaterally
- -Brief jerking or stiffening of extremities that may occur singly or in groups
- -Lasts just a few seconds can be symmetric or assymmetric
- -Myoclonic seizures are rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body
- -Occasionally, they involve on arm of a foot
- -People usually think of them as sudden jerks of clumsiness
- -It is similar to the sudden jerk of a foot during sleep
- -Also called petit mal
- -More common in children than in adults
- -Frequently so brief that they escape detection, even if they child is experiencing 50 to 100 attacks daily
- -May occur for several months before a child is sent for a medical evaluation
- -No aura
- -Abrupt onset
- -Brief duration
- -Prompt recovery
- -Often confused with complex partial seizures
- -Body is there but the patient is disassociated
- -Lasts seconds to minutes
- -More common in children and tends to run in families
- -Consists of brief periods of loss of consciousness and blank starring as though a perosn is day dreaming
- -Often school teachers pick up on them first
- -Eyes may flutter and automatisms (invol behavior) like lip smacking and picking at clothes may occur
- -Patient returns to the baseline immediatley after seizure
- -Seizures may occur frequently throughout the day interfering with school and daily activities
Absence Seizures: what to do?
No first aid is necessary, but if this is the first observation of an absence seizure, medical evaluation is recommended.
- -Just protect the patient
- -Put on side in recovery position
Myoclonic Seizures: what to do?
First aid is usually not needed.
However, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.
- -Also called Grand Mal or a Convulsion
- -Most common and best known type of generalized seizure
- -Begins with stiffening of the limbs (the tonic phase): part of arms and legs and loss of consciousness
- -Followed by jerking of the limbs and face (the clonic phase): client may bite tongue and become continent of feces
- -Lasts 2 to 5 minutes
- -Fatigue, acute confusion, and lethargy can last up to an hour after the seizure
Tonic-Clonic Seizures: what to do?
- -Prevent further injury
- -Do not restrain the person's movements unless they place him or her in danger
- -Stay with the person until the siezure ends
- -If the person does not resume breathing after the seizure, start cardiopulmonary resuscitation
- Postictal Stage: lasts from 1 to 2 minutes to half hour, just sleeping sometimes snoring very loudly
- -Let the person rest until he or she is fully awake
- -Be reassuring and supportive when consciousness returns
Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations
- -During partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain)
- -AKA focal or local seizures begin in part of one cerebral hemisphere
- -Most often seen in adults and less responsive to medical tx
- -MOST COMMMONE TYPE OF SEIZURE EXPERIENCED BY PEOPLE WITH EPILEPSY!
- Partial seizures are subdivided into:
- -Simple partial seizures: consciousness is retained
- -Complex partial seizures: consciousness is impaired or lost
Simple Partial Seizures:
- -Remain conscious throught the seizure
- -Often reports and aura before the seizure takes place
- -Can consist of deja vu, perception of offensive smell, or sudden onset of pain
- -During the seizure the patient may have one sided movement of an extremity, experience unusual sensations, or autonomic sx
- Autonomic changes include:
- -Change in the HR
- -Skin flushing
- -Epigastric discomfort
Simple Partial Seizure: what to do?
They do not require any spicial response except to recognize whats happening and be supportie when the seizure is over
*protection and support
Complex Partial Seizures:
Although complex partial seizures can affect any area of the brain, they often take place in one of the brains two temporal lobes. Because of this, the condition is sometimes called "temporal lobe epilepsy"
May cause a loss of consciousness or syncope for 1 to 3 minutes; automatisms may also occur
- -Starts with a blank stare and loss of contact with surroundings
- -Often followed by chewing movements with the mouth, picking of fumbling with clothing, mumbling, and performing simple, unorganized movements over and over again
- -Sometimes people will wander
- -A person cannot interact normally with other people, is not in control of his movements, speech, or actions; doesn't know what he's doing and cannot remember afterwards what happened during the seizure
- -May even be able to speak, but the words are unlikely to make sense and he or shit will not be able to respond to others in an appropriate way
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