Convulsions
1. The first phase, or the prodromal phase, occurs hours or days before a seizure.
Fatigue, malaise, or headaches may be experienced during this phase.
2. In the second phase (the aura phase of a seizure), an olfactory, visual, or emotional
disturbance or hallucination may be experienced. This phase can act as a warning sign
and is helpful for some clients with seizure disorders to plan and prepare for potential
seizure activity by calling for help and moving to an area where they can be safer.
3. The third phase is the ictus phase. Depending on the type of seizure, symptoms may
range from staring into space to full convulsions. A client may experience a tonic phase,
which includes muscle contractions with excessive muscle tone, or a clonic phase, which
includes alternating contractions and relaxation of muscle.
4. In the last phase (the postictal phase), a client is usually disoriented and/or confused
and may experience fatigue, headaches, or muscle soreness. This phase can last to two
hours. In some cases, the presence of this phase can help distinguish a seizure from an
alternate syncopal event.
Risk factors for a seizure disorder include the following:
Genetic predisposition: A family history of epilepsy significantly increases the risk to
the client.
Head trauma: Injuries to the head can lead to post-traumatic epilepsy. This is often due
to cerebral edema or sheer injury to neurons in the brain. Sometimes, anti-seizure
medications are even started as a precaution against potential seizures.
Tumors: Brain tumors are space-occupying lesions within the skull that can increase
seizure risk.
Vascular events: Abnormal blood vessels in the brain, bleeding into the skull cavity, or a
cerebral vascular accident can be a risk factor for seizures.
Infections: While meningeal infections like meningitis can increase the risk of seizures,
other infections, including neurocysticercosis (a common opportunistic infection
associated with human immunodeficiency virus [HIV]), can also increase the risk of a
seizure disorder.
Developmental disorders: Because developmental disorders can be caused by delayed
brain development or brain injury, seizures are more likely. This can include conditions
, like autism, cerebral palsy, and neurofibromatosis, which can be associated with a
higher risk of seizures.
Age: Children, especially very young or premature infants, and older adults have an
increased risk of seizures.
Alcohol or drug misuse: Too much or a combination of some recreational or prescription
drugs and alcohol can be risk factors for seizures.
Oral medications must be avoided during active seizures. Safety precautions are
essential to prevent injury and include supporting the head and body with pillows or
padding. Airway patency is critical. A side-lying position is used to prevent saliva or
vomiting from blocking the airway and being aspirated.
Potential clues that suggest a psychogenic cause include the
following:
unequal or fluctuating movements between the client’s right and left
side
signs of consciousness during the episode; this can include intermittent
consciousness
side-to-side neck movement
breaking a fall by holding onto a wall or furniture
easing oneself to the ground during the event
eyes are closed
yelling verbal phrases
a startle response caused by an environmental stimulus like noise or
intense light
no postictal confusion or sleepiness
may be an emotional or psychological stressor that starts the event
The pathophysiology of an The pathophysiology of a
epileptic seizure includes the psychogenic nonepileptic
following: seizure includes the following:
abnormal electroencephalogram normal electroencephalogram (EEG)
(EEG) patterns during episodes findings during episodes
changes in ion channels and no change in the brain's electrical
neurotransmitter imbalances activity
responsive to antiepileptic drugs not responsive to antiepileptic drugs
associated with brain injury or lesion often associated with mental health
disorder
1. The first phase, or the prodromal phase, occurs hours or days before a seizure.
Fatigue, malaise, or headaches may be experienced during this phase.
2. In the second phase (the aura phase of a seizure), an olfactory, visual, or emotional
disturbance or hallucination may be experienced. This phase can act as a warning sign
and is helpful for some clients with seizure disorders to plan and prepare for potential
seizure activity by calling for help and moving to an area where they can be safer.
3. The third phase is the ictus phase. Depending on the type of seizure, symptoms may
range from staring into space to full convulsions. A client may experience a tonic phase,
which includes muscle contractions with excessive muscle tone, or a clonic phase, which
includes alternating contractions and relaxation of muscle.
4. In the last phase (the postictal phase), a client is usually disoriented and/or confused
and may experience fatigue, headaches, or muscle soreness. This phase can last to two
hours. In some cases, the presence of this phase can help distinguish a seizure from an
alternate syncopal event.
Risk factors for a seizure disorder include the following:
Genetic predisposition: A family history of epilepsy significantly increases the risk to
the client.
Head trauma: Injuries to the head can lead to post-traumatic epilepsy. This is often due
to cerebral edema or sheer injury to neurons in the brain. Sometimes, anti-seizure
medications are even started as a precaution against potential seizures.
Tumors: Brain tumors are space-occupying lesions within the skull that can increase
seizure risk.
Vascular events: Abnormal blood vessels in the brain, bleeding into the skull cavity, or a
cerebral vascular accident can be a risk factor for seizures.
Infections: While meningeal infections like meningitis can increase the risk of seizures,
other infections, including neurocysticercosis (a common opportunistic infection
associated with human immunodeficiency virus [HIV]), can also increase the risk of a
seizure disorder.
Developmental disorders: Because developmental disorders can be caused by delayed
brain development or brain injury, seizures are more likely. This can include conditions
, like autism, cerebral palsy, and neurofibromatosis, which can be associated with a
higher risk of seizures.
Age: Children, especially very young or premature infants, and older adults have an
increased risk of seizures.
Alcohol or drug misuse: Too much or a combination of some recreational or prescription
drugs and alcohol can be risk factors for seizures.
Oral medications must be avoided during active seizures. Safety precautions are
essential to prevent injury and include supporting the head and body with pillows or
padding. Airway patency is critical. A side-lying position is used to prevent saliva or
vomiting from blocking the airway and being aspirated.
Potential clues that suggest a psychogenic cause include the
following:
unequal or fluctuating movements between the client’s right and left
side
signs of consciousness during the episode; this can include intermittent
consciousness
side-to-side neck movement
breaking a fall by holding onto a wall or furniture
easing oneself to the ground during the event
eyes are closed
yelling verbal phrases
a startle response caused by an environmental stimulus like noise or
intense light
no postictal confusion or sleepiness
may be an emotional or psychological stressor that starts the event
The pathophysiology of an The pathophysiology of a
epileptic seizure includes the psychogenic nonepileptic
following: seizure includes the following:
abnormal electroencephalogram normal electroencephalogram (EEG)
(EEG) patterns during episodes findings during episodes
changes in ion channels and no change in the brain's electrical
neurotransmitter imbalances activity
responsive to antiepileptic drugs not responsive to antiepileptic drugs
associated with brain injury or lesion often associated with mental health
disorder
