Seizures/Epilepsy
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within
the brain that can cause alterations in the LOC and/or changes in motor and sensory ability
and/or behavior
- Can result from substance withdrawal or fever
Epilepsy: term used to define chronic recurring in abnormal brain electrical activity resulting in
two or more seizures.
Risk factors
- Genetic predisposition: absence seizures are more common in children and occurs in
families
- Acute febrile state: particularly among infants and children younger than 2 y/o
- Head trauma: can be early or late onset (up to 9 months), and incidence is increased
when skill fracture is included
- Cerebral edema: occurs acutely and seizure activity tends to disappear when the edema
is successfully treated
- Abrupt cessation of antiepileptic drugs (AEDs): rebound activity
- Infection: if intracranial, a result of increased ICP; if systemic, a result of persistent
febrile state
- Metabolic disorder: result of insufficient or excessive chemicals within the brain; such as
occurring with hypoglycemia or hyponatremia
- Exposure to toxins: pesticides, carbon monoxide, and lead poisoning
- Stroke: occurs within the first 24 hours following a stroke as a result of ICP
- Heart disease: common cause of new-onset seizures in older adults
- Brain tumor: benign, seizures caused by the increased bulk associated with the tumor;
malignant is associated with the ability of the brain tissue to function
- Hypoxia: results in decreased oxygen levels of the brain; necessary for neuronal activity
- Acute substance withdrawals: dehydration accompanies withdrawal, creating a toxic
level of the substance in the body
- Fluid and electrolyte imbalances: results in abnormal levels of nutrients required for
neuronal function
- Triggering factors: increased physical activity, excessive stress, hyperventilation,
overwhelming fatigue, acute alcohol ingestion, excessive caffeine intake, exposure to
flashing lights, substances such as coke, aerosols, and inhaled glue products
Expected Findings
, - Generalized seizures: involves both cerebral hemispheres; can begin with an aura
(alteration in vision, smell, hearing, or emotional feeling)
o Tonic-clonic seizure – begins for only a few seconds with a tonic episode
(stiffening of muscles and LOC)
1 to 2 minute clonic episode (rhythmic jerking of the extremities) follows
tonic episode
Breathing can stop during tonic phase and become irregular
Cyanosis can accompany breathing irregularities
Biting of the cheek or tongue can occur during
Incontinence can also accompany a tonic-clonic seizure
During the postictal phase, a period of confusion and sleepiness follows
o Tonic seizure – experienced, clients suddenly lose LOC and experience sudden
increased muscle tone, LOC, and automatic manifestations (arrhythmia, apnea,
vomiting, incontinence, salivation), seizure usually lasts 30 seconds to several
minutes
o Clonic seizure – experience, last several minutes, during this type of seizure, the
muscles contract and relax
o Myoclonic seizure – consist of brief jerking or stiffening of the extremities, which
can be symmetrical or asymmetrical
o Atonic/akinetic seizure – characterized by a few seconds in which muscle tone is
lost, seizure is followed by a period of confusion, loss of muscle tone frequently
results in falling
- Partial or focal/local seizure: involves only one cerebral hemisphere
o Complex partial seizure – have associated automatisms (behaviors that client is
unaware of, such as lip smacking or picking at clothes); can cause LOC or blackout
for several minutes; amnesia can occur immediately prior to and after seizure
o Simple partial seizure – consciousness is maintained throughout simple partial
seizures; seizure activity can consist of unusual sensations (déjà vu, automatic
abnormalities such as changes in HR and abnormal flushing, unilateral abnormal
extremity movements, pain, or offensive smell)
- Unclassified or idiopathic seizures: do not fit into other categories; accounts for half of
all seizure activity and occur for no known reason
Laboratory tests
, - Alcohol and illicit substance levels, HIV testing, and if suspected, screen for presence of
excessive toxins
Diagnostic procedures
- EEG records electrical activity and can ID origin of seizure activity
- MRI, CT/CAT, PET, CSF, and skull x-ray can be used to identify or rule out potential causes
of seizures
Nursing care
- During seizure:
o Protect client’s privacy and injury (move furniture away, hold head in lap if on the
floor), Position client to provide patent airway
o Be prepared to suction oral secretions, Turn client to the side to decrease risk of
aspiration, Loosen restrictive clothing
o Do not attempt to restrain the client or open the jaw or insert airway during
seizure activity (can damage teeth, lips, and tongue), Do not use padded tongue
blades
o Document onset and duration of seizure and findings (LOC, apnea, cyanosis,
motor activity, incontinence) prior to, during, and following
- After seizure
o This is the postictal phase of the seizure episode
o Maintain the client in a side-lying position to prevent aspiration and to facilitate
drainage of oral secretions
o Check vital signs, assess for injuries, perform neurological checks
o Allow the client to rest if necessary, Reorient and calm the client, who might be
agitated or confused
o Determine is client experienced an aura, which can indicate the origin of seizure
in the brain, Try to determine possible trigger such as fatigue
Medications: administer prescribed antiepileptic drugs (AEDs) = phenytoin
- Initial goal is to control seizure activity using one medication. If the chosen medication is
not effective, either the dose is increased, or another medication is added or substituted
- Therapeutic levels are determined by blood tests and performed on a routine schedule
to ensure compliance and effectiveness of the medication
- The client should take medications at the same time everyday to enhance effectiveness;
Allergic reactions to these medications are rare
, - When using phenytoin, specific instructions should include avoidance or oral
contraceptives, as this medication decreases their effectiveness. Warfarin should also
not be given with this medication as it can decrease absorption and increase metabolism
of oral anticoagulants
Interprofessional care
- Initiate a social services referral to aid in obtaining medications if cost will affect the
client’s ability to adhere to the medication routine
- If employment is affected by seizure activity, refer to social agencies for financial support
and vocational evaluation
- If seizure activity affects a school-age child’s performance in the classroom, this
condition should be reported to the disability office, which can develop specialized
interventions or facilitate an IEP
- Discrimination on the basis of epilepsy is illegal in all states
Therapeutic procedure
- Vagal nerve stimulation and conventional surgical procedures can be helpful for clients
whose seizures are not controlled with medication therapy
- Vagal nerve stimulator – indicated for treatment of partial seizures; it is a device
implanted into the left chest wall and connected to an electrode placed on the left Vagus
nerve; this procedure is performed under general anesthesia
o The device is then programmed to administer intermittent stimulation of the
brain via stimulation of the vagal nerve, at a rate specific to the client’s need
Client education
- In addition to routine stimulation, the client may initiate VNS by holding a magnet over
the implantable device, at the onset of seizure activity. This either aborts the seizure, or
lessen its severity
- Avoid diagnostic procedures, such as MRI, ultrasound diathermy, and the use of
microwave ovens and shortwave radios
o Conventional surgical procedures: available for clients who experience partial or
generalized seizures
- Prior to surgery, ARDs are discontinued and the specific area of the seizure activity is
identified through the use of EEG monitoring. Surgically implanted electrodes can also
be used
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within
the brain that can cause alterations in the LOC and/or changes in motor and sensory ability
and/or behavior
- Can result from substance withdrawal or fever
Epilepsy: term used to define chronic recurring in abnormal brain electrical activity resulting in
two or more seizures.
Risk factors
- Genetic predisposition: absence seizures are more common in children and occurs in
families
- Acute febrile state: particularly among infants and children younger than 2 y/o
- Head trauma: can be early or late onset (up to 9 months), and incidence is increased
when skill fracture is included
- Cerebral edema: occurs acutely and seizure activity tends to disappear when the edema
is successfully treated
- Abrupt cessation of antiepileptic drugs (AEDs): rebound activity
- Infection: if intracranial, a result of increased ICP; if systemic, a result of persistent
febrile state
- Metabolic disorder: result of insufficient or excessive chemicals within the brain; such as
occurring with hypoglycemia or hyponatremia
- Exposure to toxins: pesticides, carbon monoxide, and lead poisoning
- Stroke: occurs within the first 24 hours following a stroke as a result of ICP
- Heart disease: common cause of new-onset seizures in older adults
- Brain tumor: benign, seizures caused by the increased bulk associated with the tumor;
malignant is associated with the ability of the brain tissue to function
- Hypoxia: results in decreased oxygen levels of the brain; necessary for neuronal activity
- Acute substance withdrawals: dehydration accompanies withdrawal, creating a toxic
level of the substance in the body
- Fluid and electrolyte imbalances: results in abnormal levels of nutrients required for
neuronal function
- Triggering factors: increased physical activity, excessive stress, hyperventilation,
overwhelming fatigue, acute alcohol ingestion, excessive caffeine intake, exposure to
flashing lights, substances such as coke, aerosols, and inhaled glue products
Expected Findings
, - Generalized seizures: involves both cerebral hemispheres; can begin with an aura
(alteration in vision, smell, hearing, or emotional feeling)
o Tonic-clonic seizure – begins for only a few seconds with a tonic episode
(stiffening of muscles and LOC)
1 to 2 minute clonic episode (rhythmic jerking of the extremities) follows
tonic episode
Breathing can stop during tonic phase and become irregular
Cyanosis can accompany breathing irregularities
Biting of the cheek or tongue can occur during
Incontinence can also accompany a tonic-clonic seizure
During the postictal phase, a period of confusion and sleepiness follows
o Tonic seizure – experienced, clients suddenly lose LOC and experience sudden
increased muscle tone, LOC, and automatic manifestations (arrhythmia, apnea,
vomiting, incontinence, salivation), seizure usually lasts 30 seconds to several
minutes
o Clonic seizure – experience, last several minutes, during this type of seizure, the
muscles contract and relax
o Myoclonic seizure – consist of brief jerking or stiffening of the extremities, which
can be symmetrical or asymmetrical
o Atonic/akinetic seizure – characterized by a few seconds in which muscle tone is
lost, seizure is followed by a period of confusion, loss of muscle tone frequently
results in falling
- Partial or focal/local seizure: involves only one cerebral hemisphere
o Complex partial seizure – have associated automatisms (behaviors that client is
unaware of, such as lip smacking or picking at clothes); can cause LOC or blackout
for several minutes; amnesia can occur immediately prior to and after seizure
o Simple partial seizure – consciousness is maintained throughout simple partial
seizures; seizure activity can consist of unusual sensations (déjà vu, automatic
abnormalities such as changes in HR and abnormal flushing, unilateral abnormal
extremity movements, pain, or offensive smell)
- Unclassified or idiopathic seizures: do not fit into other categories; accounts for half of
all seizure activity and occur for no known reason
Laboratory tests
, - Alcohol and illicit substance levels, HIV testing, and if suspected, screen for presence of
excessive toxins
Diagnostic procedures
- EEG records electrical activity and can ID origin of seizure activity
- MRI, CT/CAT, PET, CSF, and skull x-ray can be used to identify or rule out potential causes
of seizures
Nursing care
- During seizure:
o Protect client’s privacy and injury (move furniture away, hold head in lap if on the
floor), Position client to provide patent airway
o Be prepared to suction oral secretions, Turn client to the side to decrease risk of
aspiration, Loosen restrictive clothing
o Do not attempt to restrain the client or open the jaw or insert airway during
seizure activity (can damage teeth, lips, and tongue), Do not use padded tongue
blades
o Document onset and duration of seizure and findings (LOC, apnea, cyanosis,
motor activity, incontinence) prior to, during, and following
- After seizure
o This is the postictal phase of the seizure episode
o Maintain the client in a side-lying position to prevent aspiration and to facilitate
drainage of oral secretions
o Check vital signs, assess for injuries, perform neurological checks
o Allow the client to rest if necessary, Reorient and calm the client, who might be
agitated or confused
o Determine is client experienced an aura, which can indicate the origin of seizure
in the brain, Try to determine possible trigger such as fatigue
Medications: administer prescribed antiepileptic drugs (AEDs) = phenytoin
- Initial goal is to control seizure activity using one medication. If the chosen medication is
not effective, either the dose is increased, or another medication is added or substituted
- Therapeutic levels are determined by blood tests and performed on a routine schedule
to ensure compliance and effectiveness of the medication
- The client should take medications at the same time everyday to enhance effectiveness;
Allergic reactions to these medications are rare
, - When using phenytoin, specific instructions should include avoidance or oral
contraceptives, as this medication decreases their effectiveness. Warfarin should also
not be given with this medication as it can decrease absorption and increase metabolism
of oral anticoagulants
Interprofessional care
- Initiate a social services referral to aid in obtaining medications if cost will affect the
client’s ability to adhere to the medication routine
- If employment is affected by seizure activity, refer to social agencies for financial support
and vocational evaluation
- If seizure activity affects a school-age child’s performance in the classroom, this
condition should be reported to the disability office, which can develop specialized
interventions or facilitate an IEP
- Discrimination on the basis of epilepsy is illegal in all states
Therapeutic procedure
- Vagal nerve stimulation and conventional surgical procedures can be helpful for clients
whose seizures are not controlled with medication therapy
- Vagal nerve stimulator – indicated for treatment of partial seizures; it is a device
implanted into the left chest wall and connected to an electrode placed on the left Vagus
nerve; this procedure is performed under general anesthesia
o The device is then programmed to administer intermittent stimulation of the
brain via stimulation of the vagal nerve, at a rate specific to the client’s need
Client education
- In addition to routine stimulation, the client may initiate VNS by holding a magnet over
the implantable device, at the onset of seizure activity. This either aborts the seizure, or
lessen its severity
- Avoid diagnostic procedures, such as MRI, ultrasound diathermy, and the use of
microwave ovens and shortwave radios
o Conventional surgical procedures: available for clients who experience partial or
generalized seizures
- Prior to surgery, ARDs are discontinued and the specific area of the seizure activity is
identified through the use of EEG monitoring. Surgically implanted electrodes can also
be used
