Epilepsy and Disorders
what is a seizure?
sudden, abnormal, excessive, electrical discharge of neurons in the brain.
describe the phases of a tonic-clonic seizure? (bonus points: is there memory of this seizure?)
tonic: body stiffens for 10-20 seconds
clonic: extremities jerk for 30 to 40 seconds up to several minutes
postictal: muscle soreness, tiredness, may sleep for several hours. Can not feel normal for hours or days
bonus points: no memory of seizure
where do focal onset seizures begin, what do they cause, are they motor or non-motor, and meaning of focal impaired awareness seizure?
begins in 1 hemisphere of the brain, causes sensory, motor, cognitive, or emotional symptoms based on affected part of the brain, can be both motor/non-motor, and this means loss of awareness/dream-like state.
describe Psychogenic Nonepileptic Seizures (PNES)? (trigger, is it a seizure disorder, what does it require, and treatment)
triggered by emotional events (NOT neuronal activity), sometimes misdiagnosed as seizure disorder but requires video EEG during attack to rule out, and treated with cognitive behavioral therapy and serotonin reuptake inhibitors.
important thing to note with anti-seizure medications.
need to monitor levels for therapeutic range for certain drugs and do not abruptly stop.
what is considered a seizure disorder?
2 or more seizures more than 24 hours apart without an underlying problem.
describe a tonic seizure.
Sudden onset of increased tone in muscles, with sudden stiffness that last 20 seconds, patients are usually aware.
indication of benzodiazepines and types.
Lorazepam, Midazolam, and Diazepam
Anticipate intubation for airway protection if patient requires multiple benzodiazepines.
describe status epilepticus (SE)?
continuous seizure activity (neurological emergency), lasts longer than 5 minutes/limited postictal time between each seizure, no return of consciousness between seizures, and occurs with any type of seizure.
name gaba analogs (2)
Gabapentin (Neurontin) and Pregabalin (Lyrica)
name known causes of seizures. Bonus points if you name other causes :)
usually stroke, brain tumors, cerebral infection, traumatic, brain injury, hypoxic birth injury, neurodevelopmental disorders, neurogenerative disease, and autoimmune diseases
bonus points if you name the following...
hypo/hyperglycemia, electrolyte imbalances (sodium, magnesium, calcium), eclampsia, lack of sleep, and alcohol withdrawal.
describe a clonic seizure.
Loss of awareness and sudden loss of muscle tone, followed by rhythmic limb jerking that may or may not be symmetric
patient teaching for seizures
Prevention is major goal, Medication compliance, and Teaching of drug side effects
what are the types of status epilepticus (SE)? (bonus points: what is the most common?)
Convulsive SE (most common), non-convulsive SE, super refractory SE, and subclinical seizures.
name hydantoins (2)
Phenytoin (Dilantin) and Fosphenytoin (Cerebyx)
what is the patho of seizures?
when a group of abnormal neurons fire without clear cause. could be release of neurotransmitters/absence of neuroinhibitory activity.
describe atonic seizure (drop attack).
Brief, sudden loss of tone. Results in patient falling to ground, usually only last a couple of seconds. Brief LOC and brief postictal confusion. Risk of head injury
what does treatment of SE require?
rapid acting antiseizure medication
diagnostics of seizures
H&P, CBC, CMP, UA, LP, CT, MRI, MRA, MRS, PET, and EEG
name iminostillbenes (2)
Carbamazepine and Oxcarbazepine
describe generalized/focal seizures and what it depends on? (bonus points: what are the 4 phases?)
depends on the site of electrical disturbance. Generalized onset can be around the brain, while focal onset in in particularly one spot.
(Further classified by motor/non motor and level of awareness)
bonus points:
Prodromal phase, Aural phase, Ictal phase, Postictal phase
describe absence seizures (petit mal)? (describe typical and atypical)
bonus points: which population does this often occur in?
typical: staring spell resembling daydreaming with sudden recovery. 10-20 seconds and often unnoticed.
atypical: staring spell w/other signs and symptoms (eye blinking, jerking movements of lips, repetitive finger movements). Often lasts as much as 30 seconds, with gradual beginning and end.
bonus points: occurs most often in children
references?
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C., (2023).
Lewis's medical-surgical nursing: Assessment and management
of clinical problems (12th Edition). Elsevier.
emergency management of seizures.
bonus points: for specific management
abc's, protect pt from injury, do not restrain, pad side rails, nothing in pt mouth, remove or loosen tight clothing, stay with pt until symptoms pass, anticipate antiseizure meds, keep suction as needed, monitor vitals, GCS, pupil size/reactivity, IV dextrose for hypoglycemia, maintain NPO until awake with gag reflex.
bonus points: assist ventilations if patient apneic, anticipate intubation.
name miscellaneous anti-seizure drugs (5)
Clonazepam, Divalproex (Depakote), Lacosamide (Vimpat), Levetiracetam (Keppra), and Valporic acid