Seizures (convulsions) are the result of uncontrolled electrical discharges from the nerve cells of the cerebral cortex
and are characterized by sudden, brief attacks of altered consciousness, motor activity, and/or sensory phenomena.
Seizures can be associated with a variety of cerebral or systemic disorders as a focal or generalized disturbance of
cortical function. Sensory symptoms arise from the parietal lobe; motor symptoms arise from the frontal lobe.
The phases of seizure activity are prodromal, aural, ictal, and postictal. The prodromal phase involves mood or
behavior changes that may precede a seizure by hours or days. Theaura is a premonition of impending seizure activity
and may be visual, auditory, or gustatory. The ictal stage is characterized by seizure activity, usually musculoskeletal.
The postictal stage is a period of confusion/somnolence/irritability that occurs after the seizure.
The main causes for seizures can be divided into six categories:
Toxic agents: Poisons, alcohol, overdoses of prescription/nonprescription drugs (with drugs the leading cause).
Chemical imbalances: Hyperkalemia, hypoglycemia, and acidosis.
Fever: Acute infections, heatstroke.
Seizures can be divided into two major classifications (generalized and partial). Generalized seizure types include tonic-clonic, myoclonic, clonic, tonic, atonic, and absence seizures. Partial (focal) seizures are the most common type and are categorized as either (1) simple (partial motor, partial sensory) or (2) complex.
Cerebrovascular accident (CVA)/stroke
Craniocerebral trauma (acute rehabilitative phase)
Psychosocial aspects of care
Substance dependence/abuse rehabilitation
Internal/external stressors related to condition and/or treatment
Irritability; sense of helplessness/hopelessness
Changes in relationships
aura in some cases and lasting minutes to hours
Presence of aura (stimulation of visual, auditory, hallucinogenic areas)
Postictal: Weakness, muscle pain, areas of paresthesia/paralysis
Tonic-clonic (grand mal): Rigidity and jerking posturing, vocalization, loss of consciousness, dilated pupils, stertorous respiration, excessive salivation (froth), fecal/urinary incontinence, and biting of the tongue may occur and last 2\u20135 min. Postictal phase: Patient sleeps 30 min to several hours, then may be weak, confused, and amnesic concerning the episode, with nausea and stiff, sore muscles
Absence (petit mal): Periods of altered awareness or consciousness (staring, fluttering of eyes) lasting 5\u201330 sec, which may occur as many as 100 times a day; minor motor seizures may be akinetic (loss of movement), myoclonic (repetitive motor contractions), or atonic (loss of muscle tone). Postictal phase: Amnesia for seizure events, no confusion, able to resume activity
Status epilepticus: Defined as 30 or more minutes of continuous generalized seizure activity or two or more sequential seizures without full recovery of consciousness in between, possibly related to abrupt withdrawal of anticonvulsants and other metabolic phenomena. If absence seizures are the pattern, problem may go undetected for a period of time because patient does not lose consciousness
Complex (psychomotor/temporal lobe): Patient generally remains conscious, with reactions such as dream state, staring, wandering, irritability, hallucinations, hostility, or fear. May display involuntary motor symptoms (lip smacking) and behaviors that appear purposeful but are inappropriate (automatism) and include impaired judgment and, on occasion, antisocial acts; lasts 1\u20133 min. Postictal phase: Absence of memory for these events, mild to moderate confusion
Simple (focal-motor/Jacksonian): Often preceded by aura (may report deja vu or fearful feeling); no loss of consciousness (unilateral) or loss of consciousness (bilateral); convulsive movements and temporary disturbance in part controlled by the brain region involved (e.g., frontal lobe [motor dysfunction], parietal [numbness, tingling], occipital [bright, flashing lights], posterotemporal [difficulty speaking]). Convulsions may march along limb or side of body in orderly progression. If restrained during seizure, patient may exhibit combative and uncooperative behavior; lasts seconds to minutes
Alteration in muscle tone
Familial history of epilepsy
Drug (including alcohol) use/misuse
Increased frequency of episodes/failure to improve
Complete blood count (CBC): Aplastic anemia may result from drug therapy.
Serum drug levels: To verify therapeutic range of antiepileptic drugs (AEDs).
Toxicology screen: Determines potentiating factors such as alcohol or other drug use.
Skull x-rays: Identifies presence of space-occupying lesions, fractures.
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