Headache, muscle/back soreness postictallyParoxysmal abdominal pain during ictal phase (may occur during some partial/focalseizures without loss of consciousness)
Guarding behavior Alteration in muscle toneDistraction behavior/restlessness
Ictal: Clenched teeth, cyanosis, decreased or rapid respirations; increased mucoussecretionsPostictal: Apnea
History of accidental falls/injuries, fracturesPresence of allergies
Soft-tissue injury/ecchymosisDecreased general strength/muscle tone
Problems with interpersonal relationships within family/sociallyLimitation/avoidance of social contacts
Familial history of epilepsyDrug (including alcohol) use/misuseIncreased frequency of episodes/failure to improve
DRG projected mean length of inpatient stay: 4.4 days
May require changes in medications, assistance with some homemaker/maintenance tasksrelative to issues of safety, and transportation
Refer to section at end of plan for postdischarge considerations.
Imbalances may affect/predispose to seizure activity.
Hypoglycemia may precipitate seizure activity.
Blood urea nitrogen (BUN):
Elevation may potentiate seizure activity or may indicate nephrotoxicity related tomedication regimen.
Complete blood count (CBC):
Aplastic anemia may result from drug therapy.
Serum drug levels:
To verify therapeutic range of antiepileptic drugs (AEDs).
Determines potentiating factors such as alcohol or other drug use.
Identifies presence of space-occupying lesions, fractures.
Electroencephalogram (EEG) may be done serially:
Locates area of cerebral dysfunction; measures brain activity.Brain waves take on characteristic spikes in each type of seizure activity; however, up to 40% of seizure patientshave normal EEGs because the paroxysmal abnormalities occur intermittently.
Video-EEG monitoring, 24 hours (video picture obtained at same time as EEG):
May identify exact focus of seizureactivity (advantage of repeated viewing of event with EEG recording).
Computed tomography (CT) scan:
Identifies localized cerebral lesions, infarcts, hematomas, cerebral edema, trauma,abscesses, tumor; can be done with or without contrast medium.
Magnetic resonance imaging (MRI):
Localizes focal lesions.
Positron emission tomography (PET):
Demonstrates metabolic alterations, e.g., decreased metabolism of glucose atsite of lesion.
Single photon emission computed tomography (SPECT):
May show local areas of brain dysfunction when CT andMRI are normal.
Maps the electrical impulses/potential of brain for abnormal discharge patterns.
Detects abnormal cerebrospinal fluid (CSF) pressure, signs of infections or bleeding (i.e.,subarachnoid, subdural hemorrhage) as a cause of seizure activity (rarely done).
Determines hemispheric dominance (done as a presurgical evaluation before temporal lobectomy).