An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of

"abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as
dramatic as a wild thrashing movement (tonic-clonic seizure) or as mild as a brief loss of
awareness. It can manifest as an alteration in mental state, tonic or clonic movements,
convulsions, and various other psychic symptoms (such as déjà vu or jamais vu). Sometimes it is
not accompanied by convulsions but a full body "slump", where the person simply will lose
control of their body and slump to the ground. The medical syndrome of recurrent, unprovoked
seizures is termed epilepsy, but seizures can occur in people who do not have epilepsy.

About 4% of people will have an unprovoked seizure by the age of 80 and yet the chance of
experiencing a second seizure is between 30% and 50%. Treatment may reduce the chance of a
second one by as much as half. Most single episode seizures are managed by primary care
physicians (emergency or general practitioners), whereas investigation and management of
ongoing epilepsy is usually by neurologists. Difficult-to-manage epilepsy may require
consultation with an epileptologist, a neurologist with an interest in epilepsy.

Classification
Seizure types are organized according to whether the source of the seizure within the brain is
localized (partial or focal onset seizures) or distributed (generalized seizures). Partial seizures
are further divided on the extent to which consciousness is affected (simple partial seizures and
complex partial seizures). If consciousness is unaffected, then it is a simple partial seizure;
otherwise it is a complex partial seizure. A partial seizure may spread within the brain—a
process known as secondary generalization. Generalized seizures are divided according to the
effect on the body, but all involve loss of consciousness. These include absence, myoclonic,
clonic, tonic, tonic–clonic, and atonic seizures. A mixed seizure is defined as the existence of
both generalized and partial seizures in the same patient.

Following standardization proposals published in 1970, out-dated terms such as "petit mal",
"grand mal", "Jacksonian", "psychomotor", and "temporal-lobe seizure" have fallen into disuse.

Signs and symptoms

Seizures can cause involuntary changes in body movement or function, sensation, awareness, or
behavior. Seizures are often associated with a sudden and involuntary contraction of a group of
muscles and loss of consciousness. However, a seizure can also be as subtle as a fleeting
numbness of a part of the body, a brief or long term loss of memory, visual changes,
sensing/discharging of an unpleasant odor, a strange epigastric sensation, or a sensation of fear
and total state of confusion. A seizure can last from a few seconds to status epilepticus, a
continuous seizure that will not stop without intervention. Therefore seizures are typically
classified as motor, sensory, autonomic, emotional or cognitive. After a seizure, while the brain
is recovering, there can be a transient loss of memory; usually the short term memory.[citation needed]
In some cases, the full onset of a seizure event is preceded by some of the sensations described
above. These sensations can serve as a warning to the sufferer that a generalized tonic–clonic
seizure is about to occur. These "warning sensations" are cumulatively called an aura. Also, it is
commonly believed among healthcare providers[citation needed] that many seizures, especially those
in children, are preceded by tachycardia that frequently persists throughout the seizure. This
early increase in heart rate may supplement an aura as a physiological warning sign of an
imminent seizure.

Some patients are able to tell when a seizure is about to happen. Some symptoms experienced by
the person before a seizure may include dizziness, lightheadedness, tightening of the chest, and
some experience things in slow-motion just prior to the seizure. Symptoms experienced by a
person during a seizure depend on where in the brain the disturbance in electrical activity occurs.
Partial and frontal seizures and focal epileptic discharges tend to happen more during sleep than
during wakefulness. In contrast, psychogenic nonepileptic seizures are rare between midnight
and 6 a m. and never occurred during sleep.[5] Generalized epilepsy but not focal epilepsy is
higher in the morning probably reflecting a diurnal variation in cortical excitability.[6] A person
having a tonic–clonic seizure may cry out, lose consciousness and fall to the ground, and
convulse, often violently. A person having a complex partial seizure may appear confused or
dazed and will not be able to respond to questions or direction. Some people have seizures that
are not noticeable to others. Sometimes, the only clue that a person is having an absence seizure
is rapid blinking, extreme confusion for a few seconds or sometimes into hours.[citation needed]

Causes
Unprovoked seizures are often associated with epilepsy and related seizure disorders.

Causes of provoked seizures include:

 sleep deprivation
 cavernoma or cavernous malformation is a treatable medical condition that can cause
seizures, headaches, and brain hemorrhages. An MRI can quickly confirm or reject this as
a cause.
 arteriovenous malformation (AVM) is a treatable medical condition that can cause
seizures, headaches, and brain hemorrhages. An MRI can quickly confirm or reject this as
a cause.
 head injury may cause non-epileptic post-traumatic seizures or post-traumatic epilepsy, in
which the seizures chronically recur.
 intoxication with drugs
 drug toxicity, for example aminophylline or local anaesthetics
 normal doses of certain drugs that lower the seizure threshold, such as tricyclic
antidepressants
 infection, such as encephalitis or meningitis
 fever leading to febrile convulsions (but see above)
 metabolic disturbances, such as hypoglycaemia, hyponatremia or hypoxia
 withdrawal from drugs (anticonvulsants, antidepressants, and sedatives such as alcohol,
barbiturates, and benzodiazepines,)
  space-occupying lesions in the brain (abscesses, tumors)
 seizures during (or shortly after) pregnancy can be a sign of eclampsia.
 seizures in a person with hydrocephalus may indicate severe shunt failure.
 binaural beat brainwave entrainment may trigger seizures in both epileptics and non-
epileptics
 haemorrhagic stroke can occasionally present with seizures, embolic strokes generally do
not (though epilepsy is a common later complication); cerebral venous sinus thrombosis,
a rare type of stroke, is more likely to be accompanied by seizures than other types of
stroke
 multiple sclerosis sufferers may rarely experience seizures

Some medications produce an increased risk of seizures and electroconvulsive therapy (ECT)
deliberately sets out to induce a seizure for the treatment of major depression. Many seizures
have unknown causes.

Seizures which are provoked are not associated with epilepsy, and people who experience such
seizures are normally not diagnosed with epilepsy. However, the seizures described above
resemble those of epilepsy both outwardly, and on EEG testing.

Seizures can occur after a subject witnesses a traumatic event. This type of seizure is known as a
psychogenic non-epileptic seizure and is related to posttraumatic stress disorder.

Mild seizures can be induced through a combination of quickly standing, hyperventilation and
applying pressure to the sternum.

Diagnosis
Only about 25 percent of people who have a seizure or develop status epilepticus have epilepsy.
It is important to distinguish primary epileptic seizures from secondary causes. Blood tests,
lumbar puncture or toxicology screening can be helpful in specific circumstances suggestive of
an underlying cause like alcohol or benzodiazepine withdrawal, meningitis or drug overdose, but
there is insufficient evidence to support their routine use in the work-up of an adult with an
apparently unprovoked first seizure. A 2007 evidence-based review from the American Academy
of Neurology and the American Epilepsy Society recommends an electroencephalogram (EEG,
brain wave activity) and brain imaging with CT scan or MRI scan in the work-up. MRI is more
sensitive in a first apparently unprovoked seizure.

Differentiating an epileptic seizure from other conditions such as syncope can be difficult. A
reliable description of a witnessed seizure is the most important factor in determining whether a
seizure has occurred.

Physical examination

Most patients are in a post-ictal state following a seizure. In this state they are drowsy and often
confused. There may be signs of other injuries. A small study found that finding a bite to the side
of the tongue was very helpful when present: while only a quarter of those with seizures had
such a bite (sensitivity of 24%), the finding was very specific for seizures, with only 1% due to
other causes (specificity of 99%).

Serum prolactin level

Two meta-analyses have quantified the role of an elevated serum prolactin. The first meta-
analysis found that[: "If a serum prolactin concentration is greater than three times the baseline
when taken within one hour of syncope, then in the absence of test "modifiers":

1. the patient is nine times more likely to have suffered a GTCS as compared with a
pseudoseizure positive LR = 8.92 (95% CI (1.31 to 60.91)), SN = 0.62 (95% CI (0.40 to
0.83)), SP = 0.89 (95% CI (0.60 to 0.98))
2. five times more likely to have suffered a GTCS as compared with non-convulsive
syncope positive LR 4.60 (95% CI (1.25 to 16.90)), SN = 0.71 (95% CI (0.49 to 0.87)),
SP = 0.85 (95% CI (0.55 to 0.98)). "

The second meta-analysis found:

1. "Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10
to 20 minutes after a suspected event, is a useful adjunct for the differentiation of
generalized tonic-clonic or complex partial seizure from psychogenic nonepileptic
seizure among adults and older children (Level B)."
2. "Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B).
3. "The use of serum PRL assay has not been established in the evaluation of status"
epilepticus, repetitive seizures, and neonatal seizures (Level U)."

The serum prolactin level is less sensitive for detecting partial seizures.

EEG

An isolated abnormal electrical activity recorded by an electroencephalography examination

without a clinical presentation is called subclinical seizure. They can identify background
epileptogenic activity, as well as help identify causes of seizures.

[edit] Investigation of underlying cause

Additional diagnostic methods include CT Scanning and MRI imaging or angiography. These
may show structural lesions within the brain and heart, but the majority of those with epilepsy
show nothing unusual.

As seizures have a differential diagnosis, it is common for patients to be simultaneously

investigated for cardiac and endocrine causes. Checking glucose levels, for example, is a
mandatory action in the management of seizures as hypoglycemia may cause seizures, and
failure to administer glucose would be harmful to the patient. Other causes typically considered
are syncope and cardiac arrhythmias, and occasionally panic attacks and cataplexy. In addition,
5% of patients with a positive tilt table test may have seizure-like activity that seems to be due to
cerebral hypoxia.. For more information, see non-epileptic seizures.

Management
The first aid for a seizure depends on the type of seizure occurring. Generalized seizures will
cause the person to fall, which may result in injury. A tonic–clonic seizure results in violent
movements that cannot and should not be suppressed. The person should never be restrained, nor
should there be any attempt to put something in the mouth. Potentially sharp or dangerous
objects should also be moved from the vicinity, so that the individual is not hurt. After the
seizure if the person is not fully conscious and alert, they should be placed in the recovery
position. Bystanders should remain calm and avoid crowding the person.

It is not necessary to call an ambulance if the person is known to have epilepsy, if the seizure is
shorter than five minutes and is typical for them, if it is not immediately followed by another
seizure, and if the person is uninjured. Otherwise, or if in any doubt, medical assistance should
be sought.

A seizure longer than five minutes is a medical emergency. Relatives and other caregivers of
those known to have epilepsy often carry medicine such as rectal diazepam or buccal midazolam
in order to rapidly end the seizure.

Safety

A sudden fall can lead to broken bones and other injuries. Children who are affected by frequent
drop seizures may wear helmets to protect the head during a fall.

The unusual behavior resulting from the chaotic brain activity of a seizure can be misinterpreted
as an aggressive act. This may invoke a hostile response or police involvement, where there was
no intention to cause harm or trouble.

A seizure response dog can be trained to summon help or ensure personal safety when a seizure
occurs. These are not suitable for everybody. Rarely, a dog may develop the ability to sense a
seizure before it occurs.

See also
 Epilepsy
 Epileptogenesis
 Photosensitive epilepsy
 Psychogenic non-epileptic seizures
 EPUNA or episode of unusual neurological activity
 Postictal state
 Seizure trigger
 Seizure prediction
Seizures

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal
electrical activity in the brain.

See also:

 Generalized tonic clonic seizureGeneralized tonic clonic seizure

 Partial (focal) seizurePartial (focal) seizure
 Petit mal (absence) seizurePetit mal (absence) seizure
 EpilepsyEpilepsy
 Fever (febrile) convulsionsFever (febrile) convulsions (seizures in children with high fever)

Considerations

Considerations

There are a wide variety of possible symptoms of seizures, depending on what parts of the brain
are involved. Many, if not all, types of seizures cause loss of awareness and some cause
twitching or shaking of the body.

However, some seizures may be hard to notice because they consist of staring spells that can
easily go unnoticed. Occasionally, seizures can cause temporary changes in sensation or vision.

Symptoms of seizures come on suddenly, over just seconds to a minute, and may include:

 Change in consciousness, so that you can't remember some period of time

 Change in emotion, like unexplainable fear, panic, joy, or laughter
 Change in sensation of the skin, usually spreading over the arm, leg, or trunk
 Changes in vision, including flashing lights, or (rarely) hallucinations (seeing things that aren't
there)
 Loss of muscle control and falling, often very suddenly
 Muscle movement such as twitching that might spread up or down an arm or leg
 Muscle tension/tightening that causes twisting of the body, head, arms, or legs
 Tasting a bitter or metallic flavor

Symptoms may stop after a few minutes, or continue for 15 minutes. They rarely continue
longer.

Shaking of the entire body when it occurs should last a few minutes and stop within 5 minutes.
Causes

Causes

A seizure may be related to a temporary condition, such as exposure to drugs, withdrawal from
certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the repeated
seizures do not happen again once the underlying problem is corrected, the person does not have
epilepsy.

In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be
abnormally excited.

In some people, a problem that is passed down through families (inherited) affects nerve cells in
the brain, which leads to seizures. In these cases, the seizures happen spontaneously, without an
immediate cause, and repeat over time. This is epilepsy.

Idiopathic seizures are chronic seizures that occur without an identifiable cause. They usually
begin between ages 5 and 20, but can occur at any age. The person can have a family history of
epilepsy or seizures.

Other more common causes of seizures include:

 Tumors (such as brain tumorbrain tumor) or other structural brain lesions (such as bleeding in
the brain)
 Traumatic brain injury, stroke, or a transient ischemic attack (TIA)
 Stopping alcohol after drinking heavily on most days
 Illnesses that cause the brain to deteriorate
 Dementia such as Alzheimer's disease
 Problems that are present from before birth (congenital brain defects)
 Injuries to the brain that occur during labor or at the time of birth
 Low blood sugar or sodium levels in the blood
 Kidney or liver failure
 Use of cocaine, amphetamines, or certain other recreational drugs
 Stopping certain drugs, such as barbiturates, painkillers (morphine, gabapentin) and sleeping
pills, after taking them for a period of time
 Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)
 Phenylketonuria (PKU), which can cause seizures in infants

Home Care

Home Care

If someone who has never had a seizure before has one, call 911 or your local emergency
number immediately.

Persons with epilepsyepilepsy should always wear a medical alert tag.

Most seizures stop by themselves. However, a person having a generalized seizure may be
injured; breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a
generalized seizure, it is important to protect the person from injury. Turn the person on the side,
so that any vomit leaves the body and does not enter the lungs. See: Seizure first aidSeizure first
aid

After a generalized seizure, most people go into a deep sleep. Do not prevent the person from
sleeping. The person will probably be disoriented, or possibly agitated for awhile after
awakening.

EMERGENCY FIRST AID

 Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the
teeth. You can cause more damage than you can prevent.
 Do not try to hold the person down during the seizure.
 Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping
after the seizure is over.
 If the person having a seizure turns blue or stops breathing, try to position their head to prevent
their tongue from blocking their airways. Breathing usually starts on its own once the seizure is
over.
 CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed
during the seizure.

If a person has repeated or prolonged seizures without regaining consciousness or returning to

normal behavior, the body may develop a severe lack of oxygen. This is an emergency situation.
Seek immediate medical help.

AFTER THE SEIZURE

Treat any injuries from bumps or falls. Record details of the seizure to report to the person's
primary health care provider. You should note the following details:

 How long it lasted

 What body parts were affected
 Type of movements or other symptoms
 Possible causes
 How the person behaved after the seizure

When to Contact a Medical Professional

When to Contact a Medical Professional

If this is the first time someone has ever had a seizure, or if this is an unusually long seizure in
someone who has a seizure disorder, call 911 or your local emergency number immediately.
These symptoms can be caused by life-threatening conditions, such as a stroke or meningitis.
Report all seizures (even a mild one) to the health care provider. If the person is known to have
epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted
or other instructions given.

What to Expect at Your Office Visit

What to Expect at Your Office Visit

Often, a person who has had a new or severe seizure will be seen in an emergency room, rather
than a doctor's office.

The health care provider will try to diagnose the type of seizure based on the symptoms.

Other medical conditions that can cause a seizure or similar symptoms will be ruled out.
Disorders that may cause similar symptoms include fainting, TIA or stroke, rage or panic attacks,
migraine headaches, sleep disturbances, and conditions that cause loss of consciousness.

The following tests may be done:

 Blood tests
 CT scan of the headCT scan of the head or MRI of the headMRI of the head
 EEGEEG (usually not in the emergency room)
 Lumbar punctureLumbar puncture (also called a spinal tap)

The need for further tests or treatment depends on a number of factors.

 A single seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating or
avoiding that trigger.
 A new seizure without an obvious trigger will require further testing and possible treatment.
 A seizure in a person with known epilepsy will require tests to make sure the patient is taking
the correct dose of their medicines. A possible change in medicines may be needed.

Prevention

Prevention

Instructions for taking any prescribed medications should be strictly followed. Family members
should observe and record any seizure information to make sure the person gets proper
treatment.

Good health habits may help to control seizures. Because sleep deprivation, stress, and a poor
diet can contribute to increased seizures, good sleep habits, stress reduction, proper exercise, and
sound nutrition may help.

There is no specific way to prevent all seizures. Use helmets when appropriate to prevent head
injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid
recreational drugs. People with epilepsy should take medication as directed and avoid excessive
amounts of alcohol.

People with uncontrolled seizures should not drive. Each state has a different law that determines
which people with a history of seizures are allowed to drive. People with uncontrolled seizures
also should avoid activities where loss of awareness would cause great danger, such as climbing
to high places, biking, and swimming alone.

2.11.2007
NCP Seizure Disorders

digg

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. The aura 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.

Cerebral pathology: Resulting from head injury, infections, hypoxia, expanding brain lesions, increased
intracranial pressure.

Eclampsia: Prenatal hypertension/toxemia of pregnancy.

Idiopathic: Unknown origin.

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.

CARE SETTING

Community; however, may require brief inpatient care on a medical or subacute unit for
stabilization/treatment of status epilepticus.

RELATED CONCERNS

Cerebrovascular accident (CVA)/stroke

Craniocerebral trauma (acute rehabilitative phase)

Psychosocial aspects of care

Substance dependence/abuse rehabilitation

Patient Assessment Database

ACTIVITY/REST

May report: Fatigue, general weakness

Limitation of activities/occupation imposed by self/significant other (SO)/healthcare provider or others

May exhibit: Altered muscle tone/strength

Involuntary movement/contractions of muscles or muscle groups (generalized tonic-clonic seizures)

CIRCULATION

May exhibit: Ictal: Hypertension, increased pulse, cyanosis

Postictal: Vital signs normal or depressed with decreased pulse and respiration

EGO INTEGRITY

May report: Internal/external stressors related to condition and/or treatment

Irritability; sense of helplessness/hopelessness

Changes in relationships

May exhibit: Wide range of emotional responses

ELIMINATION

May report: Episodic incontinence

May exhibit: Ictal: Increased bladder pressure and sphincter tone

Postictal : Muscles relaxed, resulting in incontinence (urinary/fecal)

FOOD/FLUID

May report: Food sensitivity nausea/vomiting correlating with seizure activity

May exhibit: Dental/soft-tissue damage (injury during seizure)

Gingival hyperplasia (side effect of long-term phenytoin [Dilantin] use)

NEUROSENSORY

May report: History of headaches, recurring seizure activity, fainting, dizziness

History of head trauma, anoxia, cerebral infections

Prodromal phase: Vague changes in emotional reactivity or affective response preceding 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

May exhibit: Seizure characteristics: (ictal, postictal)

Generalized seizures:

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 2–5 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

Myoclonic: Short abrupt muscle contractions of arms, legs, torso; may not be symmetrical; lasts seconds

Clonic: Muscle contraction with relaxation resembling myoclonic movements but with slower
repetitions; may last several minutes

Tonic: Abrupt increase in muscle tone of torso/face, flexion of arms, extension of legs; lasts seconds

Atonic: Abrupt loss of muscle tone; lasts seconds; patient may fall

Absence (petit mal): Periods of altered awareness or consciousness (staring, fluttering of eyes) lasting 5–
30 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

Partial seizures:

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 1–3 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 fearfulfeeling); 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

PAIN/DISCOMFORT

May report: Headache, muscle/back soreness postictally

Paroxysmal abdominal pain during ictal phase (may occur during some partial/focal seizures without loss
of consciousness)

May exhibit: Guarding behavior

Alteration in muscle tone

Distraction behavior/restlessness

RESPIRATION

May exhibit: Ictal: Clenched teeth, cyanosis, decreased or rapid respirations; increased mucous
secretions

Postictal: Apnea

SAFETY

May report: History of accidental falls/injuries, fractures

Presence of allergies

May exhibit: Soft-tissue injury/ecchymosis

Decreased general strength/muscle tone

SOCIAL INTERACTION

May report: Problems with interpersonal relationships within family/socially

Limitation/avoidance of social contacts

TEACHING/LEARNING

May report: Familial history of epilepsy

Drug (including alcohol) use/misuse

Increased frequency of episodes/failure to improve

Discharge plan

DRG projected mean length of inpatient stay: 4.4 days

May require changes in medications, assistance with some homemaker/maintenance tasks relative to
issues of safety, and transportation

Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

Electrolytes: Imbalances may affect/predispose to seizure activity.

Glucose: Hypoglycemia may precipitate seizure activity.

Blood urea nitrogen (BUN): Elevation may potentiate seizure activity or may indicate nephrotoxicity
related to medication regimen.

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.

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
patients have 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 seizure activity (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 at site of lesion.

Single photon emission computed tomography (SPECT): May show local areas of brain dysfunction when
CT and MRI are normal.

Magnetoencephalogram: Maps the electrical impulses/potential of brain for abnormal discharge

patterns.

Lumbar puncture: Detects abnormal cerebrospinal fluid (CSF) pressure, signs of infections or bleeding
(i.e., subarachnoid, subdural hemorrhage) as a cause of seizure activity (rarely done).

Wada’s test: Determines hemispheric dominance (done as a presurgical evaluation before temporal
lobectomy).

NURSING PRIORITIES

1. Prevent/control seizure activity.

2. Protect patient from injury.
3. Maintain airway/respiratory function.
4. Promote positive self-esteem.
5. Provide information about disease process, prognosis, and treatment needs.

DISCHARGE GOALS

1. Seizures activity controlled.

2. Complications/injury prevented.
3. Capable/competent self-image displayed.
4. Disease process/prognosis, therapeutic regimen, and limitations understood.
5. Plan in place to meet needs after discharge.