Professional Documents
Culture Documents
Seizures can occur in anyone (children and adults) due to a severe acute
condition, such as a high fever, illness (especially central nervous system types
like bacterial meningitis), hypoglycemia, acid-base imbalances like acidosis,
alcohol withdraw, brain tumor etc. Once the condition is corrected the seizures
tend to stop.
In the brain, our neurons are tasked with handling and transmitting
information. There are two types of neurons I want to discuss. These are
excitatory and inhibitory neurons.
***For seizure activity not to occur in a healthy brain, there needs to be a proper
balance between these two types of neurons. If there is an imbalance of
excitatory neurons vs. inhibitory neurons seizures will occur. For example, if there
is not enough GABA (remember this is the inhibitory neurotransmitter) being
released, too much excitation will occur leading to seizure activity.
The reason I cover this is to help you understand how some of the anti-
seizure drugs work to treat seizures. For instance, barbiturates stimulate
GABA receptors which help control excitation and decreases seizure activity
(more about medications below).
Types of Seizures
◦ It will be like the child is just daydreaming but can’t be snapped out
of it….can go unnoticed by others for a while because it short and
the child won’t remember it. The person will look confused and won’t
be able to talk during the even.
• Very short…..seconds
• “A” means without and when you put the word tonic after it the meaning
is: WITHOUT MUSCLE TONE
◦ The patient goes limp and falls if standing or slumps over if sitting…
at risk for head injury (may need helmet)
Myoclonic:
• Patient usually aware and conscious (this is what makes it different from a
clonic seizure)
Two types: know the main differences which is that with focal onset aware
(simple partial) the patient is AWARE of their surroundings but with focal
impaired awareness (complex partial) the patient is NOT aware of their
surroundings AND will have motor symptoms called automatisms.
• Also sometimes called an aura too because it can happen right before
focal impaired awareness (complex partial)
We can divide how a person experiences a seizure into stages (it varies
depending on the seizure type, so remember that)
• many times it gives the patient time to prepare self for seizure. As the
nurse (if you are present) help the patient lay down onto their side with a
pillow under the head.
• Symptoms vary among patients but can include: sudden weird smell or
taste, déjà vu feeling, feeling anxious like something bad is about to
happen, altered vision (lights or spots in vision) or hearing (hallucination
type sounds or increased ability to hear sounds), dizzy (different for every
person), inability to speak etc.
Post Ictus: (after the seizure) brain is going to rest and recover from the seizure
Assess risk factors for seizure (remember any patient can experience this if
any of the causes mentioned above are presenting…you want to be
prepared. If risk factors present initiate seizure precautions:
◦ remove objects that can cause injury (remove any restrictive clothing
or items the patient may be wearing….eye glasses etc. )
Assess if your patient has a history of seizures in the past and if so what
type of seizure, ask if the patient experiences prodromal signs and symptoms or
an aura before the seizure, how long does the seizure last?
• gently lying the patient down and turning them onto their side. WHY? This
helps prevent the tongue from covering the airway and helps saliva and
blood drain from the mouth.
• DO NOT restrain patient or try to hold the patient down
• Protect their head and extremities (pillow and bed pads will help with this)
• Remove anything that can impede breathing or break (eye glasses, tight
clothing etc. ).
• When the seizure started what was the patient’s behavior right before
and during it? (did they cry out, become confused, report an aura,
become unconscious) and the characteristics of the body movements (if
any) presented at the beginning and throughout the seizure…..stiffening of
the whole body or just the extremities and then jerking or just jerking, was
it on just one side or both sides of the body….be sure to be as detailed as
possible…this helps the healthcare team determine what type of seizure
this was and what treatment may be needed
Note the time the seizure stopped and how the patient is behaving afterwards:
• Are they tired (let them sleep and rest), confused, can’t think or talk, have
a headache (ask where it is located and pain rating), has any injuries
(some patienst may bite their tongue or cheek)
• Maintain airway (suction, administer oxygen)
• If a tonic-clonic seizure, the patient will be very sleepy, won’t remember
what happened.
• Assess vital signs and neuro status: pupils, reflexes, is patient confused or
oriented
• Document and report it to the physician… is this your patient’s first seizure,
are they on anything for seizures (is drug level not therapeutic….may need
to draw a drug level if ordered by MD)
• Painless
“Stop Seizure”
Stress
Overexertion
Sleep depravation
Under medicated with seizure med (remind patient importance of taking and
coming to office visits to get drug levels drawn)
Recreational drugs
ETOH use
• 10 to 20 mcg/mL
• Reversal agent: Flumazenil (*used with extreme caution due to its risks)
Other treatments:
• Ketogenic diet (used in pediatric patient who have epilepsy): high fat, low
carb, diet….used when seizures not controlled by medication