Seizure Disorder: Presented By: Binisha Dahal M.SC Nursing 2 Year

SEIZURE DISORDER
PRESENTED BY : BINISHA DAHAL

M.SC NURSING 2nd
YEAR
Definition
• Seizures are the discrete , time limited
alterations in brain function including changes
in motor activity, autonomic function,
consciousness or sensation that results from an
abnormal and excessive electrical discharge of
a group of neurons within the brain.
• Seizure disorder includes disturbance of
brain’s electrical activity periodically resulting
in some degree of temporary brain dysfunction
• Electrical impulses enable the brain to

communicate with spinal cord , nerves and
muscles as well as within itself
• Epilepsy is a chronic disorder of recurrent

seizures
Cont’d……….
• An epilepsy syndrome consists of recurrent
episodes of one or more of the following
manifestations
 Loss of consciousness
 Convulsive movements or other motor activity
Incidence
• About 2.5 to 11.9 per 1000 population in
different parts of india.
• India is home to 10 million epileptics ,

accounting for one to fifth of global burden
Etiology
 Epilepsy occurs when permanent changes in
brain causes it to be too excited or irritable
 Severe birth injuries
 Congenital defects
 Infections
 Trauma
 Cerebrovascular disease
 Hypoxemia
 Childhood fever
Cont’d……
 HTN
 CNS infections
 Brain tumor
 Metabolic and toxic conditions( renal
failure,hypoglycemia,hypocalcemia)
 Alcohol and drug withdrawl
 Allergies
 Abnormal blood vessels in brain
Classification
1. Partial seizure
 Consciousness
 Alert  simple partial
 Altered  complex partial
2. Unclassified
3. Generalized
• Generalized toinc clonic seizure
Cont’d…….
• Absence seizure
• Myoclonic
• Tonic
• Clonic
• Atonic
Partial seizure (focal origin)
• These are the most common type of epilepsy.
The first clinical and electroencephalographic
changes indicate initial activation of neurons
in one part of cerebral hemisphere
1. Simple partial seizure
 No impairement of consciousness
 It has 4 types that do not impair consciouness
Motor manifestation
Somato sensory manifestation
Autonomic manifestations
Pyschic manifestations
Complex partial seizure
 Location of discharging focus is usually the
temporal lobe
 Also termed as temporal lobe seizure
 Usually lasts longer than 1 minute
 Lip smacking and automatism
 Feeling of dejavu
 Disorientations of visual or auditory sensations
Partial seizure
 These seizures starts from a particular focus
and then the electrical discharges spread
throughout the brain
 Consciousness is lost if the discharges spread

throughout the brain
Generalized seizures
 It involves both sides of the brain
characterized by synchronous epileptic
discharges from the brain
 No warning sign or aura as entire brain is

affected loss of consciousness for few seconds
to several minutes
Tonic – clonic seizure
• Most common generalized seizure
• Also known as grandmal seizure
• Characterized by :
 LOC
 Fall , if patient is upright
 Stiffening of body
 Excessive salivation
 Tongue and cheek biting
Absence seizure
 Occurs only in children
 Rarely continuous beyond adolesence
 Brief staring spell may go unnoticed
 If untreated may occur upto two times a day
 Can often be percipitated by hyperventilation
and flashing lights
Myoclonic seizures
 Sudden , excessive jerk of the body or
extremities
 Jerk may be forceful
 This seizure may be very brief
Tonic seizure
 These include an abrupt increase in muscular
tone and muscular contraction
 Loss of consciousness and the presence of
autonomic manifestations
 Tonic seizures may last from 30 seconds to
several minutes
Clonic seizure
 The clinical manifestations of clonic seizures
include rhythmic muscular contractions and
relaxations lasting several minutes
Atonic seizure
• It is associated with total loss of muscle tone
• The person may sudden fall
• Normal activity can be resume immediately
• Chances of head injury
• Consciousness is impaired
Pathophysiology
• Due to any etiological factors 
the intregity of the neuronal cell is altered 
the cell begins firing with increased frequency
and amplitude 
when intensity of the discharges reaches the
threshold the neuronal firing spreads to
adjacent neurons  ultimately resulting in
seizure
Clinical manifestations
• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms
and legs
• Odd sounds
• Odd secretions
• Visual hallucinations
• Muscles spasms
Phases of seizure
Prodeomal
Aural
Ictal
post ictal
Diagnostic evaluation
• History taking
• Physical examination
• EEG
• CT scan
• PET
• SPECT
• Other lab studies
Management
• Goals
 To prevent injury during seizures
 To eliminate factors that precipitate seizure
 To control seizure to allow a desired life style
During seizure
 To maintain the airway
 To prevent injury
Cont’d…..
 To observe seizure activity
 To administer appropriate anti convulsant
drugs
The durgs are
Gabapentin
Carbamezipine
Phenobarbitol
Phenytoin
Valporic acid
Cont’d ……
 Primidone
 Levietirractum
 Carbamazepine
 Phenobarbitol
 Valporic acid
Surgical management
 Resectioning of epileptogenic tissue
The epileptogenic tissue from frontal and
temporal origin are re sectioned
 Sectioning of corpus callosum

It is usually done in generalized seizure
Cont’d………
 Hemispherectomy
It is usually done on ittractable unilateral
multifocal epilepsy associated with infantile
hemiplasia
 Callostomy : full removal of corpous callosum

First Aid Management
• Ease the person to the floor
• Turn on the person gently onto one side.this
will help the person to breath.
• Clear the area around the person to avoid
anything sharp
• Cushion aid
• Remove eyeglasses
• Loosen the tight clothings
• Time the seizure with watch
• Look for his ID
DO NOT
• Do not Held the person to try to stop his
movement
• Do not put anything in person’s mouth. This
can injure teeth and jaws
• Do not try to give mouth to mouth breaths
• Do not offer food or water until he/she is fully
alert
Nursing management
• Assessment
 History taking and physical examination
 History of seizure
• How long did it last ?
• Where in the body did the seizure begin ?
• How did it progress ?
• Did the client’s eye or head deviated ?
• Was the client unconscious ?
• Parts of body involved ?
Diagnosis
Risk for injury related to seizure activity
Ineffective breathing pattern related to
neuromuscular impairment
Ineffective individual coping related stresses
imposed by epilepsy
Deficient knowledge related epilepsy and its
control
Fear related to possibility of seizure
Planning
 Control seizure activity
 Prevent complications and injury
 Make the patient understand about prognosis
therapeutic regimen and limitations understood
 Plan in place to meet needs after discharge
Interventions
 Prevent or control the seizure activity
 Prevent patient from injury
 Maintain airway or respiratory function
 Promote positive self esteem
 Provide information about the disseas ,
prognosis and treatment
 Monitoring and managing potential
complications
Cont’d
 Promoting home and community based care

 Educating the patient
 Continuing care
 Improving coping
Evaluation
 Expected outcomes
 Sustains no injury during seizure activity
 Decrease in fear
Health education
• Ketogenic diet (high in fats and proteins and
low in carbohydrates)
• Tell the patient to take medicine on regular
basis
• Adequate rest and sleep
• Avoid driving , operating machines, swimming
until seizures are well controlled
• Lead on active life
• Regular follow up
Complications
 Physical complications
 Status epilepticus
 Eclampsia
 Severe injury
 Even deaths
 Psychological complications
 Effects on patients lifestyle
 May develop ineffective coping
 Social stigma
 Discrimination in job and educational
opportunities.

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SEIZURE DISORDER

PRESENTED BY : BINISHA DAHAL

• Electrical impulses enable the brain to

• Epilepsy is a chronic disorder of recurrent

• India is home to 10 million epileptics ,

 Consciousness is lost if the discharges spread

 No warning sign or aura as entire brain is

 Sectioning of corpus callosum

 Callostomy : full removal of corpous callosum

 Promoting home and community based care

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