Neurological

disorders
Topic name : seizures and epilepsy
Presentation
Presented to: Madam Naila Shaheen
Presented by: Maryam Saleem
BSN 3rd prof.
College of Nursing, FJMU, Lahore
Lesson plan
Objectives Contents Time Method of Resources Evaluation
presentation
The student will
be able to:
 Define • Introduction • 3 min • Lecture • Multi media • Brainstormin
seizures and Method g
epilepsy • Define
 Describe
factors • Etiology • 3 min
leading to • Types of
seizures. seizures • 7min
 Explain
types and • Clinical • 5 min
sign/ manifestatio • Discussion • White board • Cross
symptoms of n Questioning
seizures
 Explain
diagnostic • Diagnostic
evaluation , evaluation • 3 min
medical • Medical and • 10min
management surgical • Discussion • Presentation • Tests
of seizures. management slides
 Explain
nursing
management
 Objectives
The students will be able to know about the:
● Introduction to seizures and epilepsy
● Definition of seizures and epilepsy
● Etiology and risk factors of epilepsy
● Pathophysiology of epilepsy/seizures
● Types of seizures
● Diagnostic evaluation for seizures/epilepsy
● Therapeutic management and treatment for seizures
● Nursing management for epilepsy
● Nursing care plan for seizures disorders
● References
 Table of contents
01. 02. 03.
About the disease Etiology Pathophysiology
Etiology and risk factors
Introduction to epilepsy Pathophysiology of
of epilepsy
Definition of epilepsy seizures and epilepsy

04. 05. 06.

Types &Diagnosis Treatment Nursing
management
Types &Diagnostic Pharmacological, medical
evaluation of seizures surgical therapy Nursing care for
epilepsy and nursing
care plan for seizures
 Introduction
Seizure is a “transient occurrence of signs
and/or symptoms due to abnormal excessive
and synchronous neuronal activity . Seizures
are the most common pediatric neurological
disorder. About 4 to 10 % of children will have at
least one seizure in first 16 years of life

The manifestation depends on the region of brain

in which they originate .
 Epilepsy
Definition
● Epilepsy is defined as two or more unprovoked seizures more than 24
hours apart and can be caused by a variety of pathologic processes”
● Single seizure is not classified as epilepsy and is generally not treated with
long-term antiepileptic drugs. Some seizures may result from an acute
medical or neurologic illness and cease after the illness is treated. In other
cases, children.
 Difference
Epilepsy:
Epilepsy is defined as two or more unprovoked seizures more than 24
hours apart and can be caused by a variety of pathologic processes in
the brain
Seizures:
Seizure is a “transient occurrence of signs and/or symptoms due to
abnormal excessive and synchronous neuronal activity
Not all that shakes Is epilepsy
 Etiology of seizures and epilepsy
Non recurrent (acute) Recurrent (chronic)

• Idiopathic epilepsy
• Febrile episodes • Epilepsy-sensory stimulus
• Intracranial infection • Epilepsy stimulating states such as
• Intracranial hemorrhage psychogenesis , narcolepsy
• Acute cerebral edema • Hypoglycemic states, hepatic
• Lesion, cyst disorders
• Anoxia • Uremia
• Toxins ,drugs,tatnus • Allergy
• Lead encephalopathy • Migraine , CVS dysfunction
• Shigella and salmonella • Epilepsy secondary to the;
• Metabolic alterations • Trauma, anoxia, infections
• Congenital defects
• Parasitic brain infection
Pathophysiology
Generalized seizures
Arise from the simulation
activation of neurons in
both hemispheres

Focal seizures
Seizures restricted to one
area of cerebral cortex

Unclassified seizures
Seizures that may begin in
localized area or spread to
other areas of brain
 Pathophysiology
● A seizure occurs when there is sudden excessive excitation and loss of
inhibition within neuronal circuits, allowing the circuits to amplify their
discharges simultaneously. These discharges occur in response to the activity
of sodium, potassium, calcium, and chloride ion channels. Normally these
discharges are restrained by inhibitory mechanisms. In response to
physiologic stimuli, such as brain injury or infection, genetic abnormalities,
severe hypoglycemia, electrolyte imbalance, sleep deprivation, and toxic
exposures, these abnormal neuronal discharges can spread to nearby cortex
and sub- cortical structures.
 Concepts and typology

Focal Generalized Clonic

Myoclonic Atonic Myoclonic

 Focal seizures
● Focal seizures may arise from any area of the cerebral cortex, but the
frontal, temporal, and parietal lobes are most often affected and are
characterized by localized motor symptoms; somatosensory, psychic, or
autonomic symptoms; or a combination of these. Focal seizures are
subdivided into three types:
1. Focal seizures without impaired awareness (formerly simple partial
seizures) Sensory symptoms that occur in one part of the brain and cause no
alteration of consciousness, often referred to as aura. Sometimes
accompanied by motor movements.
 Cont’….
2.Focal seizures with impaired awareness ( complex partial seizures) Sensory
and/or motor symptoms that result in a change or loss of consciousness.
3.Focal to bilateral tonic-clonic seizures (formerly simple or complex seizures
secondarily generalized)-Focal seizures with or without awareness that evolve
into generalized seizures, usually a tonic clonic.
● Focal seizures exhibit manifestation related to where they occur in the brain.
The postictal state (the period after a seizure) may be varied. The child may
be drowsy, be uncoordinated, have transient aphasia or confusion, and
display some sensory or motor impairment. Document neurologic changes.
Weakness, hypotonia, or inactivity of a body part may indicate an
epileptogenic focus in the corresponding contralateral cortical region.
 Generalized seizures
● Generalized seizures without a focal onset indicate that the initial
involvement is from both hemispheres. Loss of consciousness and
impairment of motor function occur from the outset. Unlike focal seizures
that become generalized, there is no aura. Seizures can occur at any time,
day or night. The interval between events may be minutes, hours, weeks, or
even years.
● 1.Tonic-clonic seizures. The generalized tonic-clonic seizure, formerly
known as grand mal, is the most dramatic of all seizure manifestations of
childhood. The seizure usually occurs without warning and consists of two
distinct phases: tonic and clonic. In the tonic phase the child stiffens, the
eyes roll upward, and the child loses consciousness. If standing, the child
falls to the ground.
 Types of generalized seizures
● In the clonic phase the tonic rigidity is replaced by intense jerking
movements as the trunk and extremities undergo rhythmic contractions and
relaxation. During this time the child cannot control oral secretions and may
be incontinent of urine and feces. As the seizure ends, the movements
become less intense and occur at less frequent intervals until they cease
entirely. The average clonic phase lasts 30 to 50 seconds.
● In the postictal phase the child may remain semiconscious and difficult to
arouse. The postictal phase can last 30 minutes to several hours . The child
may remain confused or sleep. He or she may have mild impairment of fine
motor movements, have visual and speech difficulties, and may vomit or
complain of headache.
 Types of generalized seizures
2.Absence seizures. Absence seizures, formerly called petit mal, are
generalized seizures. They have a sudden onset and are characterized by a brief
loss of awareness, a blank stare, and automatisms. Absence seizures are divided
into typical and atypical. These seizures almost always first appear during
childhood, usually between the ages of 5 to 8 years, oftenly stops over teenage
years. Hyperventilation and photic stimulations are potent precipitators of
absence seizures
3.Atonic seizures are sudden, momentary, total loss of muscle tone. Onset is
usually between 2 and 5 years of age. The child losses consciousness, suddenly
falls and after a few seconds gets up like nothing happened.
 Types of generalized seizures..
● 4.Myoclonic seizures: myoclonic seizures are characterized by sudden,
brief, shock like movements of a muscle or group of muscles. The seizures
may involve only the face and trunk or 5 to one or more extremities. They
may occur singly or repetitively. The seizures may or may not be symmetric.
Myoclonic seizures often occur in combination with other seizure types.

● 5.Tonic seizures. Tonic seizures are characterized by a sudden be onset of

increased tone. The child falls if standing. The child may involuntarily cry
out because of contraction of the respiratory and abdominal muscles. Tonic
seizures are longer than myoclonic seizures, with an average duration of 10
seconds. Postictal confusion, tiredness, headache are common.
 Cont’…
6.Clonic seizures.
Clonic seizures are characterized by loss of consciousness and
decreased tone followed by jerking movements of the extremities. These
movements may be more predominant in one extremity. The duration is
typically from 1 to several minutes and may be followed by a rapid recovery or
may have a period of postictal confusion.
 Clinical manifestation/ Symptoms

Seizures Amnesia
Localized motor , Inability to respond,
somatosensory, psychotic, impaired consciousness
symptoms

Loss of Stiffening of muscles

consciousness Maybe myoclonic, tonic or
Aura may or may not be Clonic
present
 Focal seizures
Focal seizures :
● Drowsiness
● Uncoordinated movements
● Having transient aphasia or confusion
● Sensory and motor impairment, hypotonia
● Numbness , tingling, paresthesia
● Altered behavior, amnesia, altered behavior
● Jacksonian march –rare in children
● Tonic-colonic movements , aversive seizures
● Generalized seizures
Generalized seizures
● Eyes rolled upward
● Immediate loss of consciousness
● If standing, falls to floor or ground • Stiffens in generalized,
symmetric tonic contraction of entire body musculature
● • Arms usually flexed Legs, head, and neck extended
● May utter a peculiar piercing cry
● Apneic, may become cyanotic
● Increased salivation and loss of swallowing reflex
● Violent jerking movements as the trunk and extremities undergo
rhythmic
● contraction and relaxation
● May foam at the mouth May be incontinent of urine and faces
 Diagnosis

01. How fast the episode started Pattern of starting a seizur

02. Abnormal muscle movements Types of abnormal muscle

movements

03. How long it lasted How long it lasts?

How quickly the person

04. recovered
Recovery after seizure
 Diagnosis
● A thorough medical history
● A complete physical and neurological examination
● Family history
● Developmental assessment of language, learning, behavior, development
and motor abilities
● EEG and aEEG ( amplitude integrated –electroencephalography
● Laboratory studies including WBC count, blood glucose measurements .
● Serum electrolytes, blood urea nitrogen, calcium, serum amino acids,
lactate, ammonia, and urine organic acids
● MRI
● CT scan
 Management

Drug therapy Surgical therapy Medical therapy

It’s the closest planet to Venus has a beautiful Despite being red, Mars is
the Sun and the smallest name and is the second actually a cold place. It’s
in the Solar System planet from the Sun full of iron oxide dust
 Treatment
01.
Drugs to control seizures
02.
Epileptics and anticonvulsants are used to
treat epilepsy and seizures Surgery if drugs are ineffective

Surgery is intended based on the cause of

the seizure.
 Drug therapy
● The primary therapy for epilepsy is the administration of the appropriate
antiepileptic drug or combination of drugs in a dosage that provides the
desired effect without causing adverse side effects or toxicity. Antiepileptic
drugs are believed to exert their effect primarily by reducing the
responsiveness of neurons to the sudden, high-frequency nerve impulses that
arise in the epileptogenic focus. Thus the seizure is effectively suppressed.
● The initiation of anticonvulsant therapy is based on several factors,
including the child’s age, type of seizure, risk of recurrence, and other
comorbid or predisposing medical issues. For children who develop
recurrent seizures or epilepsy, treatment is begun with a single drug known
to be effective for the child’s seizure type and have the lowest risk of
adverse side effects.
 Drugs used for seizures
● The dosage is gradually increased until the seizures are controlled. If a child
develops intolerable side effects, the medication is stopped and another one
is tried. Some anticonvulsant and epileptics are given below
● Levetiracetam
● Phenytoin
● Carbamazepine, Phenobarbitone are antiepileptic's
● Clonazepam, lamotrigine, and divalproex; topiramate, gabapentin, and
Levetiracetam are some anticonvulsants that are most commonly prescribed
by neurologists
 Medical therapy
Ketogenic Diet
● The ketogenic diet is a high-fat, very-low-carbohydrate, and adequate-
protein diet that has shown effectiveness for treatment of epilepsy. It is also
the first-line treatment for certain metabolic disorders, including pyruvate
dehydrogenase deficiency, glucose transporter type 1 deficiency.
● A liquid formula is available for children who can’t take solid foods
● The diet is deficient in nutrients and vitamins , minerals; this it is necessary
to take vitamin and mineral supplements
● Vagus nerve stimulation
● It is another useful method to treat epilepsy, through stimulating the vagus
nerve (CNX).done through a programmable signal generator.
 Surgical therapy
When seizures are caused by a hematoma, vascular malformation. Tumor, or other cerebral
lesion, surgical removal is usually recommended. Epilepsy surgery is the most effective
treatment for children with medically refractory epilepsy due to focal cortical dysplasia and
mesial temporal sclerosis. About 80% of these patients will be seizure free 4 years after
surgery .
● Epilepsy surgery does not always eliminate the need for antiepileptic drug therapy.
The goal is to improve seizure control without worsening or producing serious
deficits. Some children will see improvements in their cognition, behavior, and quality
of life .Types of surgeries include focal resection of the epileptogenic focus, functional
hemispherectomy, and corpus callosotomy, which severs the connection between the
hemispheres.
 Nursing management
● A important nursing responsibility is to observe the seizure episode accurately
document the events. Record and note any alterations behavior preceding the seizure
and the characteristics of the episode, such as sensory-hallucinatory phenomena (e.g.,
an aura), motor effects, alterations in consciousness, , and postictal state.
● The nurse should describe only what is observed rather than try to label a seizure
type. Note the time that the seizure began and the duration of the seizure.
● Any unusual behavior, even seemingly inconsequential, such as a momentary
interruption of activity, staring, or mental blankness, should be described. The more
detailed.
 Nursing management…
● Suctioning of the oral cavity and posterior oropharynx may be necessary.
● Take vital signs and allow the child to rest.
● When feasible, the child is integrated into the environment as soon as
possible.
● Sending a child with a chronic seizure disorder home from school is not
necessary unless requested by the parents.
● Always be aware of the patient’s Activity and movement .
● Prevention from choking and aspiration is most important during a seizure.
 Nursing care plan for seizures
Assessment Diagnosis Planning Intervention Evaluation

Subjective • Risk for • After 8 Explore with • After 8

data: fall/ injury hours of the patient the hours of
Suddenly my related to nursing various stimuli nursing
daughter loss of interventio that may interventio
started large ns, the precipitate ns, the
shaking muscle patient will seizure patient was
uncontrollably) coordinatio demonstrat activity. Keep able to
as verbalized n. e padded side demonstrat
by the mother. behaviors, rails up with e
OBJECTIVE: lifestyle bed in the behaviors,
Weakness changes to lowest lifestyle
Facial grimace reduce risk position. changes to
Irritability factors and Maintain strict reduce risk
protect self bed rest if factors and
Vital signs are from injury. prodromal protect self
stable signs or aura from injury.
experienced.
Epilepsy may be hard to
live with but it’s how ,You
deal with it that can make
all the difference
@epilepsybeingstronger
 70% 10 years
Of people can eventually stop taking medication Epilectic seizures are considered resolved

5 minutes 50 M
Seizures requiring emergency treatment People suffer from epilepsy in the world
 “Don’t hide!
Talk about
your epilepsy, ask questions, and tell YOUR
STORY”

“Heather”
 Conclusions

“Epilepsy seizures are neurological

disorders caused by different
etiological factors. Epilepsy can be
cured if diagnosed early, depending
on its cause , through medicines or
surgery. “
 Question:
Q. Write down the etiology/risk factors of seizures.

( Wong’s essential of pediatrics nursing 10 th edition,

unit11,ch# 27,pg no #911)
 MCQ’s :
1.Seizures can be caused by:

A. Brain injury that left scar tissue or other damage

B. Infection that left scar tissue in or caused other damage to the brain

C. Exposure to a toxic substance

D. Gene that does not work correctly

E. All of the above

2. Epilepsy is most likely to begin in which age group?

A. Early childhood
B. Adolescence
C. Middle age
D. Age over 65
E. A, B and D
 References

1. Hockenberry, Marilyn J., and David Wilson. Wong’s Essentials of

Pediatric Nursing. 10th ed. St. Louis, MO: Mosby/Elsevier, 2012,
(pg#911…914)

2. https://www.livescience.com/48817-light-therapy-stops-seizures.html