CONVULSIVE DISORDER (CONVULSIONS)- disorder of the CNS char.

by paroxysmal seizures with or

without loss of consciousness; abnormal motor activity, alteration in sensation & perception & change in behavior.

Can you outgrow febrile seizure? Difference between: Seizure---- 1st convulsive attack

Febrile seizure: Normal if < 5 yo Epilepsy – 2nd and with history of seizure

Pathologic: if > 5 yo

Predisposing Factor

•Head injury due birth trauma

•Toxicity of carbon monoxide

•Brain tumor

•Genetics

•Nutritional & metabolic deficit

•Physical stress

• Sudden withdrawal to anticonvulsants will bring about status epilepticus

• Status epilepticus – drug of choice: Diazepam & glucose

 Types:
I. Generalized Seizure –
a.) Grand mal / tonic clonic seizures
With or without aura – warning symptoms of impending seizure
attack-
5. Epigastric pain- associated with olfactory, tactile, visual, auditory
sensory experience
6. Loss of consciousness 3 – 5 min
7. Tonic clonic contractions
8. Direct symmetrical extension of extremities-TONIC. Contractions-
CLONIC
9. Post ictal sleep -state of lethargy or drowsiness - unresponding
sleep after tonic clonic

b.) Petit mal seizure – (same as daydreaming!) or absent seizure.

- Blank stare
- Decrease blinking eye
- Twitching of mouth
- Loss of consciousness – 5 – 10 secs (quick & short)
II. Localized/partial seizure
•Jacksonian seizure or focal seizure – tingling/jerky
movement of index finger/thumb & spreads to shoulder &
1 sideof the body with jacksonian march

•Psychomotor/ focal motor - seizure

-Automatism – stereotype repetitive & non-purposive
behavior
- Clouding of consciousness – not in control with
environment
-Mild hallucinatory sensory experience

HALLUCINATIONS
•Auditory – schitzo – paranoid type
•Visual – korsakoffs psychosis – chronic alcoholism
•Tactile – addict – substance abuse
III. Status epilecticus – continuous,
uninterrupted seizure activity, if untreated, lead
to hyperprexia – coma – death

Seizure: inc electrical firing in

brain=increased metabolic activity in
brain=brain using glucose and O2=dec glucose,
dec O2.

Tx:Diazepam (drug of choice), glucose

Dx-Convulsion- get health history!
7.CT scan – brain lesion
8.EEG electroencephalography
•Hyperactive brain waves
Nsg Mgt
Priority – Airway & safety
3.Maintain patent a/w & promote safety
Before seizure:
1.Remove blunt/sharp objects
2.Loosen clothing
3.Avoid restraints
4.Maintain siderails
5.Turn head to side to prevent aspiration
6.Tongue guard or mouth piece to prevent biting of
tongue-BEFORE SEIZURE ONLY! Can use spoon at
home.
7.Avoid precipitating stimulus – bright glaring lights &
noises
8.Administer meds
 Administer meds:

3.Dilantin (Phenytoin) –( toxicity level – 20 )

SE: Gingival hyperplasia
H-hairy tongue
A-ataxia
N-nystagmus
A-acetaminophen- febrile pt
Mix with NSS
-Don’t give alcohol – lead to CNS depression

2. (Tegretol) Carbamasene- given also to Trigeminal

Neuralgia. SE: arrythmia

3. Phenobarbital (Luminal)- SE: hallucinations

2.Institute seizure & safety precaution.
Post seizure: Administer O2.
Suction apparatus ready at bedside

3. Monitor onset & duration

- Type of seizure
-Duration of post ictal sleep. The longer the duration of
post ictal sleep the higher chance of having status
epilepticus!

4. Assist in surgical procedure. Cortical resection.

5. Complications: Subarachnoid hemorrhage and

encephalitis
SPECIFICS
Types of Seizures
Seizures take many forms. Before your doctor can
prescribe the right treatment, he or she must figure out
which type (or types) you have.
 Epilepsy is a disorder characterized by transient but
recurrent disturbances of brain function that may or may not
be associated with impairment or loss of consciousness and
abnormal movements or behavior.
 There are so many kinds of seizures that neurologists
who specialize in epilepsy are still updating their thinking
about how to classify them.
Usually, they classify seizures into two types, primary
generalized seizures and partial seizures. The difference
between these types is in how they begin:
Primary generalized seizures
Primary generalized seizures begin with a
widespread electrical discharge that involves
both sides of the brain at once. Hereditary
factors are important in many of these seizures.

Partial seizures
Partial seizures begin with an electrical
discharge in one limited area of the brain. Some
are related to head injury, brain infection, stroke,
or tumor, but in most cases the cause is
unknown.
One question that is used to further classify partial seizures is
whether consciousness or unconsciousness or state of
awareness is present; if consciousness is preserved during a
seizure, the person can respond (either in words or actions,
such as raising a hand on command) and recall what occured
during the spell. Memory (the ability to respond and remember)
is "impaired" or "preserved." The difference may seem obvious,
but really there are many degrees of impairment or
preservation of consciousness.

Identifying certain seizure -sudden, excessive discharge of

nervous-system electrical activity that usually causes a change
in behavior and other characteristics of a person's epilepsy like
the age at which it begins, for instance, allows doctors to
classify some cases into epilepsy syndromes. This kind of
classification helps us to know how long the epilepsy will last
and the best way to treat it.
Primary Generalized Seizures

Absence seizures

Atypical absence seizures

Myoclonic seizures

Atonic seizures

Tonic seizures

Clonic seizures

Tonic-clonic seizures

Partial Seizures

Simple partial seizures

Complex partial seizures

Secondarily generalized seizures

1.Absence Seizures

What are they like?

Here's a typical story: Frank, a 7-year-old boy, often
"blanks out" anywhere from a few seconds to 20
seconds at a time. During a seizure, SeizureA
sudden, excessive discharge of nervous-system
electrical activity that usually causes a change in
behavior.Close Frank doesn't seem to hear his
teacher call his name, he usually blinks repetitively,
and his eyes may roll up a bit. During shorter
seizures, he just stares. Then he continues on as if
nothing happened. Some days Frank has more than
50 of these spells.
How long do they last?
Usually less than 10 seconds, but it can be as long as 20.
They begin and end suddenly.

Tell me more
Absence seizures are brief episodes of staring. (Although the
name looks like a regular English word, your neurologist may
pronounce it ab-SAWNTZ.) Another name for them is petit mal
(PET-ee mahl).
During the seizure, awareness and responsiveness are
impaired.
 People who have them usually don't realize when they've
had one.
There is no warning before a seizure, and the person is
completely alert immediately afterward.
Simple absence seizures are just stares. Many
absence seizures are considered complex absence
seizures, which means that they include a change in
muscle activity.

The most common movements are eye blinks.

Other movements include slight tasting
movements of the mouth, hand movements such as
rubbing the fingers together, and contraction or
relaxation of the muscles.
Complex absence seizures are often more than
10 seconds long.
Who gets them?
Absence seizures usually begin between
ages 4 and 14. The children who get them
usually have normal development.

Development- the process of physical

growth and the attainment of intelligence and
problem-solving ability that begins in infancy;
any interruption of this process by a disease
or disorder is called developmental delay.
What's the outlook?
In nearly 70% of cases, absence seizures stop by
age 18. Children who develop absence seizures
before age 9 are much more likely to outgrow them
than children whose absence seizures start after age
10.
Children with absence seizures do have higher rates
of behavioral, educational, and social problems.

What else could it be?

Absence seizures can resemble some complex
partial seizures or episodes of daydreaming:
How is the diagnosis made?

The EEG (electroencephalogram)

Electroencephalogram (EEG)--A diagnostic
test of brain electrical activity; helpful in
diagnosing records brain waves, is helpful in
diagnosing absence seizures. Having the
child breathe very rapidly often will produce
a seizure. Images of the brain such as CT
and MRI scans are usually normal, so they
are seldom needed if the EEG and other
features are typical.
2.Atypical Absence Seizures

What are they like?

Here's a typical story: "It's hard to tell

when Kathy's having one of her "staring
spells". During the spells she doesn't
respond as quickly as at other times.
But even when she's not having a
seizure she often just stares and
responds slowly.
How long do they last?
Usually 5 to 30 seconds (commonly more than 10),
with a gradual beginning and ending.

Tell me more
Atypical (a-TIP-i-kul) means unusual or not typical.
The person will stare (as they would in any absence
seizure) Absence seizureA primary generalized
epileptic seizure, usually lasting less than 20
seconds, characterized by a stare sometimes
associated with blinking or brief automatic
movements of the mouth or hands; formerly called
petit mal seizure.
Who gets them?
They generally begin before age 6.
Most of the children affected have
below-average intelligence and other
types of seizures that are difficult to
control.

What's the outlook?

Atypical absence seizures usually
continue into adulthood.
How is the diagnosis made?

The diagnosis can be difficult if the behavior

during seizures is similar to the child's usual
behavior. Electroencephalogram (EEG)--A
diagnostic test of brain electrical activity; helpful
in diagnosing epilepsy which records brain
waves, will be used; but most children with
these seizures have patterns on their EEG
when they're not having a seizure that are
similar to the seizure pattern.
How is the diagnosis made?

The diagnosis can be difficult if the behavior

during seizures is similar to the child's usual
behavior. Electroencephalogram (EEG)--A
diagnostic test of brain electrical activity;
helpful in diagnosing epilepsy which records
brain waves, will be used; but most children
with these seizures have patterns on their
EEG when they're not having a seizure that
are similar to the seizure pattern.
3.Myoclonic Seizure

What are they like?

Here's a typical story: "In the morning, I get
these 'jumps.' My arms fly up for a second,
and I often spill my coffee or drop what I'm
holding. Now and then my mouth may shut for
a split second. Sometimes I get a few jumps
in a row. Once I've been up for a few hours,
the jumps stop."
How long do they last?
They're very brief jerks. Usually they don't
last more than a second or two. There can be
just one, but sometimes many will occur
within a short time.
Tell me more
Myoclonic (MY-o-KLON-ik) seizures are brief,
shock-like jerks of a muscle or a group of
muscles. "Myo" means muscle and "clonus"
(KLOH-nus) means rapidly alternating
contraction and relaxation—jerking or
twitching—of a muscle.
In epilepsy, myoclonic seizures usually cause
abnormal movements on both sides of the body
at the same time. They occur in a variety of
epilepsy syndromes that have different
characteristics:
Juvenile myoclonic epilepsy: The
.seizures usually involve the neck,
shoulders, and upper arms. In many
patients the seizures most often occur
soon after waking up
Lennox-Gastaut syndrome: This is an uncommon
syndrome--a group of signs and symptoms that
collectively define or characterize a disease or
disorder; signs are objective findings such as
weakness, and symptoms are subjective findings
such as a feeling of fear or tingling in a finger.

•Progressive myoclonic epilepsy: The rare

syndromes in this category feature a combination
of myoclonic seizures and tonic-clonic seizures.
Treatment is usually not successful for very long,
as the patient deteriorates over time.
Who gets them?
The epileptic syndromes that most commonly
include myoclonic seizures usually begin in
childhood, but the seizures can occur at any age.
Other characteristics depend on the specific
syndrome.

What's the outlook?

The outlook for patients with the various
syndromes that include myoclonic seizures varies
widely.
What else could it be?
As mentioned, some episodes of myoclonus are
normal. Some myoclonic seizures occur in reflex
epilepsies, triggered by flashing lights or other
things in the environment.

How is the diagnosis made?

The seizures themselves are easy to identify.
The syndromes usually can be diagnosed on the
basis of the medical history and on the account of
a patient's presentations plus EEG patterns.
4.Atonic Seizures

What are they like?

Here's a typical story: "When Bob has a 'drop' seizure, a
sudden, excessive discharge of nervous-system
electrical activity that usually causes a change in
behavior.
He falls to the ground and often hits his head and
bruises his body. Even if I'm right next to him and
prepared, I may not catch him. Even with carpet in the
bedroom and mats in the bathroom, he gets hurt."

How long do they last?

Less than 15 seconds.
Tell me more
Muscle "tone" is the muscle's normal tension. "Atonic"
(a-TON-ik) means "without tone," so in an atonic seizure,
an epileptic seizure characterized by sudden loss of
muscle tone it may cause the head to drop suddenly,
objects to fall from the hands, or the legs to lose
strength, with falling and potential injury; usually not
associated with loss of consciousness while the muscles
suddenly lose strength.

The eyelids may droop, the head may nod, and the
person may drop things and often falls to the ground.
These seizures are also called "drop attacks" or "drop
seizures." The person usually remains conscious.
Another name for this type of seizure is "akinetic"
(a-kin-ET-ik), which means "without movement.“

Who gets them?

Atonic seizures often begin in childhood.

What's the outlook?

They often last into adulthood. Many people with
atonic seizures are injured when they fall, so they
may choose to use protection such as a helmet.
What else could it be?
Patients who have seizures that cause them to
fall when they're standing often have
tonic seizures (involving sudden muscle
contraction) rather than atonic seizures.

How is the diagnosis made?

Usually descriptions of the seizures by witnesses
will suggest the diagnosis. Some EEG monitoring
may be performed to confirm it. If the seizures
persist, other tests may be used to make sure
that changes in the heart rhythm or blood
pressure are not causing the patient to fall down.
5.Tonic Seizures

What are they like?

Here's a typical story: "When Jeff has an
episode, he just stiffens up. Both arms are
raised over his head and his face has a
grimace, as if someone is pulling on his
cheeks. If he's standing, he may lose his
balance and fall. These seizures don't knock
him out like the tonic-clonic seizures, but if he
has a few close together, he is often tired."
How long do they last?
Usually less than 20 seconds.

Tell me more
Muscle "tone" is the muscle's normal tension at rest. In a "tonic"
seizure sudden, excessive discharge of nervous-system
electrical activity usually causes a change in behaviour--the
tone is greatly increased and the body, arms, or legs make
sudden stiffening movements. Consciousness is usually
preserved.
Tonic seizures most often occur during sleep and usually
involve all or most of the brain, affecting both sides of the body.
If the person is standing when the seizure starts, he or she
often will fall.
Who gets them?
They are particularly common in people who have the epilepsy
syndrome
What's the outlook?
Tonic seizures is seen in Lennox-Gastaut syndrome – a group
of signs and symptoms that collectively define or characterize
a disease or disorder; signs are objective findings such as
weakness, and symptoms are subjective findings such as a
feeling of fear or tingling in a finger.

What else could it be?

Children with neurological impairments sometimes make
movements that could be mistaken for tonic seizures. The
EEG should be able to tell the difference.

How is the diagnosis made?

The EEG can clearly show these seizures if they occur during
monitoring.
6.Clonic Seizures

What are they like?

Clonic seizures consist of rhythmic jerking movements of the arms
and legs, sometimes on both sides of the body.

How long do they last?

The length varies.

Tell me more
"Clonus" (KLOH-nus) means rapidly alternating contraction and
relaxation of a muscle -- in other words, repeated jerking. The
movements cannot be stopped by restraining or repositioning the
arms or legs. Clonic (KLON-ik) seizures are rare, however. Much
more common are tonic-clonic seizures, in which the jerking is
preceded by stiffening (the "tonic" part). Sometimes tonic-clonic
seizures start with jerking alone. These are called clonic-tonic-
clonic seizures!
Who gets them?
Clonic seizures are not seen very often. They can occur
at various ages, including in newborns.
What's the outlook?
Brief and infrequent clonic seizures in infants usually
disappear on their own within a short time. Other types
may need prolonged treatment.
What else could it be?
Occasionally "jitteriness" in a young infant can be
mistaken for a clonic seizure, Seizure a sudden,
excessive discharge of nervous-system electrical activity
usually causes a change in behaviour especially if it is
severe (during crying, for instance). Changing the
position of the baby's arms or legs should reduce or stop
jitteriness.
How is the diagnosis made?

The doctor should recognize the appearance of a

clonic seizure if he or she witnesses an episode.
The EEG pattern will change during a seizure, so
video-EEG is very useful.
A factor distinguishing clonic from tonic-clonic
seizures is that clonic seizures are not followed
by a period of tiredness or confusion. Tonic-
clonic seizures usually are.
7.Tonic-clonic Seizure

What are they like?

Here's a typical story from a parent's view: "These
seizures frighten me. They only last a minute or two but
it seems like an eternity. I can often tell my daughter is
going to have one because she acts cranky and out of
sorts. It begins with an unnatural shriek. Then she falls,
and every muscle seems to be activated. Her teeth
clench. She's pale, and later she turns slightly bluish.
Shortly after she falls, her arms and upper body start to
jerk, while her legs remain more or less stiff. This is the
longest part of the seizure. Finally it stops and she falls
into a deep sleep."
How long do they last?
Generally, 1 to 3 minutes.
A tonic-clonic seizure – a newer term for grand mal or major
motor seizure; characterized by loss of consciousness, falling,
stiffening, and jerking; electrical discharge involves all or most of
the brain sometimes lasts longer than 5 minutes.

A seizure that lasts more than 30 minutes, or three seizures

without a normal period in between, indicates a dangerous
condition called convulsive status epilepticus.

Status epilepticus, a prolonged seizure (usually defined as lasting

longer than 30 minutes) or a series of repeated seizures; a
continuous state of seizure activity; may occur in almost any
seizure type.
Status epilepticus is a medical emergency, and medical help
should be obtained immediately
Tell me more

This type is what most people think of when they hear the word "seizure." An
older term for them is "grand mal. Grand mal—an older term for a tonic-clonic
seizure as implied by the name, combine the characteristics of tonic seizures
and clonic seizures.

The tonic phase comes first: all the muscles stiffen. Air being forced past the
vocal cords causes a cry or groan. The person loses consciousness; if
consciousness is preserved during a seizure, the person can respond (either in
words or actions, such as raising a hand on command) and recall what occured
during the spelland later falls to the floor. The tongue or cheek may be bitten,
so bloody saliva may come from the mouth. The person may turn a bit blue in
the face.
After the tonic phase comes the clonic phase: The arms and usually the legs
begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips,
and knees. After a few minutes, the jerking slows and stops. Bladder or bowel
control sometimes is lost as the body relaxes. Consciousness returns slowly,
and the person may be drowsy, confused, agitated, or depressed.
Who gets them?
They affect both children and adults.
What's the outlook?
For children who have had a single tonic-clonic seizure,
the risk that they will have more seizures depends on
many factors. Some children will outgrow their epilepsy
What else could it be?
Some nonepileptic (psychogenic) seizures resemble
tonic-clonic seizures. The surest way to tell the
difference is with video-EEG monitoring. In some cases,
the same person may have both tonic-clonic and
nonepileptic seizures.
People who faint sometimes develop tonic or clonic
movements. These movements are rarely as intense or
prolonged as a tonic-clonic seizure.
8.Simple Partial Seizure

What are they like?

They are remarkably different from person to person, depending on
the part of the brain where they begin. The one thing they all have
in common is that the person remains alert and can remember
what happens.

Here are a couple of experiences:

•"I almost enjoy them. The feeling of déja vu, as if I've lived through
this moment and I even know what's going to be said next.
Everything seems brighter and more alive."
•"It is a pressure that starts in my stomach, then rises to my chest
and throat. When it reaches my chest, I smell an unpleasant odor of
something burnt. At the same time I feel anxious."
How long do they last?
Only a short time, usually less than 2 minutes.

Tell me more
Doctors often divide simple partial seizures into
categories depending on the type of symptoms the
person experiences:

Motor seizures:
These cause a change in muscle activity. For example,
a person may have abnormal movements such as
jerking of a finger or stiffening of part of the body. These
movements may spread, either staying on one side of
the body (opposite the affected area of the brain) or
extending to both sides.
Sensory seizures:
These cause changes in any one of the senses. People
with sensory pertaining to the senses (touch, vision,
hearing, taste, smell) may smell or taste things that
aren't there; hear clicking, ringing, or a person's voice
when there is no actual sound; or feel a sensation of
"pins and needles" or numbness.

Autonomic seizures:
These cause changes in the part of the nervous system
that automatically controls bodily functions. These
common seizures may include strange or unpleasant
sensations in the stomach, chest, or head; changes in
the heart rate or breathing; sweating; or goose bumps.
Psychic seizures:

These seizures change how people think, feel, or experience

things. They may have problems with memory, garbled speech,
an inability to find the right word, or trouble understanding spoken
or written language. They may suddenly feel emotions like fear,
depression, or happiness with no outside reason. Some may feel
as though they are outside their body or may have feelings of déja
vu ("I've been through this before") or jamais vu ("This is new to
me"— even though the setting is really familiar).

Who gets them?

Anybody can get them. They may be more likely in people who
have had a head injury, brain infection, stroke, or brain tumor but
most of the time the cause is unknown.
What's the outlook?
These seizures often can be controlled by seizure medicines.

What else could it be?

Medical disorders such as, stomach disorders or a pinched nerve
can cause some similar symptoms. Hallucinations can accompany
psychiatric illness or the use of certain drugs. And some
symptoms (such as déja vu) are experienced by almost everyone
at some time. Whether the symptoms represent simple partial
seizures depends on how often they occur and whether they are
associated with other episodic changes or other seizure types.

How is the diagnosis made?

A complete medical history and close physical examination can
help to rule out other possible causes of the symptoms and
assess the likelihood of epilepsy.