SEIZURE DISORDER

PRESENTED BY :
Rohini Rai
MSc Nursing student
College of Nursing,
N.B.M.C.H
INTRODUCTION
Our normal brain function requires an orderly,
organized, co-ordinated discharge of electrical
impulses. Electrical impulses enable the brain to
communicate with spinal cord, nerves and muscles as
well as within itself. Seizure disorders include
disturbance of brain’s electrical activity periodically,
resulting in some degree of temporary brain
dysfunction.
DEFINITION OF SEIZURE
Seizures are sudden abnormal electrical discharges
from the brain that results in changes in sensation,
behaviour, movements, perception or consciousness.
ETIOLOGY
Seizures in newborn and infants are caused due
to:
 Congenital brain defects
 Birth injuries
 Metabolic problems such as anoxia, hypoglycaemia or

hypocalcemia.
 Fever
 Genetic factors
 In adult, seizures may be due:
 CVA
 Head injury
 Brain tumour
 Delirium
 Alzheimer’s disease
 Central nervous system Infection
 Brain trauma
 Metabolic and toxic condition
 Drug and alcohol withdrawal
 Genetic link
 SEIZURES

FOCAL/ PARTIAL GENERALIZED

SEIZURE SEIZURES
PARTIAL SEIZURES
Simple partial/ focal seizures (Focal Awareness
Seizure )
 Motor seizure
 Sensory seizure
 Autonomic seizure
 Psychic seizures
Complex partial seizures
(Focal impaired awareness seizure )
 This type of seizure typically begins with behavioural arrest
and is followed by a blank stare, automatisms and post ictal
confusion. Typical automatisms are chewing, lip smacking,
mumbling and fumbling with hands. While the Focal
impaired awareness seizure lasts only for few minutes (60 –
90 seconds), post seizure confusion can lasts substantially
longer. This condition should not be mistaken as intoxication.
GENERALIZED SEIZURES
1. Generalized Tonic- Clonic (Grand Mal)

2. Absence seizure (Petit Mal)

3. Atypical absence seizure

4. Atonic seizure

5. Myoclonic seizure

6. Clonic seizures

7. Tonic seizures
 Absence (Petit Mal): An absence seizure is
a generalized onset seizure, which means it begins in
both sides of the brain at the same time. An older
term is petit mal seizure. Absence seizures are brief
episodes of impaired consciousness with no aura or
postictal confusion. They typically lasts less than 20
seconds and are accompanied by few or no
automatisms.
Atypical absence seizures:

This means it’s different, unusual, or not typical

compared to typical absence seizures. They are a
type of generalized onset seizure, which means
they start in both sides of the brain.
The person will stare (just like in absence seizure)

but they may be able to respond a bit.

Eye blinking, chewing movements, lip smacking,

or slight jerking movements of the lips may occur.

There may be rubbing of the fingers or hands or

other small hand movements.

 These seizures may begin and end gradually. This is
different from the sudden start and stop of a typical
absence seizure.
 Falling during the seizure is also more common than

it is during typical absence seizures.

 Atypical absence seizures usually last 5 to 30

seconds, most often more than 10 seconds.

 Atonic seizures: Atonic seizures are also called
“drop attacks”. There is a brief loss of postural tone,
often resulting in falls and injuries.

 Myoclonic seizures: Myoclonic seizures consists of

brief sporadic or isolated jerking movements that last
less than 1 seconds. There can be just one, but
sometimes many will occur within a short time.
 Clonic seizure: Clonic seizures consists of
rhythmic jerking motor movements. If a person is
standing when a clonic seizure occurs, they may
fall. Sometimes a focal clonic seizure affects both
the motor and sensory parts of the brain. It may
also include tingling or numbness of the body part
with the jerking.
 Tonic seizures: Tonic seizures consists of sudden
onset tonic extension or flexion of the head, trunk,
and /or extremities for several seconds. These
seizures typically occur in relation to drowsiness,
shortly after patients fall asleep, or just after they
awaken.
 Many persons with tonic seizures have a syndrome
called Lennox Gastaut syndrome. This condition
may involve intellectual disability, multiple seizure
types including tonic seizures.
Non Epileptic Events
Pseudo-seizures, are associated with extreme stress
and psychological disorders.
These seizures commonly affect people who have:

◦ Post Traumatic Stress Disorder

◦ Anxiety Disorder
◦ Major Depressive Disorder
◦ Personality Disorders
PATHOPHYSIOLOGY
PHASES OF SEIZURES
 The Prodromal phase: This phase involves
mood or behaviour changes that may precede
seizures by hours or days.
 The Aural phase: This is a phase of sensory
warning. It happens right before a seizure
starts. Over 5 to 20 minutes, and usually last
60 minutes.
 The Ictal phase: This is a stage of seizure.

 Postictal Phase: Period of recovery after seizure.

During this final stage, brain tries to get nerve
cells to stop misfiring, body begins to relax.
CLINICAL MANIFESTATION
With a seizure, sign and symptoms can range
from mild to severe and vary depending on
the type of seizure. Seizures signs and
symptoms may include the following:
 Impaired consciousness or temporary

confusion.
 A staring spell.
 Disturbed muscle tone or movement.
 Sensation or perception disturbance.
….Clinical Manifestation
 Uncontrollable jerking movements of arms
and legs.
 The person may not appear to be breathing.
 Cognitive or emotional symptoms, such as

fear, anxiety or dejavu.

 Mood swings.
 Memory lapses
 Psychic symptoms – out of body feelings or

not feeling “ in the moment”

Diagnostic evaluation
 History
 Neurological examinations
 Blood tests
 CBC
 Serum chemistries
 LFT
 Urine analysis

 Prolactin study
 Serum studies of anticonvulsant agents
Diagnostic evaluation
 Lumber puncture
 Electro encephalogram
 Video EEG (EEG Telemetry)
 Magneto encephalography
 Computerised tomography of brain
 Magnetic resonance imaging
 Positron emission tomography
 Single Photon Emission Computerized

tomography (SPECT)
MEDICAL MANAGEMENT
 Drug therapy: Medications control
seizure in about 70% of patients. Because
cure is not possible the goal of therapy is
to prevent seizures with a minimum of
toxic side effects from drug therapy.
ANTI-EPILEPTIC DRUG (AED)
 A drug which decreases the frequency and or severity
of seizures in people with epilepsy.
 Treats the symptoms of seizures not the underlying
epileptic condition.
 Goal: maximize quality of life by minimizing seizures
and adverse drug effects.
 Currently no “anti – epileptogenic” drugs available.
Classification of AED
Classical Newer
 Pnenytoin Lamotrigine
 Phenobarbital Felbamate
 Primidone Topiramate
Carbamazapine Gabapentin
Ethosuximide Tiagabine
Sodium valproate Oxycarbazepine
Levetiracetam
Vigabatrin
Fosphenytoin
GUIDELINE OF ANTIEPILEPTIC DRUG
EPILEPSY TYPE FIRST LINE SECOND LINE THIRD LINE
Focal onset and/or Lamotrigine Carbamazepine Clobazam
secondary GTCS Levetiracetam Gabapentin
Sodium Oxcarbazepine
valporate Phenobarbital
Topiramate Phenytoin
Zonisamide Pregabalin
Primidone
Tiagabine
GTCS Sodium Lamotrigine Carbamazepine
valproate Topiramate Phenytoin
Levetiracetam Zonisamide Primidone
Phenobarbital
Acetazolamide
Absence Ethosuximide Sodium Lamotrigine
valporate Clonazepam
Myoclonic Sodium Levetiracetam Lamotrigine
HISTORY OF ANTIEPILEPTIC DRUG
THERAPY IN THE U.S.
 1974 - Carbamazepine
 1975 - Clonazepam
 1978 - Valproate
 1933 - Febamate, Gabapentin
 1995 - Lamotrigine
 1997 - Topiramate, Tiagabine
 1999 - Levetiracetam
 2000 - Oxcarbazepine, Zoonisamide
SIDE EFFECTS OF ANTI-SEIZURE DRUGS

DRUGS SIDE EFFECTS

Carbamazepine SIADH, rash, pruritis, fatigue, blurred vision,
diplopia, lethargy
Valproic acid Teratogenic, Abnormal LFTs, pancreatitis, weight
gain, menstrual irregularities, reduces fertility and
osteoporosis.
Phenytoin Teratogenic, gingivial hyperplasia, hair growth, rash,
diplopia, ataxia, slurred speech, hypotension /
arrythmias
Lamotrigine Rash, Steven Johnson Syndrome.

Topiramate Teratogenic, weight loss, nephrolithiasis

NURSING RESPONSIBILITY OF AED
 Explain the importance of taking drugs at a fixed time for
maintaining therapeutic blood level.
 Observe the side effects and monitoring the changes to prevent
complications.
 Monitor intake and output chart.
 Check therapeutic blood levels on admission and at regular
intervals.
 Evaluate therapeutic response, cardiac status, BP, pulse,
respiration.
 Monitor LFT and renal function.
 Urine may become pink. Let the patient be aware of this.
 Motivate the client/ family to maintain compliance to drug
therapy.
 Monitor oral health:

◦ Observe for signs of gingival hypertrophy, bleeding

or inflammation

◦ Instruct the client to use a soft tooth brush

◦ Avoid mouth wash containing alcohol.

◦ Report inflammation or bleeding of gums.

◦ Have dental check ups regularly.

 Pnenytoin, valproic acid, carbamazepine,
gabapentin, primodone, phenobarbital,
topiramate, lamotrigine should not be
administered to pregnant women due to
teratogenic effects.
 Valproic acid is a gastric irritant and an anticoagulant,

therefore there is risk of developing GI ulcer and bleeding.

 Instruct the patient to take drug with food.

 Instruct to report any severe or persistent heart burn,

upper GI pain, nausea and vomiting.

 Conduct guaiac test for occult blood.

 Abrupt discontinuation of antiseizure
medications can cause status epilepticus.

 Use with caution in patients with hepatic and

renal impairment.

 Instruct to hold medication if respiration rate

is below 12 breath per minute.

 Avoid driving and other hazardous activity

until the effects of drugs are known
 SURGICAL MANAGEMENT
 Anterior temporal lobe resection: Focal resection of part of the
temporal lobe usually on the right side, is performed. Approximately
70% of the patients are essentially seizure free after this procedure.
The benefits of surgery include cessation or reduction in frequency of
seizures. However not all types of epilepsy benefit from surgery.

 Selective amygdalohippocampectomy: Two structures within the

temporal lobe that are commonly the genesis of seizure activity are
removed.
SURGICAL MANAGEMENT
 Sub-pial resection: Fine cuts are made into the
motor areas of the brain that do nto control motor
function but do prevent the spread of seizure.

 Corpus callostomy: Fibres that connect the two

halves of brain are cut.
VAGAL NERVE STIMULATION
 Vagus nerve stimulation prevents seizures by sending
regular, mild pulses of electrical energy to the brain via
the vagus nerve. It is sometimes referred to as a
"pacemaker for the brain." A stimulator device is
implanted under the skin in the chest. A wire from the
device is wound around the vagus nerve in the neck.
Stimulation of the vagus nerve leads to the discharge of
electrical energy into a wide area of the brain,
disturbing the abnormal brain activity that causes
seizures.
NON INVASIVE VAGUS NERVE
STIMULATION
DEEP BRAIN STIMULATION
KETOGENIC DIET
BIO FEEDBACK
 Biofeedback to control seizures is aimed at
teaching the patient to maintain a certain
brain wave frequency that is refractory to
seizure activity.
NURSING DIAGNOSIS
 Risk for trauma or suffocation related to loss of large or
small muscle contraction.
 Risk for injury related to weakness, balancing difficulties,
cognitive limitations or altered consciousness.
 Risk for ineffective airway clearance related to
neuromuscular impairment.
 Situational low self-esteem related to stigma associated
with the condition.
 Deficient knowledge related to lack of exposure ,
unfamiliarity with resources, information
misinterpretation and lack of recall.
NURSING INTERVENTION
Prevent trauma/injury. 

• Uphold strict bed-rest if pro-dromal signs or aura experienced.

• Ease the patient to floor if possible.

• If the person is having a convulsive type of seizure, loosen any tight

clothing and remove eye glasses if they wear them.

• Push aside any furniture that may injure the patient during the seizure.

• If the patient is on the bed remove the pillows and raise side rails.

• Avoid using thermometers that can cause breakage.

• Use tympanic thermometer when necessary to take temperature

◦ support head, place on soft cushion or soft

clothing under the head.

◦ do not attempt to restrain.

◦ Stay with the person, continue to monitor him

after the seizure

◦ After the seizure assist the person to a

comfortable place and allow time to rest

 Promote airway clearance. 
 Maintain side lying position.
 Turn head to side during seizure activity; loosen clothing
from neck or chest and abdominal areas.
 If possible place the patient on one side with head flexed
forward, which allows the tongue to fall forward and
facilitate drainage of saliva and mucus. If suction is
available, use it to clear secretions.
 Supervise supplemental oxygen or bag ventilation as
needed postictally.
 Improve self-esteem. 
 Determine individual situation related to low self-esteem
in the present circumstances.
 Refrain from over protecting the patient; encourage
activities, providing supervision and monitoring when
indicated.
 Know the attitudes or capabilities of the significant
other.
 Help an individual realize that his or her feelings are
normal; however, guilt and blame are not helpful.
 Enforce education about the disease. 
 Review pathology and prognosis of condition and lifelong
need for treatments as indicated.
 Discuss patient’s particular trigger factors (sleep
deprivation, flashing lights, hyperventilation, loud noises,
video games, TV viewing)
 Know and instill the importance of good oral hygiene and
regular dental care
 Review medication regimen, necessity of taking drugs as
ordered, and not discontinuing therapy without physician
supervision; include directions for missed dose.
Patient Education
 To take medications at regular basis as directed.
 Avoid alcohol.
 Adequate rest.
 Well balanced diet
 Do with precaution:

◦ Driving
◦ Ascending heights
◦ Operating machines
◦ Swimming
◦ Work with fire or cooking
◦ Taking unsupervised baths
What not to do during a seizure
 Do NOT attempt to stop a seizure
 Do NOT restrain the person or try to hold them down

in any way
 Do NOT force any thing between their teeth or put

anything in their mouth

 Do NOT give the person anything to eat or drink until

he has fully recovered consciousness.

POST ICTAL NURSING CARE
Assessment of post-ictal period should include a
detailed description of the following:
 level of consciousness
 vital signs
 pupil size and position of the eyes
 memory loss
 muscle soreness / assess for any injury
 speech disorders (aphasia, dysarthia)
 weakness or paralysis
 sleep period
 duration of each sign and symptom.
POST ICTAL NURSING CARE
 If patient is sleepy, continue in side lying
position to prevent aspiration, making sure
the airway is patent.
 Reassure / reorient, the patient if he is

disoriented or confused.
 Gently restrain if needed, with close

observation of neurovascular status.

 Keep the patient NPO until swallowing reflex

returns.
 Document the incident and nursing care

provided.
 Health Promotion: Some cases of seizure disorders

can be prevented by promoting general safety

measures, such as :
 Wearing helmets in situations involving risk of head

injury.
 Improved perinatal, labour and delivery care have

reduced fetal trauma and hypoxia and thereby have

reduced brain damage leading to seizure disorders.

 Encouraging the patients with seizure disorder to practice

good general health habits. (Maintaining a proper diet,

getting adequate rest, exercising). Help the patient identify

events or situations that precipitate the seizure and provide

suggestion for avoiding them or handling them better.

 Teach patient to avoid excessive alcohol intake, fatigue and

loss of sleep.
 Help the patient to handle stress constructively.
COMPLICATIONS
 Injuries related to loss of consciousness and violent muscular
contraction.

 Aspiration pneumonia

 Socially stigma

 Psychological problems

 Permanent brain damage.

 SUDEP ( Sudden Un-expected Death in Epilepsy):

 CONCLUSION
 Seizure is a life long disorder which cannot
be cured but can be effectively controlled
with medications and certain life style
changes. Seizure not only has medical
problems but it also deals with feelings of
inferiority or low self esteem. Therefore a
patient with seizure must be provided with
necessary medical treatment as well as
psychological support.
QUESTIONS
 1) which of the following is the drug of choice
in case of absent seizure?
 a. Ethosuximide
 b. Sodium Valproate
 c. Lamotrigine
 d. Phenytoin
 4) A 23-year-old woman is seen in clinic for
recurrent funny turns. She is not aware of
them, but her family and friends have noticed
them. They say she looks around blankly,
then starts picking at her clothes and
sometimes yawns, then she comes back after
a minute. She can get drowsy after these
episodes. What seizure type does this patient
describe?
 a. Absence.
 b. Tonic clonic
 c. Simple partial
 d. Complex partial
 e. Generalized
 You have a patient who has a brain tumor
and is at risk for seizures. Select below all
the proper steps to take for seizure
precautions: 
 A. Oxygen and suction at bedside
  B. Bed in highest position
  C. Remove all pillows from the patient’s head
  D. Have restraints on stand-by
  E. Padded bed rails
  F. Remove restrictive objects or clothing from

patient’s body
  G. IV access
 Your patient is scheduled for an EEG
(electroencephalogram). As the nurse you
will:
  A. Keep the patient nothing by mouth.

  B. Hold seizure medications until after the test.

  C. Allow the patient to have coffee, milk, and juice

only

  D. Wash the patient’s hair prior to the test.

  E. Administer a sedative prior to the test.

 A patient who is having a tonic-clonic seizure is
prescribed Phenobarbital. During
administration of this drug, it is important the
nurse monitors for:
 A. Respiratory depression

 B. Hypertension

 C. Disseminated intravascular clotting

 D. Hypotension

 E. Fever
REFERENCE
1. Suzzane C, Smeltzer et al. Brunner and Suddharths Text Book
of medical surgical Nursing ;Wolters Kluwer Publication. 4th
Edition. India 2012: Pg 1325 to 1333 ,Pg 1351 to 1354
2. Chintamani. Lewis Medical Surgical Nursing .Elsevier
Reprint ,2011: Pg 1207 to 1215, Pg 1223-1226
3.Black JM,Hawks JH. A text book of Medical Surgical Nursing.
Saunders Publication. 8th edition. 2nd volume. pg 1811
4.O Devinsky. Effects of seizures on Autonomic and
Cardiovascular functioning. Epilepsy Curr. 2004 Mar;4(2):43-
46. Available at https://www.ncbi.nlm.gov>pmc
THANK YOU