Seizures PDF

11/20/23, 1:25 PM Realizeit for Student Summary Seizures occur when abnormal electrical signals are being rapidly fired for neurons in the brain. Seizures can have a devastating effect on a person’s life and activities. Stigma, anxiety, and fear can be an issue and cause the patient to develop unh...

11/20/23, 1:25 PM Realizeit for Student Summary Seizures occur when abnormal electrical signals are being rapidly fired for neurons in the brain. Seizures can have a devastating effect on a person’s life and activities. Stigma, anxiety, and fear can be an issue and cause the patient to develop unhealthy activities. The nurse can provide care by understanding the different types of seizures and the impact this disorder can have on the patient and the family. Seizures can occur in anyone 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, neurons are tasked with handling and transmitting information. There are two types of neurons - excitatory and inhibitory neurons. Excitatory neurons produce “an action” or cause “excitement” by releasing a neurotransmitter called glutamate (this is an excitatory neurotransmitter). Inhibitory neurons “stop an action” or cause inhibition by releasing an inhibitory neurotransmitter called GABA. If there is an imbalance of excitatory neurons vs. inhibitory neurons, seizures will occur. Some patients know that a seizure is coming. They may report a flashing light. Sweating, flushing, dilated pupils, altered level of consciousness, or a dream-like state may be observed as well. Epilepsy is a disorder of the brain. People are diagnosed with epilepsy when they have had two or more seizures. There are many types of seizures. A person with epilepsy can have more than one type of seizure. Major Types of Seizures: Seizures are classified into two groups. 1. Generalized seizures affect both sides of the brain. Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space. Tonic-clonic seizures, also called grand mal seizures, can make a person Cry out. Lose consciousness. Fall to the ground. Have muscle jerks or spasms. The person may feel tired after a tonic-clonic seizure. 2. Focal seizures are located in just one area of the brain. These seizures are also called partial seizures. Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell. Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ISxbzaOiDJV0Yn%2bNYQnPSWegn3PmZsXqM08lDfZTK… 1/3 11/20/23, 1:25 PM Realizeit for Student Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure. Treatments: medicines called anti-epileptic drugs (AEDs) surgery to remove a small part of the brain that's causing the seizures a procedure to put a small electrical device inside the body that can help control seizures a special diet (ketogenic diet) that can help control seizures Medications: Antiepileptic drugs work by suppressing discharge of neurons with a seizure focus and to suppress propagation of seizure activity from the focus to other areas of the brain. This achieved through suppression of sodium influx, suppression of calcium influx, promotion of potassium efflux, blockade of receptors for glutamate, and increase of GABA. The goal of drug therapy with seizure disorders it is to reduce seizures to allow patients to live a near-normal life. Drug selection is based on the type of seizures to be suppressed and evaluation of drug effectiveness is a trial period in which there is no guarantee that seizures will be controlled. All antiepileptic drugs require plasma drug level monitoring, which is used to guide dosage adjustments. Barbiturates (phenobarbital), benzodiazepines (diazepam), gamma-aminobutyric acid structural analogs (gabapentin), hydantoins (phenytoin), iminostilbenes (carbamazepine), and adjuvant antiepileptic medications (valproate, levetiracetam, topiramate); used when primary drugs are not effective alone. For antiepileptic drug therapy to be effective, patient adherence is crucial. Patients need to understand how to take the medications as scheduled and track seizure frequency. Phenytoin, which is a traditional antiepileptic drug, is most widely used first line to treat seizures by selective inhibition of sodium channels. Side effects include nystagmus, gingival hyperplasia, and rash. Phenytoin is teratogenic and should only be used in pregnant women when no other safe therapy is available. Because carbamazepine is better tolerated than phenytoin, it is often preferred. Status epilepticus is a life-threatening emergency that may result in hypotension, hypoxia, cardiac dysrhythmias, permanent brain damage, and death unless prompt, appropriate treatment is instituted. Side effect profiles vary with individual AEDs; potential teratogenic adverse effects, drug interactions, hypersensitivity reactions, and blood dyscrasias have been reported. The FDA has issued a BLACK BOX WARNING♦ for phenobarbital. Patients who take phenobarbital are at risk for suicidal ideation. It is important to monitor the patient for statements that indicate depression and suicide. The FDA issued a BLACK BOX WARNING♦ for diazepam. The combination of benzodiazepines and opioid medications depresses the CNS, resulting in serious adverse effects, including respiratory depression or death. The FDA has issued a BLACK BOX WARNING♦ for diazepam. The combination of any benzodiazepine and an opioid medication depresses the CNS, resulting in serious adverse effects, including respiratory depression or death. The FDA has issued several BLACK BOX WARNINGS♦ for valproate. The first instructs patients to discontinue valproate at any sign of pancreatitis; the development of this condition is life https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ISxbzaOiDJV0Yn%2bNYQnPSWegn3PmZsXqM08lDfZTK… 2/3 11/20/23, 1:25 PM Realizeit for Student threatening. The second points out that valproate is a teratogenic medication. The third instructs the patient to check for signs of bleeding or bruising. Altered bleeding times may occur. The FDA has issued a BLACK BOX WARNING♦ for carbamazepine concerning aplastic anemia and agranulocytosis. When an AED is being discontinued, its dosage should always be tapered gradually, usually over 1 to 3 months. Abruptly stopping an AED may exacerbate seizures or cause status epilepticus. Monitoring of serum drug levels is useful for most AEDs and must be interpreted in relation to clinical responses. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ISxbzaOiDJV0Yn%2bNYQnPSWegn3PmZsXqM08lDfZTK… 3/3