11. Seizure is an ACUTE
Manifestation
Epilepsy is a Chronic
DISEASE
12. SEIZURE AND EPILEPSY
• SEIZURE – Episode of paroxysmal
and transient brain dysfunction.
• EPILEPSY - Recurrent chronic
seizures. Seizures are the
indispensable characteristic of
epilepsy
13. SEIZURE
• It is episodes of
abnormal motor ,
sensory , autonomic or
psychic activity ( or
combination of this )
that result from
sudden excessive
discharge from
cerebral neuron.
14. Classification for
causes of seizures
Non-recurrent
(Acute)
With Fever
Extra-cranial
Infections
Febrile
Convulsions
Intracranial
Infections
Meningitis
Encephalitis
Brain Abscess
Subdural abscess
Extra dural
abscess
Septic venous
thrombosis
Without
Fever
Traumatic
Toxic
Hypoxic
Metabolic
Vascular
Recurrent
(Chronic)
Epilepsy
Diagnosis
requires the
occurrence of
at least ≥2
unprovoked
seizures in a
time frame of
>24 hrs
16. CAUSE
ACCORDING TO
AGE
0-1 MONTH
Birth injury
Asphyxia
Hypoxia
Infection
Congenital
malformatio
n
1-6 MONTH
CNS infection
Traumatic
Congenital
malformatio
n
6MONTH-
3YEAR
Infection
condition
Idiopathic
cause
3-6 year
Febrile
convulsion
Idiopathic
cause
18. PATHOPHYSIOLOGY
Due to any cause
↓
Prolonged depolarization and other
chemical changes
↓
Discharge the neurons in an
uncontrolled manner
↓
Spreads to adjacent areas of brain
or distant areas of the CNS
↓
SEIZURE
22. MAIN DIFFERENCE
Generalized Partial
Both Cerebral
Hemispheres
Only a part of a
hemisphere
Loss of Consciousness No loss of consciousness
Treated by Valproate Treated by
Carbamazipine
24. PARTIAL SEIZURES
• focal origine,Consciousness
is fully preserved
• Activity is restricted to
discrete areas of cerebral
cortex.
• Typically associated with
structural abnormalities of
the brain.
25. PARTIAL SEIZURES
• 1.Simple partial seizures with motor signs
• Characterized by
• Localized motor symptoms.
• Abnormal discharges remain unilateral.
• Manifestations
• Aversive seizure
• Eyes and head turn away from the side of the focus.
• Awareness of movement .
26. CONTI,….
• Sylvan (Rolandic) seizure
• Tonic-clonic movements involving the face
salivation
• Arrested speech
• Most common during sleep.
• Jacksonian march
Orderly, sequential progression of clonic
movements beginning in a foot, hand, or face and
moving or “marching” to adjacent body parts.
27. 2.Simple partial seizures with
sensory signs
• Characterized by numbness, tingling, prickling,
paresthesia or pain originating in one area.(eg.
face or extremities) and spreading to other parts
of the body.
• Visual sensations.
• Equillibrium.
• Alteration in hearing,alfaction
• Autonomic symptoms
• Odd internal feelings
• Uncommon in children younger than 8 years
28. 3.Complex partial seizures
(psychomotor seizures)
If counsciousness is imapired,
symptomatically more complex then simple
seizure is termed as”Complex seizure”
• Unable to respond appropriately to visual or
verbal commands during seizure.
• Impaired recollection of awareness of Ictal
phase.
• Aura Ictal phase Post ictal phase
29. Partial Seizures with Secondary
Generalization
• Partial seizures can spread to
involve both cerebral
hemispheres and produce a
generalized seizure, usually of
the tonic-clonic variety.
• Is often difficult to distinguish
from a primarilly generalized
tonic-clonic seizure.
• Careful history identifies a
preceding aura
31. 1.Tonic-clonic seizures (Grandmal)
• Tonic phase
• Eyes roll upward
• Immediate loss of consciousness
• Stiffens in generalized, symmetric, tonic
contraction of entire body musculature
• Arms usually flexed
• Legs, head & neck extended
• Ictal cry
• Apenic, may become cyanotic
• Increased salivation and loss of swallowing
reflex
32. Clonic Phase
• Violent jerking movement and
relaxation of muscles
• May foam at the mouth
• May be incontinent of urine &
faeces.
• Last no more than 1 minute.
34. POSTICTAL STATE
• Appear to relax
• May remain semiconscious and difficult to
arouse
• May awaken in a few minutes to hours
• Remains confused for several hours.
• Poor coordination
• Mild impairment of fine motor movement
• May have visual and speech difficulties
• May vomit or complain of severe head ache.
• On awakening is fully conscious
• Usually feels tired
• No recollection of entire event.
35. 2. ABSENCE SEIZURES
• Sudden,Brief loss of consciousness
• Counsciousness return as suddenly as it was
lost and no post ictal confusion.
• Onset usually between 4 and 12 years of age.
• More common in girls than in boys
• Usually cease at puberty
• Minimal or no alteration in muscle tone
• Abrupt onset suddenly develops 20 or more
attacks daily
• Events can be precipitated by
hyperventilation ,hypoglycemia, fatigue.
36. 3. ATONIC AND AKINETIC
SEIZURES
• Characterized by
• Onset usually between 2 and 5 years of age
• Sudden, momentary loss of muscle tone and postural
control
• Events recur frequently during the day, particularly in
the morning hours and shortly after awakening.
• Manifestations
• Loss of tone causes child to fall to the floor violently
• Unable to break fall by putting out hand
• Loss of consciousness only momentary
37. 4. MYOCLONIC SEIZURES
• Sudden and brief muscle contraction.
• No postictal state
• May or may not be symmetric
• May or may not include loss of consciousness
38. EPILEPSY
• It is a group of
syndromes
characterised
by unprovoked ,
recurring
seizures
39. • A chronic neurologic disorder
manifesting by repeated
epileptic seizures (attacks or
fits) which result from
paroxysmal uncontrolled
discharges of neurons within
the central nervous system
(grey matter disease).
40. CAUSES
• 1.Idiopathic cause
• 2.Acquired cause
Birth trauma , Asphyxia, Head injuries
Infection like bacterial , viral & parasitic
Toxicity like carbon monoxide & lead poisoning
Circulatory problem
Fever
Metabolic & nutritional disorder
Drug or alcohol intoxication
Brain disease like brain tumor , brain abscess & congenital
malformations.
42. PATHOGENESIS
• The 19th century neurologist Jackson
suggested “a sudden excessive
disorderly discharge of cerebral
neurons“ as the causation of epileptic
seizures.
• Recent studies in animal models of focal
epilepsy suggest a central role for the
excitatory neurotransmiter glutamate
(increased in epi) and inhibitory gamma
amino butyric acid (GABA) (decreased)
43. Epilepsy - Classification
The modern classification of the
epilepsies is based upon the nature of
the seizures rather than the presence
or absence of an underlying cause.
45. STATUS EPILEPTICUS
• It is a series of generalized seizures that
occours without fully recovery of
consciousness between attacks.
• Lasting atleast 30 minutes.
• Withdrawl of antiseizure medication,Fever
and concurrent infection.
46. Epilepsy
Differential Diagnosis
The following should be considered in the diff. dg. of epilepsy:
• Syncope attacks
• Cardiac arrythmias
• Migraine
• Hypoglycemia
• Narcolepsy – inappropriate sudden sleep
episodes
• Panic attacks
52. NURSING INTERVENTIONS
• During a seizure
• Indications of difficulties with airway or breathing.
• Significant pressurize events
• Behaviour before the seizure, aura
• Type of movements observed
• Time seizure began and ended
• Site where twitching or contraction began
• Areas of the body involved.
• Movements of the eyes and changes in pupil size .
• Apparent degree of consciousness during the seizure
• Incontinence
• Colour change
• Mouth
53. • After a seizure
• After Seizure(Postictal)
• Vitals & Neuro checks
• Keep patient on side
• Allow to rest
• Document seizure
• Record:
• Seizure-Date, time, duration Where
seizure began-body part first involved
• Any aura prior to seizure?
• Any Progression movement
• Type of seizure-generalized or local
• Type of movement-tonic, clonic,
automatism, blinking, staring
• Changes in pupil size & any eye
deviation
• LOCs & alertness
• Bladder &Bowel continence
• Presence of apnea, cyanosis, &
salivation
• Pt Postictal status-weak or
drowsy, confusion-keep in
calm,quiet atmosphere, re-
orient
54. NURSING DIAGNOSIS
• Risk for injury related to seizure activity
• Ineffective breathing pattern related to
spasms of respiratory musculature
• Social isolation related to the feelings
about seizures or public fears and
misconceptions.
• Chronic low self-esteem related to lack of
control over seizures.
55. NURSING INTERVENTIONS
• Use preventive measures
• Make sure the patient can be readily observed.
• During a seizure, monitor vital signs and assess
neurological status frequently.
• After a seizure, check the patient frequently and
report the following.
• Behavior changes
• Irritability
• Restlessness
• Listlessness
56. PREVENTING RESPIRATORY ARREST
• Clear the area around
• Do not restrain
• Loosen the clothing around the neck
• Turn the pt on side so saliva can flow out of the
mouth.
• Place a small, folded blanket under the head to
relevant trauma if the seizure occurs when the pt
is on the floor.
• Suction the pt. and administer o2 as necessary
• Do not give anything by mouth or attempt to lace
anything in the mouth.
• After the seizure, place the pt in a side lying
position
57. Chorea
• CHOREA is an inherited,
degenerative brain disorder
which results in loss of both
mental and physical control.
• CHOREA also known as
Huntington Chorea (chorea
mean to dance-like
movement that is
uncontrollable)
58.
59. PATHOPHYSIOLOGY
Chorea is a chromosome disorder that occurs
on 4p16.3
At 4p16.3 juncture, the Huntington gene
(HTT) contain a sequence of DNA bases
(cytosine-adenine-guanine, CAG)
This sequence repeat many times (CAG-CAG-
CAG-CAG-CAG-CAG-CAG-CAG)
Repeating of the CAG bases create a protein
called huntingtin (Htt)
< 36 repeat is Htt but > 36 is mHtt
60. NUMBER OF CAG REPEATING DETERMINE ONSET
Repeated count Classification Disease Status
< 27 Normal unaffected
27-35 intermediate unaffected
36-39 Reduce
penetrance
+/- affected
>39 Full
penetrance
affected
62. SYMPTOMS
• Motor
• Cognitive
• psychosocial
• Chorea, muscle rigidity, unbalanced
gait, tremor, dysphasia and choking
Difficulty processing information and
concentration, loss of memory, poor
judgment
• Aggressive antisocial behavior,
aggression toward others, depression
63. GENETIC ASSOCIATION
• Single gene & chromosome
related disorder
• Is autosomal dominant
disorder
• HD is inheritance/ sporadic
mutation due to (radiation,
chemical, and viral infection)
65. Nursing Diagnosis
• Risk for injury
• Risk for self-mutilation (suicide)
• Risk for imbalance nutrition less the body requirement
• Mobility impair
• Risk for ineffective airway
• Chronic confusion
• Powerlessness
• Hopelessness
• Memory impairment
• Impaired communication
66. Intervention
• Monitor pt for self-harm (sleeping, home safety)
• Keep pt away from sharp objects
• Feed pt slowly
• Use communication strategies
• Encourage pt to be socially active
• Group homes or nursing home
• Outpatient therapy (physical/speech)
• Educate family
• palliative care