2. SEIZURE
SEIZURES
• Seizures are symptoms of a brain problem.
• They happen because of sudden, abnormal electrical activity in the brain.
• When people think of seizures, they often think of convulsions in which a
person's body shakes rapidly and uncontrollably.
• Not all seizures cause convulsions.
• There are many types of seizures and some have mild symptoms.
• Seizures fall into two main groups. Focal seizures, also called partial
seizures, happen in just one part of the brain.
• Generalized seizures are a result of abnormal activity on both sides of the
brain.

3. ANATOMY
The brain is well
protected by:
• The scalp
• The Skull
• The Dura

4. ANATOMY
THE DURA
• A tough 3-layer sheath that
surrounds the brain and
spinal cord
• Layers include
– the dura mater (strongest layer)
– arachnoid mater (middle layer)
– and pia mater (closest to the brain)

5. ANATOMY
THE CEREBRUM
• Made up of two cerebral hemispheres
that are connected in the middle
• It is the largest part of the brain
• Each area of the cerebrum performs
an important function, such as
language or movement
• Higher thought (cognition) comes
from the frontal cortex (front portion
of the cerebrum)
• Outside of the cerebrum are blood
vessels
• There are fluid-filled cavities and
channels inside the brain

6. ANATOMY
THE CEREBELLUM
• Located in the lower, back part of the skull
• Controls movement and coordination
THE BRAINSTEM AND PITUITARY
GLAND
• Responsible for involuntary functions such as
breathing, body temperature, and blood
pressure regulation
• Pituitary gland is the "master gland" that
controls other endocrine glands in the body,
such as the thyroid and adrenal glands
• Pineal gland

7. ANATOMY
THE CRANIAL NERVES
• Twelve large nerves exit the
bottom of the brain to supply
function to the senses such as
hearing, vision, and taste
THE CEREBRAL BLOOD VESSELS
• A complicated system that
supplies oxygenated blood
and nutrients to the brain

8. ANATOMY
ANTERIOR CEREBRAL CIRCULATION
• The front of the brain is supplied
by the paired carotid arteries in
the neck.
POSTERIOR CEREBRAL CIRCULATION
• The back portion of the brain is
supplied by the paired vertebral
arteries in the spine.

9. PATHOPHYSIOLOGY
• A seizure occurs when a portion of the brain becomes overly excited or when
nerves in the brain begin to fire together in an abnormal fashion.
• Seizure activity can arise in areas of the brain that are malformed from birth
defects or genetic disorders or disrupted from infection, injuries, tumors, strokes,
or inadequate oxygenation.
• The pathophysiology of seizures results from an abrupt imbalance between the
forces that excite and inhibit the nerve cells such that the excitatory forces take
precedence.
• This electrical signal then spreads to the surrounding normal brain cells, which
begin to fire in concert with the abnormal cells.
• With prolonged or recurrent seizures over a short period, the risk of future
seizures increases as nerve cell death, scar tissue formation, and sprouting of new
axons occur.

10. PATHOPHYSIOLOGY
• Nerve cells between discharges normally have a negative charge
internally due to the active pumping of positively charged sodium ions
out of the cell.
• Discharge or firing of the nerve cell involves a sudden fluctuation of the
negative charge to a positive charge as ions channels into the cell open
and positive ions, such as sodium, potassium, and calcium, flow into the
cell. Both excitatory and inhibitory control mechanisms act to allow
appropriate firing and prevent inappropriate excitation of the cell.
• The pathophysiology of seizures can occur due to increased excitation of
the nerve cell, decreased inhibition of the nerve cell, or a combination
of both influences.

11. CAUSES
COMMOM CAUSES
• Alcohol abuse • Low blood oxygen
• Low blood pressure
• Alcohol withdrawal
• Encephalitis
• Cancer
• Low blood sugar
• Concussion • Petit-mal seizure
• Drug abuse • Stroke
• Head injury • Vasovagal syncope
• Insulin reaction • Epilepsy

12. PROBLEMS
• Depression
• Injuries that occur during the seizure:
– Fractures
– Tongue laceration
– Dental injury
– Shoulder dislocation
• Learning disabilities
• Medication side effects
• Status epilepticus:
– Seizure that lasts longer than 30 minutes
– Multiple episodes of seizure without complete recovery between
episodes

13. TYPES
I. PARTIAL SEIZURE
• SIMPLE PARTIAL SEIZURE : affect only a small region of the brain, often the
temporal lobes and/or hippocampi. People who have simple partial
seizures retain consciousness.
• COMPLEX PARTIAL SEIZURE : may involve the unconscious repetition of
simple actions, gestures or verbal utterances, or simply a blank stare and
apparent unawareness of the occurrence of the seizure, followed by no
memory of the seizure.

14. TYPES
II. GENERALIZED SEIZURES
• ABSENCE SEIZURES :
– Involve an interruption to consciousness where the person experiencing the seizure seems to
become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight
muscle twitching may occur.
• MYOCLONIC SEIZURES :
– Involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky
movements of muscles or muscle groups.
• CLONIC SEIZURES :
– Are myoclonus that are regularly repeating at a rate typically of 2-3 per second. in some cases,
the length varies.
• TONIC–CLONIC SEIZURES :
– Involve an initial contraction of the muscles (tonic phase) which may involve tongue biting,
urinary incontinence and the absence of breathing. This is followed by rhythmic muscle
contractions (clonic phase). This type of seizure is usually what is referred to when the term
'epileptic fit' is used colloquially.
• ATONIC SEIZURES :
– Involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes
called 'drop attacks' but should be distinguished from similar looking attacks that may occur in
cataplexy.

15. TYPES
III. MIXED SEIZURES
• Mixed seizure is defined as the existence of both generalized and partial seizures in the same
patient.
IV. CONTINUOUS SEIZURES
• STATUS EPILEPTICUS :
– Refers to continuous seizure activity with no recovery between successive seizures. When the
seizures are convulsive, it is a life-threatening condition and emergency medical assistance should
be called immediately if this is suspected. A tonic-clonic seizure lasting longer than 5 minutes (or
two minutes longer than a given person's usual seizures) is usually considered grounds for calling
the emergency services.
• EPILEPSIA PARTIALIS CONTINUA :
– Is a rare type of focal motor seizure (hands and face) which recurs every few seconds or minutes
for extended periods (days or years). It is usually due to strokes in adults and focal cortical
inflammatory processes in children (Rasmussen's encephalitis), possibly caused by chronic viral
infections or autoimmune processes.

16. SIGNS & SYMPTOMS
I. ABSENCE SEIZURE
• staring
• the consumer suddenly stops what they is doing
• a few seconds of unresponsiveness (usually less than 10 seconds, but it can be up to 20
seconds) that can be confused with daydreaming
• no response when you touch the consumer
• the consumer is alert immediately after the seizure
• the consumer may have many seizures per day
• Less common features include:
– repetitive blinking
– eyes rolling up
– head bobbing
– automatisms such as licking, swallowing, and hand movements
– autonomic symptoms such as dilated pupils, flushing, pallor, rapid heartbeat, or salivation

17. SIGNS & SYMPTOMS
II. MYOCLONIC SEIZURE
• one or many brief jerks, which may involve the whole body or a single arm or leg
• in juvenile myoclonic epilepsy, these jerks often occur upon waking
• the consumer remains conscious
III. ATONIC SEIZURE
• sudden loss of muscle tone
• the consumer goes limp and falls straight to the ground
• the consumer remains conscious or has a brief loss of consciousness
• eyelids droop, head nods
• jerking
• the seizure usually lasts less than 15 seconds, although some may last several
minutes
• the consumer quickly becomes conscious and alert again after the seizure

18. SIGNS & SYMPTOMS
IV. TONIC-CLONIC SEIZURE
• the consumer cries out or groans loudly
• the consumer loses consciousness and falls down
• in the tonic phase, the consumer is rigid, their teeth clench, their lips may turn blue
because blood is being sent to protect their internal organs, and saliva or foam may drip
from their mouth; they may appear to stop breathing because their muscles, including
their breathing muscles, are stiff
• heart rate and blood pressure rise
• sweating
• tremor
• in the clonic phase, the consumer resumes shallow breathing; their arms and legs jerk
quickly and rhythmically; their pupils contract and dilate
• at the end of the clonic phase, the consumer relaxes and may lose control of their bowel
or bladder
• following the seizure, the consumer regains consciousness slowly and may appear
drowsy, confused, anxious, or depressed

19. SIGNS & SYMPTOMS

20. SIGNS & SYMPTOMS
V. MOTOR SEIZURE
• brief muscle contractions (twitching, jerking, or stiffening), often beginning in the face, finger,
or toe on one side of the body
• twitching or jerking spreads to other parts of the body on the same side near the initial site
• other motor seizures may involve movement of the eye and head
• the seizure begins the same way each time
• the consumer remains conscious
VI. SENSORY SEIZURES
• seeing something that is not there, such as shapes or flashing lights, or seeing something as
larger or smaller than usual
• hearing or smelling something that is not there
• feeling of pins and needles or numbness in part of the body
• the consumer remains conscious

21. SIGNS & SYMPTOMS
VII. AUTONOMIC SEIZURES
• changes in heart rate
• changes in breathing
• sweating
• goose bumps
• flushing or pallor
• the consumer remains conscious
• strange or unpleasant sensation in the stomach, chest, or head
• changes in heart rate
• changes in breathing
• sweating
• goose bumps
• flushing or pallor
• the consumer remains conscious

22. SIGNS & SYMPTOMS
VIII. PSYCHIC SEIZURES
• problems with memory
• garbled speech
• problems with memory
• garbled speech
• sudden emotions for no apparent reason, such as fear, depression, rage,
or happiness
• feeling as though they are outside their own body
• feelings of déjà vu, or knowledge of the future

23. SIGNS & SYMPTOMS
COMPLEX PARTIAL SEIZURE
• warning sign such as a feeling of fear or nausea
• loss of awareness
• confusion after the seizure
• loss of memory about events just before or after the seizure
• loss of awareness
• blank stare
• walking or running
• screaming, yelling, or thrashing, either from sleep or while awake
• automatisms such as mouth movements, picking at air or clothing, repeating
words or phrases
• confusion after the seizure
• loss of memory about events just before or after the seizure

24. MANAGEMENT
RECOGNIZING A SEIZURE
• How a seizure affects a person, and what it may look like
depends on the part of the brain that is involved in the seizure.
A seizure is caused by an electrical disturbance in the brain.
Seizures can vary in how they look depending on the consumer.

25. MANAGEMENT
RESPONDING TO SEIZURES
• If a person you are supporting is experiencing a seizure, respond the way
that you have been trained in your individual orientation to that person
and your First Aid training.
• ALWAYS FOLLOW THE INDIVIDUAL PERSON’S SEIZURE PROTOCOL.
• Each person served by DDD has an Individual Support Plan that includes a
listing of ”risks” that may affect the person. A person with seizures should
have a risk assessment that outlines specific steps to follow when this
person has a seizure.

26. MANAGEMENT
SOME GENERAL GUIDELINES FOR RESPONDING TO SEIZURES INCLUDE:
• For convulsive type seizures:
– (convulsive means the person has uncontrollable movement of the muscles)
– Stay calm and time the seizure.
– If the person is having a convulsive type seizure, loosen any tight clothing and
remove eyeglasses if they wear them.
– Clear the area of any potential hazards that could cause an injury to the consumer
such as hard, sharp, or hot objects, but do not interfere with their movements
– if you can do so safely, turn the person’s body to the side to permit the draining of
fluids.
– Something soft should be placed under the head.
– Stay with the person. Continue to monitor the person after the seizure.
– If the person is tired, assist him/her to a quiet comfortable place and allow time to
rest.
• For non‐convulsive type seizures
– (seizures that may involve the person’s senses or behavior, but that do not involve
convulsions.)
– Time the seizure.
– Be available if they need assistance.

27. MANAGEMENT
WHAT NOT TO DO DURING A SEIZURE:
• Do NOT attempt to stop the seizure!
• Do NOT restrain the person or try to hold them down in
any way!
• Do NOT force anything between their teeth or put
anything in their mouth!
• Do NOT give the person anything to eat or drink until
s/he has fully recovered consciousness!

28. MANAGEMENT
WHEN TO CALL 911:
• FOLLOW THE PERSON’S SEIZURE PROTOCOL
– If the person does not have a known seizure disorder call 911
– If the seizure or recovery is different than what is typical for that person, call 911
– If a seizure lasts longer than 5 minutes call 911! (unless you have been instructed
otherwise in the individual orientation to the person)
– If a person is having repeated seizures call 911
– If the person’s well being is in question, call 911
– If a person has trouble breathing after the seizure (lips or nail beds turning blue), call
911
– If a person is injured or seems to be in pain, call 911
– If you think the person’s health, well‐being, or life are in danger, call 911

29. MANAGEMENT
REPEATED SEIZURES
• Can be life‐threatening!
• CALL 911!
• Almost all seizures end naturally with no intervention within a few
minutes. The person may be tired and confused following a seizure and
need to sleep. If however a person does not completely recover from one
seizure before beginning another one, it’s possible that they are
experiencing status epilepticus, a life‐ threatening seizure. If in question,
call 911!
SUPPORTING A PERSON AFTER A SEIZURE
• Provide any needed first aid for minor injuries or call 911 if necessary
• Be calm, friendly and reassuring
• Help the person to an area where they can rest comfortably
• The person will is likely to be very tired. Allow them to rest. They may
sleep very deeply for a period of time following a seizure.
• The person may seem confused or disoriented following a seizure.

30. MANAGEMENT
AFTER A SEIZURE
• Once the seizure is over, and the person is safe and comfortable, you will
need to document some information about the seizure. When completing
your documentation of the seizure:
• Note the time the seizure started and ended
• Note the characteristics of the seizure
– Did the person lose consciousness?
– Were they incontinent?
– Did they experience convulsions?
– What body parts were involved?
– Was there a change in the coloring of the skin, or a blue tint to the lips or nail‐beds?
– What was the consumer’s condition following the seizure, i.e. were they confused, did
they have a headache, were they aware of their environment?
• When it is safe to do so, write a seizure report and/or incident report
following your agency’s policy.
• After a seizure, a person is often very tired. Assist them as necessary to a
place where they can rest.