Seizure Study

A seizure is a sudden disruption of the brain’s normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations. Epilepsy is a condition characterized by recurrent seizures with symptoms that vary from a momentary lapse of attention to severe convulsions. Types of seizures Grand-Mal Seizures – This type of seizure presents as a generalized tonic-clonic seizure that often begins with a loud cry before the person having the seizure loses consciousness and falls to the ground.

The muscles become rigid for about 30 seconds during the tonic phase of the seizure and alternately contract and relax during the clonic phase, which lasts 30-60 seconds. The skin sometimes acquires a bluish tint and the person may bite his tongue, lose bowel or bladder control, or have trouble breathing. A grand mal seizure lasts between two and five minutes, and the person may be confused or have trouble talking when he regains consciousness. The period of time immediately following a seizure is known as the “post-ictal” state.

Primary generalized seizures – This is a primary generalized seizure that occurs when electrical discharges begin in both halves (hemispheres) of the brain at the same time. Primary generalized seizures are more likely to be major motor attacks than to be absence seizures. Absence (petit mal) seizures – This type of seizure generally begin at about the age of four, and usually stops by the time the child becomes an adolescent. Petit Mal seizures usually begin with a brief loss of consciousness and last between one and 10 seconds.

A person having a petit mal seizure becomes very quiet and may blink, stare blankly, roll his eyes, or move his lips. A petit mal seizure lasts 15-20 seconds. When it ends, the person who had the seizure resumes whatever he was doing before the seizure began. He will not remember the seizure and may not realize that anything unusual has happened. Untreated, petit mal seizures can recur as many as 100 times a day and may progress to grand mal seizures. Myoclonic seizures – This type of seizure is characterized by brief, involuntary spasms of the tongue or muscles of the face, arms, or legs.

Myoclonic seizures are most likely to occur first thing in the morning. Simple Partial seizures – This type of seizure does not spread from the focal area where they arise. Symptoms are determined by what part of the brain is affected. The patient usually remains conscious during the seizure and can later describe it in detail. Complex Partial seizures – This type of seizures presents with a distinctive smell, taste, or other unusual sensation (aura) may signal the start of a complex partial seizure. Complex partial seizures start as simple partial seizures, but move beyond the focal area and cause loss of consciousness.

Complex partial seizures can become major motor seizures. Although a person having a complex partial seizure may not seem to be unconscious, he does not know what is happening and may behave inappropriately. He will not remember the seizure, but may seem confused or intoxicated for a few minutes after it ends. PATHOPHYSIOLOGY Causes of Seizures? Most cases of epilepsy are of unknown origin. Sometimes, however, a genetic basis is indicated, and other cases may be traceable to birth trauma, lead poisoning, congenital brain infection, head injury, alcohol or drug addiction, or the effects of organ disease.

Known causes of Epilepsy and other seizure disorders can include: • Brain tumor (Lesions that occupy space) • Cerebral hypoxia (breath holding, carbon monoxide poisoning, anesthesia) • Cerebrovascular accident (infarct or hemorrhage) • Convulsive or toxic agents (lead, alcohol, picrotoxin, strychnine) • Alcohol and drug use withdrawal • Eclampsia • Hormone changes during pregnancy and menstruation • Exogenous factors (sound, light, cutaneous stimulation) • Fever (especially in children • Head injury (highest incidence is found in young adults) • Heat stroke • Infection (acute or chronic).

• Metabolic disturbances (diabetes mellitus, electrolyte imbalances) • Withdrawal from, or hereditary intolerance of, alcohol • Kidney failure (uremia, phenylketonuria) • Degenerative disorders (senile dementia) Note: Triggers for the seizures also vary widely. Among the factors that can bring on seizures are certain chemicals or foods, sleep deprivation, stress, flashing lights, menstruation, some prescription and over-the-counter medications, and possibly oral contraceptives What Is the Cause of Seizures on Dialysis Seizures are commonly seen in patients on hemodialysis.

They generally occur during or shortly after the dialysis procedure. Preventive measures can help the patients avoid the condition. Seizures in hemodialysis is mainly due to the following factors: Uremic encephalopathy Uremic encephalopathy is a brain disorder and it develops in patients with acute ore chronic renal failure. It has a complex pathophysiology and many toxins build up in body may be contributive. Dialysis disequilibrium syndrome Dialysis disequilibrium syndrome is a central nervous system disorder and it is a significant clinical problem in dialysis patients.

It is due primarily to cerebral edema. Patients who start dialysis recently are at increased risk. Dialysis dementia due to aluminum intoxication Dialysis dementia is mainly seen among long-term dialysis patients. It is due to aluminum intoxication as from aluminum-containing compounds in the dialysis fluid. The main symptoms of aluminum intoxication include reduced thinking ability, dementia, muscle cramps and seizures, etc. Hemodynamic instability Hemodynamic instability, whether hypertension or hypotension can be contributive to seizures on hemodialysis.

As hemodialysis has to remove the accumulated fluids is such a short time, it is very likely to cause hemodynamic instability, thus leading to seizures. It is important for the patients to keep their dry weight. Apart from the above the above causes, seizure on hemodialysis may also be caused by the following factors: * Drugs, such as erythropoietin, carbapenem and ertapenem * Cerebrovascular disease, such as hypertensive encephalopathy, infraction, hemorrhage and subdural hematoma * Electrolyte disorders, such as hypercalcemia, hypocalcemia, hypoglycemia, hyperglycemia, and hypernatremia *Alcohol withdrawal

* Air embolism If seisures occur, treatment should be taken immediately to keep the condition under control. Once the illness condition become stable, a through test should be performed to find out the causes of seisures for people on hemodialysis. Preventive measures can help avoid the onset of another critical issue. – See more at: http://www. kidneyabc. com/dialysis/1089. html#sthash. ZtZTjMpp. dpuf SIGNS AND SYMPTOMS Diagnosis: • The first step in diagnosing a seizure disorder is to determine whether or not the patient “did” or “did not” actually have a seizure.

To do this the following is required: • Past medial history • Careful history of clinical presentation and events related to alleged seizure • General physical and neurological examination • Diagnostic testing which include: • Computed Tomography (CT Scan) • Magnetic Resonance Imaging (MRI) • Electroencephalogram (EEG) Management Once a seizure disorder of Epilepsy has been diagnosed the first line of treatment is usually medication therapy that focuses on reducing the frequency and severity of the seizures. The goal is to find a medication that will control the seizures but not produce side effects.

Because many people will continue on medication for many years, selection of a good first drug is extremely important. Anticonvulsants and other prescription agents are usually prescribed based on the type of seizures that the patient is experiencing. The following medications are frequently prescribed: • Benzodiazepines – which are a family of drugs, used to treat insomnia, anxiety, panic attacks, muscle spasms, and seizure disorders. Examples include: o Clonazepam (Klonipin) o Clorazepate (Tranxene) o Diazepam (Valium) • Phenytoin (Dilantin) – a synthetic drug that is classified as a hydantoin.

It is used for the treatment of simple partial, complex partial and generalized tonic-clonic seizures. Phenytoin blocks post-tetanic potentiation by influencing synaptic transmission through voltage sensitive sodium channels. • Carbamazepine (Tegretol) – used as a first line agent for the treatment of simple partial, complex partial and generalized tonic-clonic seizures. The mechanism of action is depression of transmission via the nucleus ventralis anterior thalamus, which acts to decrease the spread of seizure discharge.

• Lamotrigine (Lamictal) – used when seizures are focal in onset, tonic-clonic, atypical absence and/or myoclonic in nature. • Valproate (Depakote) – used for the management of myoclonic, tonic, atonic, absence and generalized tonic-clonic seizures especially with patients with one or more type of generalized seizure. • Phenobarbital (Luminal) – Once a mainstay in the treatment of seizures (especially status epilepticus), Phenobarbital is now being replaced by other anticonvulsants but can still be used for the treatment of generalized seizures except for absence and partial seizures.

Side Effects of Anticonvulsants: The following are mild side effects that are experienced while taking anticonvulsants. Often, these side effects will go away as the patient gets used to the medication or can be resolved by adjusting the medication dose. • Visual disturbances • Lightheadedness • Balance problems • Confusion • Mild gastrointestinal dysfunction • Headaches • More serious side effects that may require the discontinuation of the drug include: • Rash • Easy bleeding (bruising).

• Jaundice (and other symptoms of blood or liver problems) Note: Some antiepileptic drugs will require routine monitoring of blood counts and liver function, so that any problems caused by the drugs, however rare, can be caught early. Diet: In addition to anticonvulsant medication, a ketogenic diet is a dietary approach based on the observation that ketosis (increased blood levels of ketones) is associated with the reduction of seizures. Ketosis can be produced by a diet high in fat and very low in carbohydrates and protein. Nursing care and management of seizures in the acute setting: Before (and During) Seizure Care:

• If the patient is seated when a major seizure occurs, ease them to the floor • Provide privacy if possible • If patient experiences an aura, have them lie down to prevent injury • Remove eyeglasses and loosen restrictive clothing • Do not try to force anything into the mouth • Guide the movements to prevent injuries (do not restrain patient) • Stay with the patient throughout the seizure to ensure safety • Time the seizure (seizure events often seem much longer then they really are) • Verbalize events as they happen to assist with more accurate recall later • If not already available have someone retrieve O2 and suction Post Seizure Care:

• Position patient on their side to facilitate drainage of secretions • Provide adequate ventilation by maintaining a patent airway • Suction secretions if necessary to prevent aspiration • Allow the patient to sleep post seizure • On awakening, orient patient to what has occurred Nursing care and management for Status Epilepticus in the acute setting (defined as seizures lasting at least 5minutes or two or more seizures in a row without complete recovery in between) Initial Nursing Management: • ABC’s of life support.

• Position patient to avoid aspiration or inadequate oxygenation • If possible as soft oral airway can be placed (again do not force teeth apart) • Suction and O2 must be available • Monitor respiratory function with ongoing pulse oximetry • IV access should be secured • Frequent monitoring of neuro exam and vital signs • Monitor ABG’s (profound metabolic acidosis can occur during seizures) • Monitor Glucose (hyperglycemia followed by hypoglycemia is common) • Treat hyperthermia (occurs often with status epilepticus) aggressively Seizures are not uncommon in patients undergoing hemodialysis [1].

Since they are more frequent in those who require acute dialysis for a severe uremic state, the current trend toward earlier initiation of dialysis has resulted in a lower incidence of seizures among these patients. Seizure activity generally tends to occur during or shortly after the dialysis procedure because of the hemodynamic and biochemical changes associated with the process [1]. Preventive measures should therefore be initiated in patients with predisposing factors, such as extreme uremia or severe electrolyte abnormalities [2] http://www. uptodate. com/contents/seizures-in-patients-undergoing-hemodialysis Thomas A. Golper MD.

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Seizures are an uncontrolled condition that electrical activity in the brain produces convulsion. These convulsions may be minor physical signs, disturbances, and or a combination of symptoms together. Seizures can be caused by head injuries, tumors in the brain, poisoning …

Seizures happen when the brain cells send out abnormal signals. When people have recurrent seizures it called a seizure disorder also known as Epilepsy. There are two general types of seizures; partial seizures and generalized seizures. Small partial seizures involve …

Physical examination in a patient who has just recovered from a paroxysmal event may hint at the diagnosis. In case of Patient X, physical examination revealed mild right hemiparesis with a reduction of tone and reflexes consistent with a post–ictal …

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