Neurological disorders

1. SEIZURE DISORDER
BY –
SHUBHRIMA KHAN

2. DEFINITIONS
• SEIZURE: Seizure is a transient, uncontrolled electrical discharge of neurons in
the brain that interrupts normal function.
• CONVULSION :A convulsion is a medical condition where body muscles
contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of
the body. Motor manifestation of seizure.
• EPILEPSY: Epilepsy is a condition to have recurrent seizures, with
neurobiological, cognitive, psychologic, and social consequences.

3. ETIOLOGY
PERINATAL
• HIE*(hypoxic Ischemic encephalopathy)
• Intra ventricular Hemorrhage *
• Cerebral malformation.
• Intra uterine TORCH Infection.
• Maternal drug abuse
• Radiation exposure.
• Perinatal trauma and anoxia

4. CONT..
TOXIC CAUSES
• DRUGS: phenothiazine, MAOI, TCA overdose
• Rapid withdrawal of antiepileptic and benzodiazepam
• Chronic alcohol abuse
• CO, lead , Hg poisoning.
INFECTIONS
• Encephalitis.*
• Meningitis.*
• Brain Abcess

5. CONT..
INTRACRANIAL EVENTS
– Brain tumor
– Subarachnoid hemorrhage
– Stroke
– Hypertensive crisis
– Increased ICP secondary to clogged shunt
METABOLIC IMBALANCES
– Fluid and electrolyte imbalance
– Hypoglycemia

6. CONT..
SYSTEMIC DISORDER
• Vasculitis.
• Systemic Lupus Erythematosus
• Hypertensive Encephalopathy.
• Renal failure.
• Hepatic Encephalopathy
OTHERS
• Trauma.
• Febrile convulsion.
• Idiopathic.
• Familial. (mostly absence seizure )

7. PHASES OF SEIZURE
Depending on the type, a seizure may occur in multiple phases:
1. Prodromal phase: started with sensations or behavior changes that precede a
seizure;
2. Aural phase: with a sensory warning that is similar each time a seizure occurs
3. Ictal phase: lasts from first symptoms to the end of seizure activity.
4. Postictal phase: the recovery period after the seizure.

8. CLASSIFICATION
1. PARTIAL SEIZURES: Also called focal seizures. The neurologic
abnormality may be limited to a specific part of the brain.
A. Simple partial seizures (no impairment of consciousness): patients remain
conscious but experience unusual feelings or sensations. They may
experience sudden and unexplainable feelings of joy, anger, sadness, or
nausea. They also may hear, smell, taste, see, or feel things that are not real.
B. Complex partial seizures: (impairment of consciousness): patients have a
loss of consciousness or an alteration in their consciousness, producing a
dream like experience. They display strange behavior such as lip smacking
and automatisms (repetitive movements that may not be appropriate).

9. CONT..
2. GENERALIZED SEIZURES:
• The seizure may involve the entire cortical surface (cerebral cortex).
• It involves both sides of the brain and are characterized by bilateral
synchronous epileptic discharges in the brain.
• In most cases the patient loses consciousness for a few seconds to several
minutes.
• It is further classified into
A. Absence (Petit mal)
B. Tonic clonic. (Grand mal)
C. Tonic
D. Clonic
E. Myoclonic.
F. Atonic.

10. CONT..
A. Absence seizure: These are abrupt periods of staring spell and lapses of
awareness lasting a few seconds to a few minutes.
B. Tonic-Clonic Seizures: The most commonest form of generalized seizure.
Tonic-clonic seizure is characterized by losing consciousness and falling to the
ground if the patient is upright, followed by stiffening of the body (tonic phase)
for 10 to 20 seconds and subsequent jerking of the extremities (clonic phase) for
another 30 to 40 seconds. Cyanosis, excessive salivation, tongue biting, and
incontinence may accompany the seizure.

11. CONT..
C. Tonic seizures: These include an abrupt increase in muscular tone & muscular
contraction. In addition, there is a loss of consciousness and the presence of
autonomic manifestations. It may last from 30 seconds to several minutes.
D. Clonic seizures: The clinical manifestations of clonic seizures include rhythmic
muscular contraction & relaxation lasting several minutes. Distinct phases of
clonic seizures are not easily observed.

12. CONT..
E. Myoclonic seizure: This type involves sudden uncontrolled jerking movements
of either a single muscle group or multiple groups, sometimes causing the client
to fall. The client loses consciousness for a moment and then is confused
postictally. These seizures often occur in morning.
F. Atonic seizures: These are associated with a total loss of muscle tone. They
may be mild, with the client briefly nodding the head (a gesture in which the
head is tilted in alternating up and down arcs), or the client may fall to the floor.
Consciousness is impaired only briefly.

13. CLINICAL MANIFESTATIONS
• Aura (peculiar sensations that precede seizure)
• Loss of consciousness
• Bowel and bladder incontinence
• Tachycardia
• Diaphoresis
• Increased salivation
• Warm skin
• Pallor, flushing, or cyanosis
• Tonic phase: Continuous muscle contractions
• Clonic phase: Rigidity and relaxation alternating in rapid succession
• Postictal phase: Lethargy, altered level of consciousness
• Confusion and headache

14. INVESTIGATIONS
• A complete seizure profile and history taking.
• Physical examination including neurologic examination & description of seizure
activity.
• Major diagnostic tool i.e., EEG (electroencephalogram). This test assists in
locating the focus of abnormal electrical discharges.
• CT scan & MRI are used to rule out brain lesions that can trigger seizures.
• PET (positron emission tomography) & SPECT (single photon emission computed
tomography) may be helpful to measure cerebral blood in clients undergoing
surgery for epilepsy.
• Lab studies may rule out other causes for the seizures: RBS, CBC, KFT, LFT,
Lumbar puncture, etc.

15. SEIZURE MANAGEMENT

16. CONT..
1. DRUG THERAPY: the drug of choice for seizure disorder are –
• Hydantoin (phenytoin, phosphenytoin): it blocks the sodium channels in the neurons,
inhibits abnormal firing of neurons and produces antiseizure effect.
• Barbiturate (phenobarbitone): act by enhancing the action of GABA through binding
to a site on the GABA-A receptor/chloride channel, thereby increases the amount of
time chloride channels are open.
• Carboxylic acid derivatives (sodium valproid): it blocks Na+ channels, increases
activity of GABA.
• Iminostilbences (Carbamazepine): like phenytoin it also blocks Na+ channels and
thereby reduces the neuronal excitement.
• Benzodiazepine (diazepam, lorazepam): They act by facilitating the binding of the
inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.
• Others (gabapentin, lamotrigine): act by releasing GABA

17. CONT..
2. SURGERY:
• Resectioning of the epileptogenic tissue: It involves the removal of a small portion
of the brain. This is usually the site of a tumor, brain injury or malformation
• Callosotomy: Sectioning of corpus callosum (bundle of nerve fiber that connect the
two hemispheres.
• Hemispherectomy: radical surgical procedure where the diseased half of the brain
is completely or partially removed from the normal hemisphere.

18. Callosotomy Hemispherectomy

19. CONT..
3. VEGUS NERVE STIMULATION:
• A surgically implanted electrode in the neck is
programmed to deliver the electrical impulse to
the vagus nerve, usually on the left side. The
patient can activate it with a magnet when he or
she senses a seizure is imminent.
• It interrupts the synchronization of epileptic
brain wave activity and stop excessive discharge
of neurons.

20. NURSING MANAGEMENT
Nursing Diagnoses:
• Ineffective breathing pattern related to neuromuscular impairment
• Ineffective health management related to drug therapy and lifestyle adjustments
• Risk for injury related to loss of consciousness during seizure activity and postictal
physical weakness.

21. COMPLICATIONS
• Fracture of bone.
• Impair intelligence.
• Socially stigmatized.
• Reduced quality of life.
• Status epilepticus: SE is a state of continuous seizure activity or a condition in
which seizures recur in rapid succession without return to consciousness between
seizures. A sudden unexpected death can occur.

22. HEALTH EDUCATION
General precaution
• Take the medications as prescribed. If you forget a dose, take it, unless it’s almost
time for your next dose. If it’s time for your next dose, skip the dose you missed
and keep your regular schedule. Don’t double your dose or take extra medication.
• Don’t stop taking the medications unless your healthcare provider tells you to stop,
even if you haven’t had a seizure or if you feel better.
• Do not take any medicine without prescription.
• Report if any side effect of drug manifests.
• Always keep a Medic Alert bracelet with you. This will let people know that you
have a seizure condition if you’re unconscious or unable to speak.

23. CONT..
• Driving should be avoided.
• Be aware of water safety. Never swim without a lifeguard. Take showers instead of
baths.
• Don’t climb ladders or work at high heights.
• Make sure you use safety equipment, such as helmets and life jackets, during
recreational activities.
• Eat a healthy diet.
• Take adequate sleep
• Avoid undesirable habits if any.
• Always wear shoes or slipper while walking.
• Keep all appointments with your healthcare providers.

24. CONT..
During a seizure episode (to family members)
• Keep calm.
• Keep them away from anything dangerous, such as sharp objects.
• Turn them on their side.
• Put something soft under their head and loosen any tight clothing.
• Note how long the seizure lasts and what the seizure looks like if you can, so you
can describe it to the healthcare provider.
• Stay with them until the seizure is over.
• Notify to the healthcare provider.
• Don’t try to stop the seizure or use any restraint, such as holding them down.
• Don’t put anything in their mouth.
• Don’t let them eat or drink anything until they’re fully awake and alert.

25. THANK YOU