Seizure+disorders

- abnormal, uncontrolled electrical discharge from a group of neurons in the cerebral cortex. - not a disease but a symptom of underlying CNS dysfunction - caused by spontaneous, uncontrolled, paroxysmal, transitory discharges from cortical centers in the brain. - It is different from __Convulsion__- specific type of motor seizure involving the entire body. __ Provoked and Unprovoked Seizures __ Unprovoked (primary or idiopathic) - those for which no identifiable cause can be determined, can be genetic. - most unprovoked seizures occur in the setting of an epileptic syndrome. Provoked (secondary or acute symptomatic) - include febrile seizures, seizures precipitated by systemic metabolic conditions, and those that follow a primary insult to the CNS. - In all cases of provoked seizures, treatment of the immediate underlying cause often results in their resolution. __Epileptic syndromes__-recurrent seizures - may occur as a reversible symptom of another disease condition or as a recurrent condition called epilepsy. - Patients with an epileptic syndrome may have several seizure types. __ Epileptic seizures __ a. __Partial seizures__ - local onset, beginning in one hemisphere. Divided into three:
 * SEIZURE and DRUGS **

- Jacksonian seizure- epileptic-type “march,” seen in seizure affecting motor area of the brain. - sensory portion of the brain involvement shows no observable clinical manifestations. - prodrome or aura - only a small area of the brain is involved and consciousness is maintained, can be a warning sign since pt is still conscious they can describe this. This can lead to complex and generalized complex seizures.
 * simple partial seizures**- consciousness is not lost, classified according to motor signs, sensory symptoms, autonomic manifestations, and psychic symptoms. Observed clinical signs and symptoms depend on the area of the brain where the abnormal neuronal discharge is taking place:

- may be referred to as temporal lobe seizures or psychomotor seizures. - involve impairment of consciousness and often arise from the temporal lobe. - The seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres. Often are accompanied by __automatisms-__ repetitive, nonpurposeful activity such as lip smacking, grimacing, patting, or rubbing clothing. Confusion, hallucinations and illusional experiences such as déjàvu/jamais vu have been reported. Overwhelming fear, uncontrolled forced thinking or a flood of ideas, and feelings of detachment and depersonalization sometimes they are believed to require hospitalization for a psychiatric disorder. (mistaken for mentally ill)
 * complex partial seizures**- begin in one hemisphere but progress to involve both.


 * secondary generalized seizure**- These seizures are focal at onset but then become generalized as the seizure activity spreads, involving deeper structures of the brain. Discharges spread to both hemispheres, resulting in progression to tonic-clonic seizure activity.

b. __Generalized seizures__- involve both hemispheres and include unconsciousness rapidly occurring, widespread, bilateral symmetric motor responses.

- typically occur only in children and cease in adulthood; have been characterized as manifesting with a blank stare, motionlessness, and unresponsiveness, motion occurs in many cases of typical absence seizures. may take the form of automatisms, increased or decreased postural tone, and autonomic phenomena. often a brief loss of contact with the environment. usually lasts only a few seconds, manifestations often are so subtle that they may pass unnoticed.
 * Absence**- Absence seizures, formerly referred to as //petit mal seizures//, are generalized, nonconvulsive epileptic events and are expressed mainly as disturbances in consciousness.


 * Atypical absence seizures** are similar to typical absence seizures except for greater alterations in muscle tone and less abrupt onset and cessation. To differentiate, EEG findings needed. important to distinguish between the two types of seizures because the drug treatment is different. Medications that are effective for partial seizures may increase the frequency of absence seizures.


 * atonic**- akinetic seizures, there is a sudden, split-second loss of muscle tone leading to slackening of the jaw, drooping of the limbs, or falling to the ground. These seizures also are known as drop attacks.


 * myotonic**- involuntary muscle contractions. involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities.

Tonic phase -> the clonic phase= rhythmic bilateral contraction and relaxation of the extremities. Postictal phase- end of clonic phase RAS function but still unconscious.. The tonic-clonic phases last approximately 60 to 90 seconds. Tonic seizures are characterized by a rigid, violent contraction of the muscles, fixing the limbs in a strained position. Clonic seizures consist of repeated contractions and relaxations of the major muscle groups.
 * tonic-clonic seizures**- aka grand mal seizures. common major motor seizure; has sharp tonic contraction of the muscles; extension of the extremities;loss of consciousness; Incontinence of bladder and bowel; Cyanosis.

c. __Unclassified seizure__- observed in neonates and infants. Determination of focus not possible Control of seizures is the primary goal of treatment and is accomplished with anticonvulsant medications. Anticonvulsant medications interact with each other and need to be monitored closely when more than one drug is used.

ANTI SEIZURE DRUGS

HYDANTOIN - **Phenytoin (Dilantin)-** tx tonic-clonic seizure and status epilipticus; prevent after neurosurgery __ Actions __ - Stabilize nerve membranes and limit the spread of excitability from the initiating focus __ Indications __ - Treatment of tonic–clonic seizures __ Contraindications __ - Hepatic or renal impairment at increased risk of toxicity __ Adverse reactions __ - Nystagmus, ataxia, dysarthria, slurred speech, dizziness, fatigue, headache, dermatitis, and gingival hyperplasia __ Nursing Administration Issues __ See purple box pg 373 - Do not mix phenytoin IV in any solution other than NS. Infusion faster than 50mg/min can cause dysrhythmia - Monitor serum drug levels q 6-12 hours when initiating therapy, then q 2 wks on oral doses __ Drug-to-drug interactions __ - Alcohol BARBITURATES/BARBITURATE-LIKE DRUG **- Phenobarbital (//Solfoton, Luminal//)-** Emergency control of status epilepticus and acute seizures; management of tonic–clonic and cortical focal seizures; treatment of simple partial seizures __ Actions __ - CNS depressants; inhibit impulse conduction in the ascending RAS __ Indications __ - Long-term treatment of generalized seizures and emergency control of certain acute convulsive episodes __ Adverse reactions __ Somnolence, insomnia, vertigo, hallucinations, and anxiety __ Nursing Administration Issues __ - Safety measures-increased risk for falls, - Do not administer if RR<10 - Instruct client to avoid operating heavy machinery, avoid alcohol and OTCs with alcohol