Consists of loss of consciousness, abnormal body movement or motor activity, abnormal behavior, or sensory involvement. Some patients experience an aura prior to a seizure. Some causes are unknown but some are at greater risk from head trauma be it acute or in their history. If cause is unknown it is idiopathic , typically starting at a young age. New onset seizures usually slows down until the older years then can be contributed to other co-morbidities such as stroke, dementia, diabetes, tumors etc. Essentially what happens during a seizure is that the neurons in the brain go into a hyperexcited state, oxygen and glucose needs are increased and used up, if the seizure lasts for a long time, as in status epilepticus, severe hypoxia can occur resulting in brain injury.
Partial seizures can actually be broken down into several groups, please review those. However, it depends on what part of the brain is effected. It can be motor, sensory, autonomic, or psychic. There are complex seizures as well, which involve more activity, with repetitive movements or a dream like state that the patient will not usually remember. They may be very subtle and not noticeable. Partial seizures may become general as well. General seizures are known to cause the patient a loss of consciousness. There are types of general seizures as well. Absence seizures are also called petit mal seizures. These are the ones where the patient appears to be staring off into space but has no loss of consciousness and occur in childhood. The grand mal seizure is the one most associated with seizures however only about 10% of all epilepsy patients experience these. Page 1813-1814 goes into detail about the stages of one of these. The greatest issue with these is keeping the patient safe. There are three phases to seizures as well. Preictal, ictal, and postictal. Preictal is the preseizure, ictal is during the seizure, and postictal is the period following. Status Epilepticus is continued seizure activity basically lasting over 30 minutes. This is considered an emergency. There is usually a loss of consciousness but doesn’t necessarily have to be the case. One of the main reasons patients go into status epilepticus is the withdrawal of antiseizure meds, fever, and infection. A major complication due to the respiratory involvement from the muscular contractions and brain activity is the lack of oxygen in the brain, resulting in brain damage.
A thorough health history must be obtained in order to determine the possible cause of the seizures. The nurse must ask the family members questions in many cases as seizures usually affects young children and the elderly. Head injuries, fevers, anything unusual that may have occurred needs to be discussed with the doctor. A thorough neuro assessment needs to be completed as well. Diagnostic procedures include EEGs, CT scans and MRIs. The CT scans and MRIs can be used to look for tumors or some other lesions that may be causing the seizure. Lab work may be drawn to look for infection or other issues. The type of seizures is determined as well as frequency and anything that triggers them. Sometimes women may experience more during their menstrual cycle as well.
Medical management is usually outpatient after epilepsy is initially diagnosed. Inpatient care may come again at times if seizure activity increases or there is an exacerbation or infection etc. The patient is almost always on an antiseizure medication. Study Tegretol, Dilantin, Depakote, Keppra. There are several side effects to these medications, one being toxicity. Levels need to be checked regularly and one of the main issues with increased seizure activity is low blood levels. These medications can get adjusted frequently if needed. Probably the biggest issue is prevention of the seizures and that is where medication compliance comes into the picture. The cost can be a factor as well. When a patient has a seizure, safety is the primary concern.