Seizures Simplified

First things first, what are seizures? A seizure is a sudden, uncontrolled burst of electrical activity in the brain. Seizures are classified as either focal seizures or generalized seizures. Focal seizures are further described according to which area of the cortex is agitated; or example, if the motor cortex is involved, the patient will exhibit abnormal movements. Generalized seizures involve the entire cortex and include tonic-clonic seizures (grand mal), clonic seizures, myoclonic, atonic, and absence seizures.

The presence of seizures indicates that there is an area or areas that are hyper-excitable and have a low threshold for stimulation. So what causes these easily stimulated areas of the brain to become activated in the first place? It’s as easy as remembering VITAMIN D: V(ascular)- CVA, I(nfectious)- meningitis/ encephalitis, T(rauma), A(utoimmune), M(etabolic)- hypoglycemia, (I)diopathic-chronic epilepsy, N(eoplasia), D(rugs & toxins) (ninjanerd.org).

When thinking about all these potential underlying causes of seizures, the next thing to consider is the pathophysiology of seizures at the neuronal level. There are two primary neurotransmitters responsible for regulating activity among neurons: GABA and glutamate. GABA is an inhibitory neurotransmitter and glutamate is an excitatory neurotransmitter; so decreased GABA activity and/or increased glutamate activity contribute to the activation of hyper-excitable neurons and seizures.

Before we discuss the various medications and interventions used to treat and reverse seizure activity, let’s break down the different types of seizures a little further, especially the ones you might see on exams:

Generalized (entire cortex is affected):

·

Tonic-clonic (grand mal)

o May experience an aura (15 minute warning)

o Loses consciousness

o Two phases: Tonic (body stiffens) and clonic (recurrent jerking)

o At risk for status epilepticus!

o If lasts greater than 5 minutes, intervention is required!

o Post-ictal for hours-days

·

Clonic

o Recurrent jerking

· Myoclonic

o Recurrent muscle jerking

o NO loss of consciousness!

·

Atonic

o Patient goes completely limp

·

Absence

o Pediatrics

Focal Seizures (affects a specific part of cortex)

·

Simple partial

o Patient is aware!

·

Complex partial

o Patient is not aware!

Ok, so we know what seizures are, the pathophysiology, the most common types of seizures, but what are we going to do when our patient experiences a seizure?

For every patient at risk for seizures, the nurse will implement seizure precautions: O2/suction at bedside, IV access, padded side rails, bed lowest/locked, remove restrictive clothing or any items that may potentially injure the patient during a seizure. During a seizure, always remember the A-B-Cs! First, the nurse should ensure patient safety by assisting them to the ground if needed. The airway will be protected by turning the patient to their side and possibly inserting a nasal trumpet for adequate ventilation. NEVER put anything in the patient’s mouth! NEVERY try to restrain a patient during an active seizure! NEVER leave the patient! Also, be sure to consider underlying causes because reversing VITAMIN D will be the first line treatment!

Aside from protective interventions, which medications will be administered during a prolonged or idiopathic seizure (status epilepticus)? Well, remember the underlying patho…we will give drugs that increase GABA activity and drugs that inhibit glutamate activity.

1st: Benzodiazepines (Lorazepam)

· Reversal: Flumazenil

2nd: Phenytoin, Fosphenytoin

· Gingival hyperplasia

· SJS

· Therapeutic level: 10-20

Valproic acid

3rd: Infusion of propofol

4th: Barbiturates: Phenobarbital- Status epilepticus

· Cardiac/respiratory depression

· Therapeutic level: 15-40

I hope this post has been helpful! Be sure to look around the site for additional helpful resources and follow us on IG (nursingschool911) for daily updates and practice questions!