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Running head: TYPES OF SEIZURES AND CARE OF THE PATIENT
Types of Seizures and Care of the Patient
Stacie Valley
Ferris State University
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TYPES OF SEIZURES AND CARE OF THE PATIENT
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Abstract
According to the Epilepsy Foundation, Seizures happen when the electrical system of the brain
malfunctions. Instead of discharging electrical energy in a controlled manner, the brain cells
keep firing. The result may be a surge of energy through the brain, causing unconsciousness and
contractions of the muscles. This paper will help give a better understanding on the types of
seizures, causes, and what triggers them. The care of the seizure patient is another issue that this
paper will address. Epilepsy is a neurological condition that makes people susceptible to
seizures. A seizure is a change in sensation, awareness or behavior brought about by a brief
electrical disturbance in the brain. Seizures vary from a momentary disruption of the senses, to
short periods of unconsciousness or staring spells, to convulsions. Some people have just one
type of seizure. Others have more than one type (Epilepsy Foundation, 2012).
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Types of Seizures and Care of the Patient
According to Ko, The diagnosis of epileptic seizures is made by analyzing the patient's
detailed clinical history and by performing ancillary tests for confirmation. Someone who has
observed the patient's repeated events is usually the best person to provide an accurate history.
However, the patient also provides invaluable details about auras, preservation of consciousness,
and postictal states. A key feature of epileptic seizures is their stereotypic nature.
The goal of treatment in patients with epileptic seizures is to achieve a seizure-free status
without adverse effects. This goal is accomplished in more than 60% of patients who require
treatment with anticonvulsants. Many patients experience adverse effects from these drugs,
however, and some patients have seizures that are refractory to medical therapy (Ko, 2013).
Generalized Seizures
Generalized seizures are caused by abnormal electrical activity that occurs over the entire
brain simultaneously. This group of seizures affects the level of awareness and muscle
movement of all extremities. Following are the main types of generalized seizures (Connell,
2012).
Absence Seizures:
This type of seizure is also known as "petit mal". They are described as staring spells. At
times they are difficult to distinguish from normal daydreaming spells. These seizures typically
start in childhood and are often outgrown by adolescence, although adults can occasionally also
have absence seizures. They can happen dozens of times a day but are very brief, usually lasting
just a few seconds, so they are not always noticed. The child may get a dazed look on their face,
have some eye blinking or head bobbing and not respond to any type of stimulus. After the
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seizure is over, the child usually continues his previous activity as if nothing happened. An EEG
is very helpful with diagnosing this type of seizure. Patients usually respond very well to
medication (Connell, 2012).
Myoclonic Seizures:
These are characterized by sudden brief jerks of a single muscle or muscle group. You
may see a sudden jerk of the hand or arm that will cause them to drop or knock things over. It
may appear as if they have been startled. You may see the head or body suddenly bend forward
or backward. At times the jerk can be so strong that the child can be thrown to the ground. These
seizures are not the same thing as the periodic muscle spasms one often experiences when falling
asleep (Connell, 2012).
Atonic Seizures:
These are also very sudden brief seizures, but they involve loss of all muscle tone. The
child will suddenly go limp and fall to the ground. There is significant risk of head injury during
the fall. So, many children with this seizure type wear helmets for protection (Connell, 2012).
Tonic Seizures:
These seizures involve stiffening of parts of the body or the entire body, sometimes
causing the child to fall down. Unlike tonic-clonic seizures, there is no progression to a clonic
phase (Connell, 2012).
Tonic-Clonic Seizures:
Also known as "grand mal", these are very intense and can often be very frightening to
witness. They generally start with a tonic phase with stiffening of the entire body. The eyes may
roll back in the head, the back arches, and arms and legs stiffen. The muscles in the chest can
also stiffen so it may appear that the person is not breathing and you may see blue around the
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lips. There may be an increase in saliva or "foaming at the mouth". The clonic part is described
as rhythmic jerking of the entire body. Once the seizure is over, they may feel worn out and may
even sleep for a period of time. They may also experience some confusion (Connell, 2012).
Partial Seizures
Partial seizures, also called focal, are those seizures that begin in one part of the brain
instead of all over. Depending on which lobe of the brain the seizure comes from will determine
the way the seizure looks. Partial seizures can be classified based on either the symptoms of the
seizure or the part of the brain where they start. Based on the symptoms of the seizures, partial
seizures can be divided into simple partial seizures and complex partial seizures (Connell, 2012).
Simple partial seizures:
Simple partial seizures are noted for staying in just one area of the brain and not
interfering with the level of consciousness. Depending on the area of the brain affected, these
seizures could be expressed as shaking of a small part of the body, an unusual tingling or
numbness of a localized body part, or even an unusual smell, visual hallucination, or ill-defined
feeling. Simple partial seizures are often also called "auras". Regardless of the specific symptom,
in all simple partial seizures, the person remains completely aware and alert during the seizure
(Connell, 2012).
Complex partial seizures:
A complex partial seizure happens when the abnormal electrical activity involves parts of
the brain that affect level of consciousness. Thus, the critical feature of the complex partial
seizure is that the person has altered consciousness, so that he may be confused or staring
unresponsively. There may also be subtle, repetitive and stereotypical movements of the face or
extremities (automatisms). Although complex partial seizures can look similar to absence
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seizures, they usually last longer, typically 1-2 minutes. In addition, unlike absence seizures,
complex partial seizures often are preceded by an aura and are followed by a state of sleepiness
(Connell, 2012).
Frontal lobe:
These seizures are usually very short and often occur during sleep. They may be
described as twitching or a funny feeling in the face, a finger or leg. The person may be aware all
of this is happening (simple partial seizure). Sometimes the head will turn to one side, and the
arm on that same side will stiffen. In other cases, very bizarre or complicated movements of the
entire body can occur. The seizure may spread causing awareness to be affected and jerking of
extremities may happen (Connell, 2012).
Temporal Lobe:
This type usually involves complex partial seizures with staring and repetitive
movements that seem to happen without purpose. These movements are called automatisms.
There may also be a complaint of a funny feeling around the mouth, be unable to speak, and have
increased saliva and twitching of the mouth. You may also see twitching, jerking, or stiffening
on one side of the body. At the beginning of the seizure, they may experience a funny smell, a
sensation of fear or a funny feeling in the stomach or chest (Connell, 2012).
Parietal Lobe:
There may be a feeling of electricity or tingling sensation that may start in a certain area,
or may spread. They may complain that one part of the body feels like it is moving. Sometimes
there is a feeling of sinking, choking or nausea, or pain (Connell, 2012).
Occipital Lobe:
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These classically begin with visual problems, such as seeing flashes of light or
hallucinations. Often the child will complain that they can't see and have rapid eye blinking. The
loss of vision is temporary and will return after the seizure is over (Connell, 2012).
Diagnosing Seizures
The diagnosis of seizures is based on the patient’s clinical history. The history as related
by a witness is of high importance, because many types of seizures are associated with
impairment of consciousness, and patients are unaware of their occurrence (Connell, 2012).
Two studies are often recommended after a seizure: neuroimaging evaluation (eg, brain
magnetic resonance imaging [MRI], head computed tomography [CT] scanning) and
electroencephalography (EEG). For neuroimaging, a CT scan is often obtained in the emergency
department to exclude an obvious structural lesion, but an MRI is indicated if the patient
continues to have seizures (Connell, 2012).
Historically, prolactin levels obtained shortly after a seizure (within 20 min) have been
used to assess the etiology (epileptic or nonepileptic) of a spell. Levels are typically elevated 3or 4-fold, and elevations are more likely to occur with generalized tonic-clonic seizures than with
other seizure types. However, not only has the considerable variability of prolactin levels
precluded routine clinical use of such testing, but a baseline prolactin level is often obtained the
next day at the same time as when the seizure first occurred, which makes the testing more
cumbersome (Connell, 2012).
The American Academy of Neurology (AAN) recommends serum prolactin assays,
measured in the appropriate clinical setting at 10-20 minutes after a suspected event as a useful
adjunct for differentiating generalized tonic-clonic or complex partial seizure from psychogenic
nonepileptic seizure in adults and older children (Connell, 2012).
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Medical Management
According AANN (American Association of Neuroscience Nurses), during the ictal
phase it is important to stay with the individual, put patient on their side if possible, keep patient
airway clear (remember to never stick anything in a seizing patients mouth during an epileptic
event) and provide a safe environment. In addition to keeping the patient safe, nurses should also
observe and record the actual seizure event as it progresses. Providing information on how the
seizure started, location and duration of motor activity, patient report of sensory activity, and any
other pertinent details that might assist in the diagnosis of seizure type are important. Any
identified aggravating or precipitating factors should also be noted.
If a patient with known seizure activities is going to have a surgery/procedure, a serum
drug levels should be checked before surgery/procedure, and additional doses should be given to
attain desired and steady-state drug levels before a surgery or procedure. Oral doses can be
administered the morning of surgery/procedure with a small sip of water. If the duration of the
surgical procedure exceeds the half-life of the maintenance AED, some AEDs can be
administered intravenously. The decision to use an intravenous AED in patients maintained on
AEDs that only can be given orally depends on several factors, including the degree of
preoperative seizure control and the anticipated surgical time. The risk of seizures is minimal if
adequate blood levels are attained before surgery. Intraoperative or postoperative seizures can
occur in undiagnosed or undertreated epilepsy patients.
Treatment
Treatment for patients with epilepsy typically begins with antiepileptic drug (AED)
therapy. The goal of treatment is complete seizure control with no side effects. Prescribing
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medication is based on research and clinical practice. The U.S. Food and Drug Administration
(FDA) have approved certain AEDs to be used for certain seizure types (AANN, 2009).
• Carbamazepine (Tegretol, Tegretol XR, and Carbatrol): approved for partial epilepsy,
primaryand secondary generalized tonic-clonic (GTC) epilepsy.
• Felbamate (Felbatol): approved for partial epilepsy, adjunctive therapy in refractory
partialand generalized epilepsy.
• Gabapentin (Neurontin): approved for partial epilepsy.
• Lamotrigine (Lamictal): approved for adjunctive therapy in partial and generalized
Epilepsy.
• Levetiracetam (Keppra): approved for partial epilepsy and myoclonic epilepsy.
• Oxcarbazepine (Trileptal): approved for partial epilepsy and generalized epilepsy.
• Phenobarbital: approved for partial and generalized seizures.
• Phenytoin (Dilantin): approved for partial seizures, primary and secondary GTCs.
• Pregabalin (Lyrica): approved for partial epilepsy.
• Tiagabine (Gabitril): approved for partial and secondary generalized epilepsy.
• Topiramate (Topamax): approved for partial seizures and GTCs.
• Valproic acid (Depakene), divalproex sodium (Depakote, Depakote ER): approved for
partial seizures, absence seizures, primary and secondary GTC, atypical absence tonic,
and clonic epilepsy.
• Zonisamide (Zonegran): approved for partial epilepsy (AANN, 2009).
Most patients with epilepsy are required to take AEDs on a long-term basis. Potential
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side effects and drug interactions should be considered for each epilepsy patient. When
Physicians or other qualified practitioners prescribe AEDs, there is usually a titration process to
prevent major side effects. The titration process can depend on the prescribed AED and the
patient’s past drug reaction history. It is not uncommon for patients to complain of dizziness
while the body adjusts to each new dosage of the AED. The dizziness should subside
before the next titration occurs. If the dizziness continues, the titration process can be changed or
the practitioner may elect to prescribe another AED (AANN, 2009).
Monitoring
AEDs that are mainly metabolized in the liver will potentially have a higher incidence of
interaction with other medications and with alternative therapies that are also metabolized in the
liver. Two of the AEDs known to affect or be affected by other medications and alternative
therapies are phenytoin and carbamazepine (AANN, 2009).
It is important that blood levels with the use of AEDs be monitored, however the
meaning of AED blood level results is presently a controversial issue among practitioners.
Practitioners do however agree on the importance of monitoring of Hepatic Function Panels,
complete blood count, basic metabolic panel, and when indicated, ammonia levels as indicators
of possible side effects of therapy. For example:
• Hepatic Function Panel results monitor the effects on liver inducer AEDs such as
phenytoin; that is essential especially for felbamate. (For patients on felbamate, Hepatic
Function Panel and complete blood count need to be monitored frequently, in some
cases monthly.)
• Platelet count needs to be monitored while on AEDs such as valproic acid; white blood
counts need to be monitored while on AEDs such as carbamazepine.
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• Sodium needs to be monitored while on AEDs such as oxcarbazepine.
• Ammonia levels need to monitored while on AEDs such as valproic acid (AANN,
2009).
Conclusion
Based on the number of individuals affected with seizure disorders, Nursing plays a vital
role in both care management as well as patient education. With the complexity of seizure
disorders, baseline symptom recognition is essential for the success level of treatment and
everyday living.
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References
American Association of Neuroscience Nurses (2009). Care of the Patient with Seizures.
Retrieved from http://www.aann.org/pdf/cpg/aannseizures.pdf
Connell T. (2012). Seizure Types. Retrieved from
http://neuro.wustl.edu/patientcare/clinicalservices/pediatricepilepsycenter/patientfamilyp
hysician/seizuretypes/
Epilepsy Foundation of America (2012). Seizures. Retrieved from
http://www.epilepsyfoundation.org/aboutepilepsy/seizures/
Ko D.Y. (2013). Epilepsy and Seizures Treatment & Management. Retrieved from
http://emedicine.medscape.com/article/1184846-treatment
Schachter S.C. (2004). About Epilepsy & Seizures. Retrieved from
http://professionals.epilepsy.com/secondary/about.html
TYPES OF SEIZURES AND CARE OF THE PATIENT
Multiple Choice
1. Generalized seizures that affect the entire brain
usually
(a) result in no loss of consciousness
(b) result in a loss of consciousness
(c) result in a partial loss of consciousness
(d) result in hallucinations
2. An EEG:
(a) records brain activity
(b) takes a picture of the brain
(c) measures heart rate
(d) measures pulse rate
3. Which of the following is not a symptom of a
complex partial seizure?
(a ) wandering
(b) altered consciousness
(c) repetitive movements
(d) coherent speech
4. Which of the following is not associated with a
tonic-clonic seizure?
(a ) w ande ring
(b) loss of consciousness
(c ) whole body convulsions
(d) abnormal breathing
5. Why is it important to time seizures?
(a) because seizures that continue for more than
five minutes can be considered an emergency.
(b) because seizures always end after five
minutes.
(c) because it’s important to know what time of
day the seizure occurred.
(d) all of the above
True of False
1. ________ Most seizures are medical
emergencies.
2. ________ Seizures result from changes in the
electrical activity of the brain.
3. ________ Brain injury is not a cause of
epilepsy.
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TYPES OF SEIZURES AND CARE OF THE PATIENT
4. ________ A person can be conscious during a
seizure.
5. ________ Seizures that last longer than five
minutes can be considered a seizure emergency.
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