6. Seizure Disorders



Seizure disorders, 780.39






II. Etiology


A. Cause may be unknown.


B. Metabolic disorders


1. Acidosis


2. Electrolyte imbalance (e.g., hyponatremia, hypocalcemia)


3. Hypoglycemia


4. Hypoxia


5. Alcohol or barbiturate withdrawal—most common cause of new-onset seizures in adults


C. CNS infection


D. Head trauma


E. Tumors and other space-occupying lesions


F. Vascular disease (common with advancing age and the most common cause of onset of seizure disorder at age 60 or older)


G. Degenerative disorders, such as Alzheimer’s disease in later life


H. Natural reaction to physiologic stress or transient systemic injury


I. Most common cause of seizures is noncompliance with a drug regimen on the part of a patient in whom epilepsy has been diagnosed.


III. Clinical manifestations


A. Partial seizures: Only a restricted part of one hemisphere has been activated.


1. Simple partial seizure


a. Consciousness is preserved; rarely lasts longer than 1 minute


b. Jacksonian march movements: convulsive jerking or paresthesias/tingling that spreads to different parts of the limb or body


c. Sensory symptoms: flashing lights, simple hallucinations, tingling, or buzzing


d. Autonomic symptoms: abnormal epigastric symptoms, pallor, sweating, flushing, pupillary dilatation, piloerection


e. Speech arrest or vocalization


f. Nausea


g. Psychic symptoms: déjàvu; dreamy states, fear, distortion of time perception


2. Complex partial seizure


a. Any simple partial seizure onset followed by impairment of consciousness


b. Automatisms (lip smacking, chewing, swallowing, sucking, picking at clothes) may occur.


c. May begin with a stare at the time consciousness is impaired


d. May have an aura


B. Secondary generalized partial seizures: simple or complex seizures progressing to generalized seizures, with loss of consciousness and motor activity that is often convulsive



D. Status epilepticus: series of grand mal seizures that may occur when the patient is awake or asleep, with the patient never gaining consciousness between attacks


1. Aggressive treatment is required for a patient with continuing seizures that last longer than 10 minutes or seizures without intervening consciousness.


2. Least common and most life threatening


IV. Diagnosis


A. Obtain a thorough history from the patient, the family, and/or observers of the event.


B. EEG is an important test for supporting the diagnosis of epilepsy, differentiating between types of seizures, and providing a guide to prognosis.


1. Focal abnormalities indicate partial seizures.


2. Generalized abnormalities indicate primary generalized seizures.


3. A normal EEG does not rule out a seizure.


C. CT or MRI of the head—performed for all new-onset seizures, especially after age 30, because of the possibility of an underlying neoplasm


D. Chest x-ray is also performed in patients older than age 30 with new-onset seizures because the lungs are a common site for primary and secondary neoplasms.


E. Lumbar puncture (if indicated) is performed to assess for an infectious process after CT or MRI has been used to rule out expanding mass that may increase ICP.


F. 24-hour EEG to document seizure activity


G. Blood analysis: CBC, glucose, liver and renal function tests, Venereal Disease Research Laboratory test (VDRL), electrolytes, magnesium, calcium, antinuclear antibody, erythrocyte sedimentation rate, and arterial blood gases


H. Urinalysis, drug screen


I. Serum prolactin—rises to 2 to 3 times above normal for 10 to 60 minutes after occurrence of 80% of tonic-clonic or complex partial seizures

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Mar 3, 2017 | Posted by in NURSING | Comments Off on 6. Seizure Disorders

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