Here’s a PDF which outlines the classification of seizures and provides information of each of them: seizure20smart20

Definition:

A seizure is a paroxysmal (sudden) uncontrolled electrical discharge of neurons in the brain that interrupts normal function. They are often symptoms of an underlying illness and if the seizures cease when the underlying cause is treated, this is not considered epilepsy.

Pathophysiology that could result in seizure activity are:

  • Head trauma
  •  CVA eg subarach haemorrhage
  • Increased ICP
  • Metabolic imbalances eg acidosis, alkalosis, electrolyte disturbances
  • Infections: meningitis, sepsis, encephalitis
  • Heart, liver, lung, kidney disease
  • Alcohol or drug withdrawal

Three quarters of seizure cases cannot be attributed to a specific cause and are considered idiopathic.

Epilepsy is a condition in which a person experiences spontaneous recurring seizures. The manifestations of a seizure depend on the brain regions involved and the classification of the seizure. Depending on the type, a seizure may progress through four phases:

  1. Prodromal phase: In this phase, groups of symptoms occur before the onset of a seizure. The symptoms are mostly emotional and can include:                                     Affection, depression, difficulty focusing, agitation, euporhia
  2. Aural phase: Alterations in activity, emotions, hearing, smell, taste, visual perception are involved. Auras are actually a small partial seizure that is often followed by a larger event.They usually come a few seconds to a few minutes before the actual seizure. The feelings of the aura are often vague and many patients are unable to describe their features. Features include: tongue biting, eye twitching, drooling, altered swallowing, breathing difficulties.
  3. Ictal phase:  Ictus is another word for the seizure itself, the part of the seizure that outsiders can witness. It can be convulsive, commonly called “grand mal,” or non-convulsive, such as staring and inability to respond normally. It’s the period of time from the first symptoms (including an aura) to the end of the seizure activity, which correlates with the electrical seizure activity in the brain.
  4. Postictal phase: The postictal stage occurs after the ictus or active stage of the seizure. During the postictal stage, the body begins to relax, and after effects may set in. The type and length of aftereffects will vary from person to person and may include:
    • Numbness
    • Headache
    • Fatigue and drowsiness
    • Partial paralysis
    • Confusion and agitation
    • Loss of consciousness or unresponsiveness
    • Loss of bowel or bladder control

 

Seizures are divided into two main categories partial and generalized.

seizures

Partial seizures involve only a portion of the brain at the onset. They can be further divided into two types:

  • simple partial, in which consciousness is not impaired
  • complex partial, in which consciousness is impaired

Both types of partial seizures can spread, resulting in secondarily generalized tonic-clonic seizures.

Generalized seizures are those in which the first clinical changes indicate that both hemispheres are initially involved. Consciousness usually is impaired during generalized seizures, although some seizures, such as the myoclonic type, may be so brief that impairment of consciousness cannot be assessed.

International Classification of Epileptic Seizures

I. Partial seizures

  • Simple partial seizures
    • 1. With motor signs
      • a. Focal motor without march
      • b. Focal motor with march (Jacksonian)
      • c. Versive
      • d. Postural
      • e. Phonatory
    • 2. With somatosensory or special-sensory symptoms
      • a. Somatosensory
      • b. Visual
      • c. Auditory
      • d. Olfactory
      • e. Gustatory
      • f. Vertiginous
    • 3. With autonomic symptoms or signs
    • 4. With psychic symptoms
      • a. Dysphasia
      • b. Dysmnesic
      • c. Cognitive
      • d. Affective
      • e. Illusions
      • f. Structured hallucinations
  • B. Complex partial seizures
    • 1. Simple partial seizures at onset, followed by impairment of consciousness
      • a. With simple partial features
      • b. With automatisms
    • 2. With impairment of consciousness at onset
      • a. With impairment of consciousness only
      • b. With automatisms
  • C. Partial seizures evolving to secondarily generalized seizures
    • 1. Simple partial seizures evolving to generalized seizures
    • 2. Complex partial seizures evolving to generalized seizures
    • 3. Simple partial seizures evolving to complex partial seizures evolving to generalized seizures

II. Generalized seizures

  • A. Absence seizures
    • 1. Typical absence seizures
      • a. Impairment of consciousness only
      • b. With mild clonic components
      • c. With atonic components
      • d. With tonic components
      • e. With automatisms
      • f. With autonomic components
  • 2. Atypical absence seizures
    • B. Myoclonic seizures
    • C. Clonic seizures
    • D. Tonic seizures
    • E. Tonic-clonic seizures
    • F. Atonic seizures

Here’s a video discussing the different classifications of seizures and another one here.

Depending on the type of seizure drug therapy may be indication. See here for a list of the antiepileptic drugs used for treatments.

Nursing management

Nursing a patient with seizures requires observation, treatment, education and psycho-social intervention.

When a seizure occurs the nurse should record details of the length, aspects of the seizure and if there was an aura stage. Also record what occurred during each stage of the seizure. Care of the seizure patient is mostly supportive; most seizures are of short duration, especially pediatric simple febrile seizures. The ABCs (A irway, B reathing, C irculation) should be evaluated as necessary, including oxygenation and airway assessment, temperature assessment, blood glucose assessment, and spinal precautions.

Intravenous (IV) access should be obtained for almost all patients (it may be deferred in those with simple febrile seizures). Emergency medical service (EMS) protocols should include benzodiazepines (IV, intramuscular [IM], or rectal) for prolonged seizures or SE.

The nurse should monitor the results of seizure management program and make recommendations to the primary care prescriber and interdisciplinary team for changes based on the progress noted. Side effects and untoward interactions of medications should be documented in the nursing notes and reported immediately to the primary care prescriber. Trends and changes in seizure activity (type and/or frequency) should be documented in the nursing notes and reported to the primary care prescriber. Seizure records should be reviewed on a regular basis for accuracy and completeness.

For in depth guidelines for monitoring and recording seizures see this PDF. It also outlines patient teaching and lifestyle factors needing consideration.

 

Other relevant information:

NZ epilepsy foundation

Care plan

Quiz to test your knowledge  and another one for good luck 

 

 

References

Elliot, M., & Brown, D. (2008). Nursing management: Chronic neurological problems. In D. Brown & H. Edwards (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (2nd ed., pp. 1628–1659). Sydney, Australia: Mosby Elsevier.

John Hopkins Medicine. (2016). Neurology and neurosurgery: Types of epilepsy. Retrieved from http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/types/

Okuma, Y. (2004). International classification of epileptic seizures, epilepsies, and epileptic syndromes. Clinical Neurology, 44(11), 970–4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15651346

The National Epilepsy Assosciation of New Zealand. (2016). Publications and information material. Retrieved from http://epilepsy.org.nz/publications-information-material 

 

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