1. Usually idiopathic

2. Genetic, congenital malformation

3. Metabolic, F&E imbalance

4. CNS infection or trauma

5. Encephalopathy, vascular disease

6. Space occupying lesion (ie. tumor, clot, edema)

7. Drugs (ie. methamphetamine)

8. ETOH & drug withdrawl

S/S vary- Jerking of body part, mumbling nonsense.

Awake afterward.

Aura, staring, automatism (lip smacking, picking at clothes, fumbling). 

Unaware of environment.

May wander.

Amnesia & confusion afterwards.

Often go unnoticed.

Staring, eye fluttering, lips moving.

Afterward don't remember seizures but no confusions & resume activity.

(Space out, then continue activity as if no time passed.)

Sudden excessive jerking of arms, legs or entire body.

May cause pt to fall.

May have subtle behavior/emotional changes, anxiety, nervousness for minutes or hours.

AURA (odor, sound, weakness, numbness)- same each time.

Epilectic cry.

Pt falls.

Tonic phase.

Clonic phase.

Ususally incontinent.

May cry out r/t air moving through vocal cords as chest muscles contract.

Forcing air out results in a blood curling, high pitch cry.

Rigidity!

May be cyanotic and apneic.

Jaw clench, bite tongue and inner cheeks.

Jerking!

Frothing of saliva as it mixes with air.

Amnesia of the event.

HA, nausea, confusion.

Muscle soreness.

Very tired and want to sleep.

Collaborative management.

Identify and treat cause.

History and Physical Exam (neurologist).

EEG, MRI, CT, Blood Studies

Sugery if r/t lesion.

Correct metabolic disorder.

Anticonvulsants (adjust according to blood levels).

Ask questions that will elicit:

*Factors/events that may have precipated seizure

*Past medical hx and head injuries

*Drugs and ETOH intake

*Description of Aura- What kind

*What pt knows/remembers about the seizure

*Have spouse/partner describe todays seizure

*Effects that the dx epilepsy will have on lifestyle, social life, occupation.

*Usual coping methods

*Compliance with meds (for pts on meds)

-Circumstances/possible stimuli/behavior just before

-Aura?

-EXACT duration of the seizure

-How and in what body part it started

-Change in pupils, direction eyes look & position of head at beginning & throughout

-Types of movements, area of body involved

-Automatisms?

-Incontinence?

-Unconciousness?

-NEURO DEFICIT AFTER, movements & behaviors after

-Confusion or sleepiness after

-Seizure awareness afterward 

-Stay with pt, provide privacy

-Ease pt to floor, if not in bed when seizure starts

-Protect from injury, use pillow to pad as necessary

-Loosen constrictive clothing

-Push aside furniture that pt may strike

-If in bed: remove pillows, raise siderails and place bed in low position

-DO NOT pry jaw open or hold pt down/restrain (could snap the long bones)

-Turn onto side so secretions can drain out of mouth

-Suction prn

-Leave pt on side until awake

-Maintain patent airway and breathing

-Allow pt to sleep

-Reorient pt when they awaken

Teach importance of taking meds as prescribed and checking levels.

Meds need to adjusted with illness, wt changes and increased stress.

Seizures are controlled, not cured!!!

Want to achieve seizure control with minimal side effects.

Start with just one med, and add as needed.

Seizure self care/learning needs?

Medication side effects and special cares:

Dilantin requires good oral care & dental care r/t gum hyperplasia.

Don't stop taking meds r/t can cause status epilepticus.

Keep medication and seizure diary.

Report s/s of toxicity, inability to take meds r/t illness.

NO OTC MEDS!

ETOH (lowers seizure threshold & messes with meds)!

 Electrical shocks, stress, caffeine, constipation, fever, hyperventilation (monitor pH), hypoglycemia, bright lights, strobe lights, tv, video games.

Causes little or no sedative effects.

Half-life increases as dose increases.

Numerous drug considerations: most common r/t altered metabolism of drugs r/t CYP inducer.

Absorption will be decreased if given w/in 2 hrs of antacid or if given NG or GT along with tube feedings.

AV heart block

Sinus bradycardia

Highly protein bound (>90%)

Most common r/t CNS depression (nystagmus, HA, sedation, ataxia, diplopia, cognitive impairment)

Gingival hyperplasia (may be disfiguring)

Tender, bleeding, softened gums

In rapid IV infusion: may cause CV collapse, hypotension, and significant CNS depression

Blood dyscrasias

Lupus erythematosus

Stevens-Johnson syndrome

May cause syndrome of fetal teratogenic effects

Class D

Lactation caution

Chemically r/t the tricyclic antidepressants and unrelated to the other AED's.

Action similar to Dilantin.

Massive hepatic cellular necrosis

Potentially lethal hematologic disturbances

Elevates seizure threshold, making seizures less likely.

Reduces synaptic nerve response to low-frequency repetitive stimulation.

Pancytopenia

In pt with psyche hx:

Emotional disturbances

Sleep disturbances

Inability to concentrate

Most common: GI effects

CNS related effects:

Sedation, ataxia, HA and blurred vision

Pruritis and rash - must d/c stat

Mental/physical ability may be impaired

May color urine pink, red or reddish-brown

Baseline and periodic CBC with diff

Report to provider:

Unexplained fever, sore throat, unusual bleeding or bruising, joint pain and rash.

DO NOT abruptly stop taking!

Employment: Often the biggest problem. Discrimination is illegal.

Financial: Burden of tx & rx, esp r/t noninsurability.

Need help to id & control precipitating factors to relieve fears of unexpected seizure causing humilation & alienation.

Need counseling to help overcome depression, shame & modify own attitude towards epilepsy, family role issues.

Seizures can increase with menses & hormonal changes.

Family planning counseling:

Contraceptions less effective

Seizures cause hypoxia in fetus

Meds can cause fetal malformations

Req frequent & specialized monitoring during pregnancy

Family needs to be included in all teaching & counseling r/t attitudes ranging from rejection to overprotection.

Many pt have psyche & behavioral problems r/t:

If temporal lobe involved- emotions are affected

Brain damage r/t seizures causes behavior changes

Pt often turn to ETOH to cope- Increases seizures