Central Nervous System
Stroke and Seizure
Epileptic Seizures Overview
Epilepsy is a recurrent seizure disorder caused by abnormal electrical discharges from brain cells, often in the cerebral cortex. It is not a distinct disease, it is a group of disorders for which recurrent seizures are the main symptom. Different forms of epilepsy are either secondary to a particular brain abnormality or neurological disorder, or are said to be "idiopathic," without any clear cause.
Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical activity. A seizure occurs when these neurons generate uncoordinated electrical discharges that spread throughout the brain.
Seizure disorders are a common neurological problem. In the United States alone, it has been estimated that more than 4 million people have some form of epilepsy.
The incidence of epilepsy, that is the number of newly diagnosed cases over a specific period of time (e.g., one year), depends somewhat on the age of the individual. The risk of epilepsy from birth through age 20 is approximately 1 percent. Within this group, the risk is highest during the first year of life and increases somewhat at the onset of puberty. From age 20 to 55 it decreases again, but increases after age 55. The prevalence of epilepsy (defined as the total of the population suffering from a disorder at a particular time) has been estimated to be about 5 to 8 in every 1,000 people.
Types of Seizures
Petit Mal Seizure
A brief, generalized seizure, the petit mal seizure commonly last no more that 10 to 30 seconds. These seizures may be accompanied by a brief loss of consciousness, eye or muscle fluttering and occasional loss of muscle tone. Unconsciousness may be so brief that the patient or observers may be unaware of the episode.
The Grand Mal Seizure
Commonly characterized by full body movement, a grand mal seizure produces loss of consciousness usually with alternating tonic (contractions) and clonic (successive contractions and relaxations) of the extremities out of the patients control. During the seizure the patient may quit breathing due to paralysis of the intercostals muscles and diaphragm causing cyanosis. Incontinence, confusion, and copious amounts of oral secretion are also common effects of grand mal seizures.
Status Epilepticus
Defined as two or more seizures without a period of consciousness or recovery. This is a true emergency requiring rapid airway control, treatment, and transport.
Phases of a grand mal seizure Aura
A "feeling" which sometimes precedes a seizure. May be of psychic or sensory nature with olfactory, visual, auditory, or taste hallucinations. These can include hearing noises, seeing lights, smelling odors or feeling strange in a given parts of the body. Not all seizures are preceded by an aura.
- Loss of Consciousness - The patient will become unresponsive after the aura sensation.
- Tonic Phase - This is a phase of continuous muscle tension, characterized by tension and contraction of the patient's muscles.
- Hypertonic Phase - The patient experiences extreme muscular rigidity, including hyperextension of the back.
- Clonic Phase - The patient experiences muscle spasms marked by muscular rigidity and then relaxation.
- Post Seizure - The patient progresses into a coma.
- Postictal - The patient will awaken confused and fatigued. He or she may complain of a headache and may experience some neurological deficit.
Treatment
In your initial assessment of the patient you'll consider one specific thing, is the patient still seizing? If so then IV diazepam is in order! Don't forget to protect the patient from harming themselves and a BVM can help the patient stay oxygenated if the patient is in Status Epilepticus. Remember that when treating any seizure patient, several things must be taken into consideration.
- Was the seizure witnessed?
- Is there a previous seizure history?
- Is a medical alert tag present?
- Do they take any seizure meds?
- Any history of trauma?
Only after taking these things into consideration can you properly treat a seizure patient.
Other things to remember:
- CBGs for all of these patients.
- First time seizures should always go to the hospital for evaluation!!
- Consider Magnesium for seizures during pregnancy due to eclampsia/preeclampsia.