Seizures: Types, Phases, Causes, and Symptoms in Neurology

What is a seizure?

A paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal brain function.

What does paroxysmal mean?

Sudden, recurring, abrupt, abnormal, excessive, or intensified symptoms occurring in short, frequent bursts.

What functions can be altered during a seizure?

Level of consciousness (LOC), motor ability, sensory ability, and behavior.

What are possible causes of seizures?

Cancer, trauma, vascular abnormalities, congenital defects, fever in children

What are common seizure triggers?

Sleep deprivation, missed medication, excessive stress, fatigue, flashing lights, cocaine, aerosols, glue products, caffeine, and alcohol.

What are the two major categories of seizures?

Generalized seizures and focal/partial seizures.

What part of the brain is involved in a generalized seizure?

Both hemispheres.

What are the three generalized seizure types discussed in the lecture?

Tonic-clonic, absence, and atonic seizures.

What part of the brain is involved in a focal/partial seizure?

Focal irritation involving one hemisphere.

What are the two types of focal/partial seizures discussed in the lecture?

Simple partial and complex partial.

What is a simple partial seizure?

A focal seizure involving one area of irritation.

What is a complex partial seizure?

A focal seizure involving multiple areas of irritation.

What are the four possible phases of a seizure?

Prodromal → Aura → Ictal → Postictal.

What is the mnemonic for the phases of a seizure?

PAIP = Prodromal, Aura, Ictal, Postictal.

What happens during the prodromal phase of a seizure?

Signs or activity occur before the seizure, such as mood changes, sleep disturbances, lightheadedness, anxiety, irritability, and difficulty concentrating.

What is an aura?

A sensory warning that may occur before a seizure.

What visual symptoms can occur during an aura?

Flickering lights, flashes, spots, or images.

What auditory symptoms can occur during an aura?

Buzzing, ringing, drumming, or tones.

What olfactory symptom can occur during an aura?

An odor or unpleasant smell.

What taste sensations can occur during an aura?

Acidic, metallic, bitter, salty, or sweet tastes.

What other sensations may occur during an aura?

Tingling, shock-like sensations, pain, or a desire to move.

What is the ictal phase?

The phase during which the full seizure occurs.

What manifestations can occur during the ictal phase?

Loss of bowel/bladder function, clonic movements, and jerking.

What is the postictal phase?

The period of rest and recovery following a seizure.

What symptoms may occur during the postictal phase?

Sleepiness, drowsiness, lightheadedness, anxiety/fear, difficulty responding to questions, memory loss, headache, and weakness.

What is another name for a tonic-clonic seizure?

Grand mal seizure.

What happens during a generalized tonic-clonic seizure?

The patient loses consciousness and falls, the body stiffens during the tonic phase, and the extremities jerk during the clonic phase.

What does "tonic" mean during a tonic-clonic seizure?

The body stiffens.

What does "clonic" mean during a tonic-clonic seizure?

Jerking of the extremities.

What is an easy way to remember tonic vs. clonic?

TONIC = TIGHT; CLONIC = CONVULSING.

What additional manifestations can occur during a tonic-clonic seizure?

Shrill cry, incontinence, apnea, dilated pupils, cyanosis, excessive salivation, and tongue or cheek biting.

What can occur after a tonic-clonic seizure?

Muscle soreness, fatigue, sleeping for hours, feeling abnormal for hours to days, and no memory of the seizure.

What is another name for an absence seizure?

Petit mal seizure.

What does an absence seizure look like?

A staring spell lasting less than 10 seconds.

What can precipitate an absence seizure?

Flashing lights and hyperventilation.

Who typically experiences absence seizures?

Children; they rarely continue beyond adolescence.

What is an easy way to remember absence seizures?

ABSENCE = the person appears "absent" for a few seconds.

What is an atonic seizure?

A seizure characterized by loss of muscle tone, causing the patient to fall.

When does consciousness usually return after an atonic seizure?

Usually by the time the person hits the ground.

What is the major risk associated with atonic seizures?

Head injury from falling.

What is an easy way to remember atonic seizures?

A-TONIC = muscle tone is absent → DROP.

What symptoms occur with focal seizures?

Signs and symptoms depend on the function of the area of the brain involved.

What can happen if a focal seizure spreads?

It can become a generalized tonic-clonic seizure.

What is epilepsy?

A neurologic disease in which a person has recurring seizures caused by an underlying chronic condition.

How does the lecture define chronic epilepsy?

Two or more seizures with an unidentifiable cause.

What are common causes of epilepsy in infants?

Severe birth injury, birth defects, and infections.

What are common causes of epilepsy in children?

Trauma and genetic factors.

What are common causes of epilepsy in young adults?

Trauma, brain tumors, and vascular disease.

What are common causes of epilepsy in adults older than 50?

Stroke and metastatic brain tumors.

Approximately what proportion of epilepsy cases have an unknown cause according to the lecture?

About one-third.

What is an EEG used for in seizure disorders?

To evaluate electrical activity in the brain.

Can a patient with seizures have a normal EEG?

Yes. Many patients do not have abnormal EEG findings.

Why is a CT or MRI performed after a new-onset seizure?

To rule out a structural lesion.

What additional diagnostic studies may be used for seizures in selected situations?

Cerebral angiography, MRA, and PET.

What are physical complications associated with seizures?

A 2-3 times higher mortality rate and severe injury or death from trauma during a seizure.

What is the most common complication of epilepsy identified in the lecture?

The effect on the patient's lifestyle.

What psychosocial complications can occur with epilepsy?

Social stigma, discrimination or limitations in employment, and driving sanctions.

What is status epilepticus?

Constant seizure activity or seizures recurring rapidly without return to consciousness between seizures.

How long must a seizure last to be considered status epilepticus according to the lecture?

Longer than 5 minutes.

Why is status epilepticus an emergency?

It can cause respiratory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, acidosis, permanent brain damage, or death.

What is the most important number to remember for status epilepticus?

5 minutes = neurologic emergency.

Why is convulsive status epilepticus especially dangerous?

Vigorous muscle contractions create a heavy metabolic demand and can interfere with respirations.

What happens to the brain's energy supply during prolonged status epilepticus?

The brain uses more energy than is supplied, causing neurons to become exhausted and cease functioning.

What respiratory complication can occur during status epilepticus?

Respiratory arrest from venous congestion and hypoxia of the brain.

What medications can be given initially for emergency seizure treatment?

IV lorazepam (Ativan) or IV diazepam (Valium).

What type of medications are lorazepam, diazepam, and midazolam?

Benzodiazepines.

What is a memory trick for acute seizure medications?

"Benzos break the seizure."

What longer-acting drugs may follow a benzodiazepine during emergency seizure treatment?

Phenobarbital or phenytoin.

When should emergency treatment be considered rather than simply waiting for a seizure to stop?

First seizure, seizure longer than normal, repeated seizures over a few minutes, or seizure lasting >5 minutes.

Do most seizures require emergency medication?

No. Most are self-limiting and rarely cause bodily injury.

What is the first nursing priority for a patient experiencing a seizure?

Maintain the airway and respiratory function.

What are the five nursing priorities for seizure patients?

Maintain airway/respiratory function, protect from injury, promote positive self-esteem, provide education about disease/prognosis/treatment, and prevent seizure activity.

What should the nurse observe during a seizure?

Time the seizure and note what activity occurs, including what, when, why, and how.

Why should the nurse time a seizure?

A seizure lasting >5 minutes indicates status epilepticus and requires emergency intervention.

How should the nurse protect the patient's airway during a seizure?

Maintain a patent airway and turn the patient to the side.

How should the nurse protect the patient's head during a seizure?

Cushion/protect the head and ease the patient to the floor if necessary.

What should be done with constrictive clothing during a seizure?

Loosen it.

Should a patient be restrained during a seizure?

No. Never restrain a patient during a seizure.

Should anything be placed in a patient's mouth during a seizure?

No. Never place objects in the patient's mouth.

What should the nurse call during an acute seizure according to the lecture?

A Rapid Response.

What is the SIDE mnemonic for seizure care?

S = Safety; I = Injury prevention; D = Don't restrain or put anything in the mouth; E = Evaluate airway and elapsed time.

What is the priority immediately after a seizure?

Airway.

What position should a patient be placed in after a seizure?

Side-lying recovery position.

Why is a patient placed side-lying after a seizure?

To help maintain the airway and decrease aspiration risk.

What respiratory interventions may be needed after a seizure?

Oxygen and suction.

What should the nurse assess after a seizure?

Vital signs and injuries.

What neurological/supportive intervention should occur after a seizure?

Reorient the patient.

What should the nurse do after completing post-seizure interventions?

Document the seizure and related findings.

What are seizure precautions for a hospitalized patient?

Padded side rails, bed in low position, fall precautions, safe environment, floor mats, never leaving the patient alone in the bathroom, and emergency supplies at the bedside.

What is the goal of antiepileptic/antiseizure medication therapy?

Prevent seizures with minimum medication side effects.

How effective does the lecture state antiseizure medication therapy is?

Approximately 70% effective.

Should antiseizure medications be discontinued abruptly?

No. Abrupt discontinuation can precipitate seizures.

What are common adverse effects of antiseizure medications listed in the lecture?

Sedation, ataxia, diplopia, mental slowing, gingival hyperplasia, and hirsutism.

Which medications are used to treat an acute seizure?

Lorazepam (Ativan) IV, diazepam (Valium) IV, and midazolam (Versed) IM.

What medications may be given as a loading dose following acute seizure treatment?

Fosphenytoin (Cerebyx) IV, phenytoin (Dilantin) IV, valproic acid (Depakote) IV, or levetiracetam (Keppra) IV.

What medications are listed for maintenance seizure therapy?

Phenytoin, carbamazepine, topiramate, valproic acid, gabapentin, lacosamide, and phenobarbital.

Which antiseizure medication levels does the lecture specifically say should be monitored?

Phenytoin and Depakote.

What important teaching should be given about taking antiseizure medications?

Take the medications every day exactly as prescribed and do not abruptly discontinue them.

Which antiseizure medication is associated with gingival hyperplasia?

Phenytoin (Dilantin).

What teaching is important for a patient taking phenytoin?

Maintain good oral hygiene and dental care because phenytoin can cause gingival hyperplasia.