Untitled Flashcards Set

ABSENCE SEIZURE • are one form of generalized seizures, formerly known as petit mal seizures. They occur more often in girls than boys usually occur in school-age children between 4 and 12 years, and consist of a staring spell that lasts for a few seconds. A child might be reciting in class, for example, when he or she pauses and stares for 1 to 5 seconds and then continues the recitation as if he or she is unaware time has passed. • Rhythmic blinking and twitching of the mouth or an extremity may accompany the staring. • As many as 100 seizures can occur during a day. ASSESSMENT • On a neurologic exam, the presence of absence seizures can usually be demonstrated by asking a child to hyperventilate while the child counts out loud. If the child is susceptible to such seizures, he or she typically breathes in and out deeply, possibly 10 times, stops and stares for 3 seconds, and then continues to hyperventilate and count, unaware that he or she paused. • They can be controlled by ethosuximide (Zarontin), valproate, or "off-label" lamotrigine. • If seizures are fully controlled by medication, children can participate in normal school activities and ride a bicycle or motorcycle. • If seizures cannot be controlled fully, parents need to anticipate potentially hazardous situations during the child's day to prevent risky activities such as swimming alone. • Approximately one third to one half of all children with absence seizures "outgrow" them by adulthood. TONIC CLONIC SEIZURE •(formerly term grand mal seizures) are generalized seizures usually consisting of three stages: • a prodromal period of hours or days or an aura, or warning, immediately before the seizure that a seizure is about to occur; a tonic-clonic stage; All muscles of the body contract, extremities stiffen, the face distorts, air is pushed through the glottis from contraction of the chest muscles to produce a guttural cry, and the child falls to the ground. Although this phase lasts only about 20 seconds. The seizure then enters a clonic stage, in which muscles of the body rapidly contract and relax, producing quick, jerky motions. The child may blow bubbles from foamy or bloody saliva and willi be incontinent of stool and urine. This phase usually lasts 20 to 30 seconds. • a postictal stage; He or she will sleep soundly for 1 to 4 hours rousing only to painful stimuli. When children awake, they often experience a severe headache. • They have no memory of the seizure. ASSESSMENT • Children with this type of seizure may or may not have an abnormal EEG pattern. • If an abnormal pattern is found, other family members may be found to have similarly abnormal EEG patterns, although they do not have symptoms. THERAPEUTIC MANAGEMENT • Therapy includes the daily administration of an antiseizure medication such as valproate (Depakene) and carbamazepine (Tegretol). • Phenobarbital may be administered to young children. STATUS EPILEPTICUS • refers to a seizure that lasts continuously for longer than 30 minutes or a series of seizures from which the child does not return to the previous level of consciousness. • This is an emergency situation requiring immediate treatment before exhaustion, respiratory failure, permanent brain injury, or death occurs. •An IV benzodiazepine drug such as diazepam (Valium) or lorazepam (Ativan) halts seizures dramatically. •Diazepam must be administered with extreme caution, however, based on the child's drug history because the drug is incompatible with many other medications, and any accidental infiltration into subcutaneous tissue causes extensive tissue sloughing. •Parents can be instructed on how to administer diazepam by enema at home. Lorazepam (Ativan), a long-acting benzodiazepine used for children older than 2 years of age, provides a longer duration of action and also less respiratory depression. •Both oxygen to relieve cyanosis and administering a medication to halt the seizure may be necessary; obtaining blood to monitor for glucose may reveal that hypoglycemia needs to be corrected.