Seizure Precautions

Seizure Precautions and First Aid

  • Author: Maureen Carroll, BS, R. EEG/EP T., RPSGT, CNIM

Old Classification of Seizures

I. Partial Seizures (Focal Seizures)

  • Definition: Involve part of the brain.

    • A. Simple partial seizures: Consciousness not impaired.

      1. With motor symptoms.

      2. With sensory symptoms.

      3. With autonomic symptoms.

      4. With psychic symptoms.

    • B. Complex partial seizures: Impaired consciousness.

      1. Simple partial followed by impairment of consciousness.

      2. Impairment at seizure onset.

    • C. Partial seizures evolving to secondarily generalized seizures:

      1. Simple partial secondarily generalized.

      2. Complex partial secondarily generalized.

      3. Evolving from simple partial to complex partial to generalized.

II. Generalized Seizures

  • Definition: Involve the entire brain.

    • A. Absence seizures: Formerly called petit mal.

    • B. Myoclonic seizures.

    • C. Clonic seizures.

    • D. Tonic seizures.

    • E. Tonic-clonic seizures: Formerly called grand mal.

    • F. Atonic seizures: Drop attacks.

III. Unclassified Seizures

IV. Status Epilepticus

ILAE 2017 Classification of Seizure Types

  • Focal Onset

    • Impaired Awareness: Tonic-clonic, clonic, automatisms, myoclonic, behavior arrest.

    • Aware: Motor (tonic) and Non-Motor (absence).

  • Generalized Onset: Tonic-clonic, myoclonic-tonic-clonic, atonic, epileptic spasms.

  • Unknown Onset: Due to inadequate information.

Important Definitions

  • Seizures: Transient symptoms due to abnormal neuronal discharges;

    • Ictal: During the seizure.

    • Inter-ictal: Time between seizures.

    • Post-ictal: Events after the seizure.

  • Epilepsy: Chronic disorder characterized by recurring seizures (2 or more).

Continued Medical Definitions

  • Status Epilepticus (SE): Seizure lasting >5 minutes or repeated without recovery.

    • Convulsive SE (CSE): Frequent clinical and EEG seizures.

    • Non-convulsive SE (NCSE): Altered consciousness without overt clinical signs.

Non-Epileptic Events

  • Mimic seizures without physiological abnormalities.

  • Psychogenic nature; formerly called pseudoseizures.

Aura and Automatisms

  • Aura: Warning sensation (visual, auditory, taste) before seizure;

  • Automatisms: Involuntary motor acts (lip smacking, fidgeting) during impaired consciousness.

Possible Causes of a Seizure

  • Trauma

  • Fevers

  • Alcohol withdrawal

  • Illicit drug use

  • Brain tumors

  • Metabolic disorders (e.g., electrolyte imbalance)

  • Hormonal changes

  • Neurodegenerative diseases

  • Unknown (idiopathic)

Triggers for Seizures

  • Flashing lights

  • Hyperventilation

  • Sleep deprivation

  • Fatigue

  • Hypoglycemia

  • Emotional stress

  • Electrical shock

  • Febrile illness

  • Alcohol consumption/withdrawal

  • Certain sounds or odors

Basic Seizure First Aid

  1. Stay calm and remain with the patient.

  2. Cushion the head and clear the area of hazards.

  3. Roll the patient onto their side if airway is at risk.

  4. If blue or stops breathing, follow medical protocol.

  5. Do not put anything in the mouth.

  6. Ensure privacy.

  7. Stay until they regain consciousness.

  8. Notify physician if seizure is prolonged.

General In-Patient Safety Procedures

  • Patients should be on seizure precautions:

    • Indicator of fall risk.

    • Bed in low position & locked.

    • Padded side rails.

    • Oxygen at bedside.

    • Suction at bedside.

    • Activity levels as per physician’s orders.

Establish Criteria for Notifying Neurologist

Conditions to Notify:

  • Frequent suspected seizure activity.

  • Status epilepticus without recovery.

  • Seizures lasting longer than 5 minutes.

Emergency Medical Assistance Criteria

  • Signs of injury during seizure.

  • Seizure lasts more than 5 minutes.

  • Difficulty breathing.

  • Second seizure occurrence.

  • Slow recovery time.

  • Other health concerns or pregnancy.

EEG Recording Considerations

  • Record the event and maintain visibility.

  • Assess orientation during the seizure (if appropriate).

Patient Care Following a Seizure

  • Assess patient during and after seizure:

    • Ensure safety with side rails up.

    • Administer oxygen if needed.

    • Roll patient onto the side.

    • Suction if necessary.

    • Monitor vitals and notify MD if complications arise.

Sample Seizure Protocol for Nursing Staff

  • Follow protocols for assessing and recording patient status.

  • Ensure patient safety and recovery monitoring.