Seizures

SEIZURES AND EPILEPSY

Pathophysiology of Seizures

A seizure is an abnormal, sudden, excessive discharge of neurons in the brain, which can lead to various neurological manifestations. Symptoms may include alterations in:

  • Level of consciousness (LOC): Ranging from complete unresponsiveness to altered awareness.

  • Motor behavior: Including involuntary movements or postures.

  • Sensory abilities: Such as experiencing unusual sensations or perceptual distortions (e.g., visual or auditory hallucinations).

A single seizure can occur without a known cause (also referred to as idiopathic) or may be due to underlying issues such as tumors, infections, or traumatic brain injuries. Understanding the etiology is crucial for treatment.

Epilepsy:

Defined by recurrent, unprovoked seizures, epilepsy may arise from various etiologies. It is often caused by repeated electrical abnormalities in neurons, commonly linked to neurotransmitter imbalances, especially involving gamma-aminobutyric acid (GABA), which is the primary inhibitory neurotransmitter in the brain.

Types of Seizures

International Classification of Epileptic Seizures:

Generalized Seizures: Involve both cerebral hemispheres, leading to loss of consciousness.

  • Tonic-Clonic Seizure: Lasts 2 to 5 minutes; begins with stiffening of muscles (tonic phase), followed by rhythmic jerking of the limbs (clonic phase). Postictal phase may involve fatigue, confusion, and a gradual return to baseline.

  • Tonic Seizure: Characterized by an abrupt increase in muscle tone, often resulting in loss of consciousness; can lead to falls.

  • Clonic Seizure: Involves alternating muscle contractions and relaxations lasting several minutes, with a noticeable rhythmic pattern.

  • Myoclonic Seizure: Involves brief jerking or stiffening of extremities lasting a few seconds, typically occurring in clusters.

  • Atonic Seizure: Characterized by a sudden loss of muscle tone; can cause falls and injuries, also known as drop attacks.

Partial Seizures (also known as focal seizures): Begin in one hemisphere of the brain and are classified into two categories:

  • Complex Partial Seizures: May cause a loss of consciousness and may include automatisms such as lip-smacking or repetitive movements.

  • Simple Partial Seizures: Consciousness is preserved; may include unusual sensations (e.g., olfactory hallucinations) or motor abnormalities (e.g., jerking of a single limb).

EPILEPSY IN OLDER ADULTS

Complex partial seizures are common in older adults but are often misdiagnosed as dementia or psychosis due to overlapping symptoms. New-onset seizures in this demographic may be linked to:

  • Hypertension

  • Cardiac disease

  • Diabetes

  • Stroke

  • Dementia

  • Recent brain injuryThese conditions necessitate careful assessment to ensure accurate diagnosis and appropriate management.

Risk Factors for Seizures

Various factors can trigger seizures, including:

  • Excessive physical activity

  • Emotional stress

  • Fatigue

  • Intake of specific foods, chemicals, or drugs (such as alcohol or recreational drugs)

Understanding these triggers can help in planning lifestyle modifications to reduce seizure occurrence.

INTERPROFESSIONAL COLLABORATIVE CARE

Assessment

  • Assess seizure frequency, duration, and patterns through patient history and records.

  • Inquire about aura sensations, medication history, substance use, and comprehensive medical history to identify potential underlying causes and triggers.

PATIENT EDUCATION

Health Teaching for Epilepsy

Patients and their families should understand:

  • Drug therapy: including name, dosage, and administration instructions for antiepileptic drugs (AEDs).

  • The importance of medication adherence to prevent breakthrough seizures.

  • Actions to take for side effects and procedures for missed doses.

  • The necessity of regular blood tests for monitoring therapeutic levels and potential side effects.

  • The importance of wearing medical identification to alert others in emergencies.

  • Knowing emergency contacts and procedures in case of a seizure.

GENDER HEALTH CONSIDERATIONS

Managing epilepsy in women involves unique considerations, including monitoring hormonal changes that can affect seizure frequency and effectiveness of treatments. Coordination of care among healthcare providers (neurologists, gynecologists, primary care providers) is essential for effective management and counseling on issues like pregnancy and potential drug interactions with oral contraceptives.

DRUG THERAPY IN EPILEPSY

Examples of Antiepileptic Drugs (AEDs) include:

  • Phenytoin

  • Levetiracetam

  • Carbamazepine

  • Valproic Acid

  • GabapentinPatients should be educated about potential drug-drug interactions and commonly associated side effects to maintain adherence and prevent complications.

SEIZURE PRECAUTIONS

During Seizures

  • Protect patients from injury—remove sharp objects and cushions fall-prone areas.

  • Ensure a clear airway and take precautions to prevent aspiration.

  • Record seizure details accurately, including duration, symptoms, and postictal behavior for further assessment.

Emergency Care for Status Epilepticus

In cases of status epilepticus, immediate action is critical:

  • Establish airway and IV access.

  • Administer supplemental oxygen to maintain oxygenation.

  • A loading dose of IV phenytoin may be given to stabilize the patient and prevent further seizures.

FAMILY EDUCATION AND SUPPORT

Encourage families to contact epilepsy organizations for resources, education, and support systems available within the community.