Term
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Definition
: a group of chronic neurologic disorders resulting from a brain dysfunction or an abnormal discharge of cerebral neurons.
~70% are idiopathic (no unidentifiable cause)
Cryptogenic (an unknown cause yet it is thought to be some unidentified abnormality in the brain).
30% have an underlying condition/cause that may or may not be treatable (head injury, OD, CVA, brain tumor etc.). |
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Term
| simple partial seizure (focal seizure) |
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Definition
| assoc. with irritation of a specific part of the brain. single body part may jerk, movements may move across the entire body, consciousness could be lost, unless it develops into a generalized convulsion. |
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Term
| complex partial seizure (psychomotor or temporal lobe) |
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Definition
Brief alterations in consciousness usually occurs
Unusual movements (chewing or swallowing repeated over and over). These repetitive movements are often called “automatisms”
Often preceded by an aura
They tend to be resistant to drug therapy.
May or may not be associated with convulsions. |
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Term
| generalized absence seizures (petit mal) |
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Definition
Temporary lapses in consciousness that last for a few seconds.
Complete and temporary loss of awareness.
Not preceded by an aura.
The person appears to stare into space or daydream.
Often occurs in children and may lead to other seizure types.
Usually diminishes in adulthood. |
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Term
| Generalized tonic-clonic seizure (Grand Mal): |
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Definition
An aura then a sudden loss of consciousness and motor control
The pattern is a series of tonic (stiffening & increase in muscle tone) then clonic (rapid, synchronous jerking) muscular contractions.
May cry upon falling due to air forced out of the lungs.
Respirations cease temporarily
The skin becomes diaphoretic and cyanotic
They may froth at the mouth
They may bite the end of their tongue
They do not swallow their tongue |
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Term
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Definition
a state of prolonged seizure
A clinical emergency
The tonic-clonic seizure lasts ~30 minutes or longer
10-20% mortality rate exists |
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Term
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Definition
Also called akinetic seizures.
A sudden loss of muscle tone.
Usually limited to the muscles of the neck “head drop”
If this includes the limbs the patient may drop suddenly to the floor |
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Term
| general myoclonic seizures |
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Definition
| sudden rapid muscle contractions, may involve one limb or whole body, usually in children- rare in adults |
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Term
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Definition
| defense mechanism. rarely goes to status epilepticus. good type of seizure- due to high sustained fever |
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Term
| idiopathic or primary epilepsy |
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Definition
| dx 5-20 yoa. involves undefines, unascertainable seizures that could be geneic in origin. Onset before or after 5-20 years of age is a non-idiopathic (non-identifiable) secondary epilepsy. |
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Term
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Definition
The meds should be highly effective with low incidence of toxicity.
The meds should be effective against more than one type of seizure and for mixed seizures.
The meds should be long acting and non-sedating
The meds should be well tolerated and inexpensive
Tolerance should not develop
The meds should control the seizure and permit the patient to function effectively (MAIN GOAL) |
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Term
| 4 basic mechanisms for anti-convulsant mechanisms to work |
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Definition
1. suppression of sodium influx.
2. suppression of calcium influx
3. antagonism of glutamate
4. potentiation of gamma-aminobutyric acid (GABA) |
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Term
| suppression of sodium influx |
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Definition
Many of these meds bind with sodium to prevent its influx through sodium channels (influx of sodium leads to neuronal stimulation) and thereby delays or decreases such stimulation.
VALPORIC ACID |
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Term
| suppression of calcium influx |
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Definition
This suppresses transmitter through axon terminals thereby suppressing stimulation
Valproic acid and Ethosuximide |
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Term
This suppresses transmitter through axon terminals thereby suppressing stimulation
Valproic acid and Ethosuximide |
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Definition
Glutamic acid (glutamate) is the primary excitatory transmitter in the CNS.
Felbamate and Topiramate |
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Term
| Potentiation of gamma-aminobutyric acid (GABA): |
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Definition
This is the main inhibitory neurotransmitter throughout the brain.
Therefore helping the release of this component assists with suppressing seizure activity
Barbiturates and Benzodiazepines |
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Term
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Definition
This suppresses seizures by stabilizing cell membrane excitability (by dec the Na influx across the cell membrane) and reducing the spread of seizure discharge by dec the cell excitability.
Many med interactions exist, therefore, a thorough med history is imperative.
When using the suspension form make sure the solution is shaken vigorously before admin.
The expected outcome is no or a greatly reduced frequency of seizure activity |
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Term
| Phenytoin (Dilantin) SE/AR |
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Definition
| usually seen in excessive doses. sedation, lazy eye, ataxia, diplopia, cognitive impairment, gum hyperplasia, swelling, bleeding, tender gums, skin rash |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Patient Education with Dilantin |
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Definition
Do not double up on a dose (will not increase serum levels and may lead to toxicity)
Do not stop med abruptly may lead to worsening of seizures
If a rash develops stop taking and call their MD immediately
Don’t operate heavy machinery or take part in higher levels of thinking activity until the CNS side effects are known.
Elderly may require smaller doses due to hepatic metabolism slowing with age. |
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Term
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Definition
The same SE and education tools are needed with any anti-anxiety/sedative meds.
Do not operate heavy machinery
Lower doses may be needed with extreme ages
If taking oral BC pills they may be rendered ineffective
The dosage should be as low as possible with therapeutic effects |
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Term
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Definition
they appear to suppress the trigger of the seizure activity produced by foci in the cortex, thalamus, and limbic areas.
Not as many SE/AR as with the Barbiturates. |
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Term
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Definition
Clonazepam (Klonopin)
Diazepam (Valium) is the main treatment used for status epilepticus and for severe recurrent convulsive seizures.
Do not withdrawal abruptly
Does cross the placental barrier (can cause cleft lip)
Caution heavy activities due to CNS depression |
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Term
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Definition
| increase seizure threwhold and reduce EEG spike wave pattern decreases nerve impulses and transmission in the motor cortex. doestn treat seizures- makes brain work harder to throw them |
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Term
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Definition
Ethosuximide (Zarontin), Monitor for blood dyscrasias, hepatic and renal functioning.
May cause drowsiness, fatigue, dizziness, tongue edema, and psychosis.
Never withdrawal suddenly
Call MD if rash develops
RUN CBC BEFORE |
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Term
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Definition
used with seizures in pregnancy (Pre-eclampsia Eclampsia).
Should not be used in the presence of heart block, heart damage, or renal failure
This works to stop premature labor by acting as a uterine relaxing agent
Does cross the placental barrier, reflexes and respiratory depression may be seen
Do not use within 2 hours of birth unless absolutely necessary. |
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Term
| Carbamazepine (Tegretol and Carbatrol) |
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Definition
Suppresses high-frequency neuronal discharge in and around the seizure foci, similar to Dilantin
Effective with partial seizures and tonic-clonic seizures
Not effective with absence seizures
USED TO REPLACE DILANTIN |
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Term
| Valproic Acid (Depakene, Depakote, Depacon) |
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Definition
Works by suppressing neuronal firing by blocking sodium channels, suppressing calcium influx and may help promote GABA influence
Has also been released for use with Migraine therapy. |
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Term
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Definition
DOC for absence seizures
Suppresses neuronal activity in the thalamus which are thought to be responsible for absence seizure activity. |
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Term
| Nursing management pertaining to Anticonvulsants |
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Definition
Use a holistic approach (the patient has many fears associated with impending seizures).
Continuously monitor the effectiveness and SE of the meds they are taking.
Continuously monitor for the frequency, duration and intensity of seizures (some patients can be med free if seizure free X 2 years).
Education (encourage a stress free environment, especially of those known stressors that may trigger a seizure).
Monitor plasma drug levels as needed: ensure adequate seizure coverage |
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