Seizure / Epilepsy

1. Diagnostic Evaluation: • Nature, occurrence rate, intensity, and triggering factors • Developmental background, medical conditions, head trauma • Neurological and comprehensive physical examination • Diagnostic procedures • MRI • EEG • Insertion of deep electrodes • SPECTs

1.1. Side Effects of Antiepileptic Drugs: • Higher risk of suicidal thoughts—evaluate patient and family history of depression, anxiety, and suicidal ideation; provide education. • Rare conditions like Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS). • Decreased levels of vitamins, particularly B12, folate, and B6; issues with high cholesterol and bone density loss.

1.1.1. Phenytoin (Dilantin)

1.1.2. LEVETIRACETAM (KEPPRA)

1.1.3. Lorazepam (Ativan)

1.1.4. Topiramate (Topamax)

2. Seizure Evaluation: •Events leading up to the seizure •Presence of an aura •Initial actions of the patient during the seizure •Body parts affected •Eye and pupil observations •Presence of automatisms, incontinence, paralysis, and movements post-seizure •Mental state and awareness

3. •Surgical options for difficult-to-treat seizures •Vagus nerve stimulator

4. Nursing Diagnoses: •Risk of harm due to seizure activity •Anxiety related to potential seizures •Difficulty coping with stress caused by epilepsy •Lack of understanding about epilepsy and anticonvulsant medications

4.1. MANAGEMENT •Nursing diagnosis: Risk of injury related to seizure activity •In the hospital: implement seizure safety measures •Educating the patient: •Opt for showers instead of baths, and never swim alone •Be aware that driver's license rules differ by state •Always carry a medical alert bracelet or ID card along with a list of medications •Refrain from activities that need alertness until you understand the side effects of medications

5. Seizure disorders involve episodes of unusual activity leading to sudden, excessive electrical discharges in the brain. These are abnormal, recurring, and uncontrolled. Epilepsy, a type of seizure disorder, is diagnosed when there are at least two unprovoked seizures occurring more than 24 hours apart.

5.1. fTriggers can include flashing lights, television, alcohol, drugs, sleep disturbances, and hormonal changes. Other causes may include cerebrovascular disease, low oxygen levels, fever, head injury, high blood pressure, central nervous system infections, metabolic and toxic conditions, brain tumors, and allergies

6. Generalized Seizure: affecting both sides of the brain and causing widespread effects

6.1. •Generalized absence seizures involve sudden "drop" episodes or staring spells. •Generalized tonic-clonic seizures are characterized by convulsions and loss of consciousness

7. Focal Seizure: starting in a few cells within a single hemisphere.

7.1. •Focal seizures may cause convulsions in a specific body area, localized disturbances, or may not show symptoms.

8. References: Schachter, S.C. (2021). Assessment and treatment of an initial seizure in adults. UpToDate. Accessed on April 16, 2021, from https://www-uptodate-com.proxy.bc.edu/contents/evaluation-and-management-of-the-first-seizure-in-adults?sectionName=TYPES%20OF%20SEIZURES&search=tonic%20clonic%20seizure&topicRef=2220&anchor=H1446120106&source=see_link#H1446120106 Carl, J.S., Weaver, S.P., & Tweet, E. (2008). Impact of antiepileptic medications on birth control pills. American Family Physician, 78(5), 634-635. Epilepsy Foundation. Seizure Triggers. Accessed on April 16, 2021, from https://www.epilepsy.com/learn/triggers-seizures Filho, J.O., & Mullen, M.T. (2020). Evaluation and initial treatment of acute stroke. UpToDate. Accessed on July 28, 2020, from https://www.uptodate.com.proxy.bc.edu/contents/initial-assessment-and-management-of-acute-stroke?search=ischemic%20stroke&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1