adult T3- seizure disorders/als

seizure disorder

aka: epilepsy
recurrent seizures
transient, uncontrolled electrical discharge of neurons in the brain interrupting normal function
may accompany variety of disorders

systemic/metabolic seizures

not considered seizure disorder if they stop when underlying problem is corrected

metabolic seizure

electrolyte imbalance
acidosis
hypoglycemia
hypoxia
alcohol/barbiturate withdrawal
dehydration
water intox

extracranial seizure

htn
sle
dm
sepsis
heart, lung, liver, or kidney disorders

common cause

structural lesions
trauma
brain tumors
vascular disease

50

over the age of ______, main cause of a seizure is
stroke or metastatic tumor

idiopathic

one third of seizure cases are _______
_____________ generalized epilepsy

prodromal phase

sensations or behavior that precede seizure by hours or a day

anural phase

sensory warning that is similar each time a seizure occurs and is considered part of the seizure

ictal phase

begins with the first symptoms of seizure until it ends

postictal phase

recovery period after seizure (groggy, lethargic)

tonic clonic

most common generalized seizure
patient loses consciousness (will fall to ground if upright)
stiff for 10-20 seconds and extremities jerk for 30-40 seconds
cyanosis, excessive salivation, tongue or chest biting, incontinence
postictally may have sore musc

tonic

sudden increase in tone of extensor muscles (sudden stiff movements)
occur in sleep
pt will fall if standing
usually last 20 seconds

clonic

loss of awareness, muscle tone, followed by rhythmic limb jerking
rare

status epilepticus

state of continuous seizure activity of a condition in which seizures recur in rapid succession
lasts more than 5 minutes
MEDICAL EMERGENCY
highest incidence in
children and older adults
brain uses more energy than can be supplied- permanent brain damage

seizure disorder

individuals have higher mortality rates than gen pop
those who lose consciousness are @ higher risk for injury

sudep

Sudden unexpected death in epilepsy
occurs in
tonic clonic
higher in males
in pts taking multiple anti seizure meds
poorly managed seizure activity
cause of death unknown, but dysrhythmias, resp dysfunction, or cerebral depression are thoughts

seizure dx

history and physical exam
eeg (within 24 hours of ______)
cbc, cmp, ua, to rule out metabolic problems
ct or mri should be done to rule out structural problems

multiple medications

1/3 of pts may need __________ _________ to control seizures

control activity

goal of treatment is to ____________ ____________ while not causing toxic side effects

phenytoin

seizure drug
monitor blood level
gingival hyperplasia (need good oral care)

carbamazepine

seizure drug
monitor blood level
do NOT give w/ grapefruit juice

divalproex

seizure drug
monitor blood level

clonazepam

seizure drug
sedation

diazepam

seizure drug
long half life

lamotrigine

seizure drug
can cause potentially fatal SJS rash

management

seizure drugs
many have long half lives
many cause sedation
abrupt withdrawal may cause seizures
need to wean off slowly
may decrease effectiveness of oral contraceptives, use a back up form of birth control

management

status epilepticus
make sure pt is safe, then use rapid acting IV Med
IV lorazepam, diazepam- then levetiracetam
pt may need oxygen
also important to document the length of seizure activity

amyotrophic lateral sclerosis

rare progressive neuromuscular disorder marked by loss of motor neurons
usually leads to death 2-5 years after dx
onset is between
55-75
common in white men, veterans of the gulf war
arms and legs initially affected
pts may initially have fine motor skill