Neurological seizures

A seizure is an abnormal behavioral (often motoric) activity caused by abnormal electrical activity of the brain. Seizures can be the symptom of a chronic neurological malfunction, i.e. epilepsy, or can appear as single events, e.g. during fever in infants. 

Seizures that occur in the outpatient setting are almost always seen first by family members or friends, rather than by a member of the medical profession. The occurrence of abnormal behavior patterns or convulsive movements usually prompts the patient to visit the primary health care provider s office or a neurologic clinic. A thorough patient history is necessary to identify the type of seizure disorder. Information the nurse should obtain from those who have observed the seizure is listed in Display 28-1. 

Similarly, convulsive seizures and a sustained epileptic state persisted after stomach contents were pumped and activated charcoal and anticonvulsive medication were administered in a 43-year-old man who ingested approximately 260 mg/kg endosulfan (Boereboom et al. 1998). At 4 days after exposure, the man was pronounced brain dead, and autopsy revealed cerebral hernia from massive cerebral edema. Eight additional accidental and/or intentional cases of acute poisoning with endosulfan resulting in adverse neurological effects have been reported in more recent studies, six by Blanco-Coronado et al. (1992), one by Lo et al. (1995), and one by Pradhan et al. (1997) two out of the eight resulted in death. Tonic-clonic convulsions were seen in the Blanco-Coronado et al. (1992) cases, whereas Lo et al. (1995) reported the development of muscle fasciculations and episodes of convulsions in their case. In the case reported by Pradhan et al. (1997), the patient had consumed about 75 mL of hquid endosulfan (35% w/v). In this case, in addition to tonic-clonic seizures and myoclonic jerks, the patient developed... 

Seizure observed at stroke onset with postictal residual neurological impairments... 

Epilepsy is a disorder that afflicts approximately 2 million individuals in the United States, with an age-adjusted prevalence of approximately 4 to 7 cases per 1000 persons.1 The incidence of epilepsy in the United States is estimated at 35 to 75 cases per 100,000 persons per year, which is similar to that of other developed countries.2,3 In developing countries, the incidence is higher at 100 to 190 cases per 100,000 persons per year, possibly related to poor health care and prenatal care, increased risk of neurologic trauma, and increased rates of infections. About 8% of the United States population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants below 1 year of age and in adults after age 55.4 However, the largest number of patients suffering from epilepsy is between the ages of 15 and 64 years. 

Idiopathic epilepsies These syndromes are thought to be due to genetic alterations, but the underlying etiology is not identified. Neurologic functions are completely normal apart from the occurrence of seizures. 

Neurologic examination Usually, the neurologic physical examination is completely normal. Any neurologic deficits that are identified should be fully investigated, because seizures do not usually cause permanent, detectable neurologic deficits. 

Cryptogenic epilepsies In these epilepsies the seizures are the result of an underlying neurologic disorder that is often ill-defined or undocumented. Neurologic functions are often abnormal or developmentally delayed in patients with cryptogenic epilepsies. 

Seizure Type American Academy of Neurology Scottish Intercollegiate Guidelines Network United Kingdom National Institute for Clinical Excellence... 

AG, a 20-year-old male college student, is seen by his physician 4 days after an apparent seizure during finals week. According to his roommate, he suddenly fell to the floor and had a generalized tonic-clonic seizure. This seizure lasted for 1 to 2 minutes. The patient was incontinent for urine during the seizure. He was sleepy and confused when the paramedics arrived 1 0 minutes later. Due to final examinations he reports being sleep-deprived. His physical exam is completely normal and no focal neurologic deficits were observed. 

Upon admission and control of seizure activity, a neurologic exam should be conducted to evaluate level of consciousness (coma, lethargy, and somnolence), motor function and reflexes (rhythmic contractions, rigidity, spasms, and posturing), and pupillary response. A physical exam to identify secondary injuries from the SE should also be conducted. 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Predictors of an unfavorable outcome seizures, focal neurologic findings, altered mental status, papilledema, hypotension, septic shock, and pneumococcal meningitis3... 

---