Sudden temporary change in PHYSICAL movement, SENSATION, BEHAVIOUR because of abnormal discharged of electrical impulses from nerve cells. CLASSIFICATION PARTIAL SEIZURE / FOCAL SEIZURE >> Aimed to determine: Type of seizure Frequency Severity Aura LOC Dyspnea Fixed and dilated pupil Incontinence Factors that precipitate them. Developmental history taking (events of pregnancy and childbirth) Questioned about illnesses or head injury

1. CME PPW 13
HAFFIZ MOHD NOOR

2. • Sudden temporary change in…
PHYSICAL movement
SENSATION
BEHAVIOUR
… because of abnormal discharged of electrical impulses
from nerve cells.
DEFINITI
ON

3. PARTIAL
SEIZURE
/
FOCAL
SEIZURE
GENERALIS
ED SEIZURE

4. (AFFECT / BEGIN IN ONE PART OF THE BRAIN)
SIMPLE COMPLEX
(CONCIOUSNESS REMAIN INTACT)
1. MOTOR
 Jerking
 Muscle Rigidity
 Head Turning
2. SENSORY (Unusual sensation
affect )
 Visual
 Hearing
 Taste
 Touch
3. PSCYCHOLOGY
 Emotional
 Memory disturbance
(IMPAIRMENT OF CONCIOUSNESS)
 Begin in one part of brain and
spreading to another part of brain.
 Postictal Symptoms (Seizure State)
 Aura Phase
 Motionless / Automatic movement
but inappropiate
 Excessive emotion – irritate / anger
etc
 Not remember when episode is
over.
 Leading to Generalised Seizure

5. Sudden onset
Duration 5-10 sec / happen 100x daily
Commonly cause by
STRESS
Fatigue
Hypoglycemia
Some known as ‘day dreaming’
Sign & Symptoms
LOR but still maintain posture
Twitching eyelids / Lips smacking
Long starring (most common)

6. • Movement Disorder
• Seen when awake / fall asleep
• Cause by touch / visual stimuli
• Symmetrical / Asymmetrical
• Sign & Symptoms :
No LOC
Sudden and simple
Shoclike involuntary
Dropping things (most common)
• 90% individuals who have
syncope hx.

7. • Muscle are maintained in continuous contracted state.
(Rigidity)
• Sign & Symptoms :
Variable LOC
Pupils dilated
Eyes roll up
Possible incontinence
May foam at mouth

8. • Opposing muscle contract and relax alternately. (Jerking)
• May occur only one limb or more.
• Sign & Symptoms :
• Mucus production
• Muscle Stiffness

9. • Violent total body seizure
• Sign & Symptoms :
Usually LOC / Collapse
Tonic phase (30-60 sec)
Clonic phase
Postictal Symptoms - Apneic

11. • Drop or fall attack
• Loss of posture tone

12. • FEBRILE FIT
 Convulsion associated with a HIGH GRADE (38C) body
temperature. They most commonly occur in children between
the ages of 6 months and 5 years of age
• STATUS EPILEPTICUS
 Acute prolonged seizure activity. Ictus more than 15-20 min.
 Series of generalized seizures that occur without full recovery of
consciousness between attacks
• EPILEPSY
 Group of syndromes characterized by unprovoked, recurring
seizures
 Ictus more than 30 min.

13. 1. Cerebral Vascular Accident (CVA)
2. Central Nervous System (CNS) Infection
3. Head Injury / Trauma
4. Hypoxemia / Anoxia
5. Hypertension
6. Metabolic / Toxic Condition
7. Brain Tumour
8. Drugs and Alcohol Withdrawal
9. Fever in childhood
ETIOLOG
Y

14. ETIOLOGY
Many neurons fire in
a synchronous
pattern, resulting in
a transient
physiologic
disturbance
Physiologic
disturbances
include abnormal
movements,
abnormal
sensations and
change in LOC
SEIZURE
STATE!

15. Aimed to determine:
1. Type of seizure
2. Frequency
3. Severity
Aura
LOC
Dyspnea
Fixed and dilated pupil
Incontinence
4. Factors that precipitate them.
5. Developmental history taking (events of pregnancy and
childbirth)
6. Questioned about illnesses or head injury

16. • Provide privacy and protect the patient from curios on-
lookers,
• Ease the patient to the floor or the lowest position, if
possible.
• Protect the head with a pad to prevent injury (from
striking a hard surface)
• Loosen constrictive clothing
• Push aside any furniture that may injure the patient
during the seizure.

17. • Do not attempt to pry open jaws that are clenched in a
spasm to insert anything. Broken teeth and injury to the
lips and tongue may result from such an action
• No attempt should be made to restrain the patient during
the seizure because muscular contractions are strong
and restraint can produce injury
• If possible, place the patient on one side with head flexed
forward, which allows the tongue to fall forward and
facilitates drainage of saliva and mucus. If suction is
available, use it if necessary to clear secretions

19. Rx GOAL : Prevent neuronal injury to the brain ( 20 min – 1hour)
 FIRST LINE THERAPY (Benzodiazephines) : Diazepam (Valium) / Lorazepam
• Function as Anti-convulsants : To prevent the prolonged time in seizure.
• Diazepam (Valium)
• IV : Adults – 5 – 10 mg/kg , Peads – 0.2 mg/kg
• Per Rectal 10 mg (> 5 min) – IV access unsuccessful – 0.5 mg/kg/dose
• Lorazepam - IV : 0.1 mg/kg
 SECOND LINE THERAPY (Phenobarbital) : Phenytoin (Cerebyx)
• Function as Anti-Epileptic
• Patient still in aggressive seize after first line therapy.
• IV : 20 mg/kg usually use doses 1 gram in ED
• Need BP & cardiac monitoring – develop hypotension and cardiac arrythmias
 THIRD LINE THERAPY (Sedative) : Propofol / Midazolam
• Function more as sedation
• Greater sedative effect and more effective in infusion.
• Propofol IV 2-5 mg/kg – IVI : 20 – 100 mcg/kg/min
• Midazolam IV 0.2 mg/kg – IVI : 0.05 – 2 mg/kg/h

20. • Diet: Ketogenic (a diet high in fats and proteins, and low in
carbohydrates)
• I.V. therapy: Secure line. Give medication.
• Activity: bed rest
• Monitoring: Vital signs, I/O chart
• Laboratory studies: glucose, potassium, and
anticonvulsant drug levels if applicable.
• Special care: seizure precautions- ABC , temperature,
blood glucose, spinal care
• Anticonvulsants: phenytoin (Dilantin), Valium (Diazepam),
Lorazepam (Ativan)

21. • BLOOD INVESTIGATION : RBS , ABG
• EEG: abnormal wave patterns, focus of seizure activity
• CT scan: a space occupying lesion
• MRI: pathologic changes
/ tissue lession
• Lumbar Puncture: need pt consideration
 Persistent fever/AMS/headache

22. • Keep the patient on one side to prevent aspiration. Make
sure the airway is patent
• There is usually a period of confusion after a grand mal
seizure
• A short apneic (sleeping) period may occur during or
immediately after a generalized seizure
• The patient, on awakening, should be reoriented to the
environment
• If the patients becomes agitated after a seizure
(postictal), use calm persuasion and gentle restraint

23. • Take medications at regular basis
• Avoid alcohol. This lowers seizure threshold
• Adequate rest
• Well-balanced diet
• Avoid driving, operating machines, swimming until
seizures are well controlled
• Lead an active life
• Parents/relative education

24. Xie Xie!