Abstract
The most widespread causes of seizures are infection. Seizure can occur in all ages and the infection can vary base from age. Toxoplasma occurs in newborns while Creutzfeldt-Jacob disease occurs in elders. Moreover, for some infections like neurocysticercosis, seizures are the only observable symptom. Seizure can be the only indication of global central nervous system dysfunction including rabies and sub-acute sclerosing panencephalitis .
This paper focuses on the discussion of seizures, their types and causes, as well as the pre-hospitalization rehabilitation and hospital rehabilitation of seizures.
Seizure is a momentary absence of control usually in the company of unconsciousness, convulsions, or both. Common seizures are caused by unexpected anomalous electrical emancipation of the brain known as the epileptic seizures .
During the seizure, the area must be cleared of tough or pointed objects to avoid damage throughout the seizure. Airway must be preserved by elating up the chin of the patient. When the seizure ended, the patient must be placed in a steady side location or so called recuperation arrangement until he or she is aware .
Every patient with seizures in the hospital ought to be located under seizure safety measures to reduce the danger of physical damage
According to the Epilepsy Foundation (2011), seizure is a brief and abrupt interruption of the brain’s regular neuron operation. The nerve cells in the brain send signals to each other and the disruption in neurons’ function made some nerve cells to send signals uncontrollably. A person that experiences this kind of disruption will experience a range of unusual actions such as falling, excessive muscular contractions, disorientation, rhythmic motions and convulsion.
There also exist seizures which are non-epileptic seizures that do not come with odd electrical emissions. Pseudoseizures were previously used for this seizure however it is found to be misleading because the seizures are existent. Non-epileptic seizures involve loss of voluntary control. They do not have particular physical origin but are believed to be caused by mental stress. Seizure can be classified as generalized seizures and partial seizures.
Seizure can be caused epileptic or non epileptic. Non-epileptic seizures can be caused by emotional and psychological stress. It can also be due to metabolic cause, brain tumors and drug toxicity.
Types of Seizures
Types of seizure can be classified as generalized seizures and partial seizures .
Generalized Seizures
When an extreme neural movement in the brain covers the brain completely, generalized seizures take place. The most ordinary forms of generalized seizure are the tonic clonic seizures and the absence seizures.
Generalized tonic clonic seizures are previously recognized as the grand mal. They are the most frequent and well identified category of generalized seizure. Tonic clonic seizure affects the entire brain and starts with the tonic stage wherein the limbs will be stiffened, then by the clonic stage wherein the limbs and face will jerk and twist . During tonic clonic phase, the patient typically produces a small cry and then faints. However, the cry does not signify pain. The patient will also lose bladder control and consciousness . This seizure can be due to metabolic disorders, brain tumors, poisoning and head trauma .
On the other hand, absence seizure is previously recognized as petit mal and they are slips of consciousness, occasionally with gazing. It starts and stops suddenly, and last a few moments. After an absence seizure, consciousness and the capability to talk typically promptly come back. It occurs in without caution and without post-effect . During an absence seizure, a person could look like gazing or staring while having his or her eyes rolling upwards. There could be a five to fifteen slips of consciousness. Generalized absence seizures frequently take place in childhood, vanish in puberty and are less common in old age . Absence seizures are recurrently so epigrammatic that they get away from discovery, although the child is having fifty to one-hundred attacks every day. Moreover, seizures may happen for a number of months prior to medical evaluation .
Partial Seizures
When an extreme neural action inside the brain is narrowed to a single region, partial seizures take place. The most ordinary forms of partial seizures are complex partial seizures and the simple partial seizures.
In a complex partial seizure, an individual could lose consciousness as the seizure starts. The patient can look like stunned and perplexed. The individual will show pointless actions such as illogical mumbling, head turning and walking. After the seizure, the actions will not be recalled by the individual . Also, this seizure merges focal symptoms with a distorted condition of awareness followed by a post-ictal stage .
In a simple partial seizure, an individual could have a variety of odd or abnormal actions or feelings, such as wooziness, stomach uneasiness, an impulsive feeling of terror or nervousness, deformations in smell or sight or abrupt erratic activities of single body part. The mentioned sensations are identified as an aura, which is a simple partial seizure that can take place unaccompanied, or can be pursued by a generalized seizure .
Causes of Seizures
A seizure can happen impulsively with unidentifiable cause. A seizure can also be a resultant to an infection, injury, or other disarray upsetting the nervous system. Non-epileptic seizures are not caused by substantial dysfunction of the brain. Non-epileptic seizures can be caused by distressing psychological occurrences or extraordinary stresses, occasionally even those in the elapsed earlier period. The usual causes of the disturbance in the neurological setting that can show the way to cause seizure are flashing lights, high fever, severe infections of the brain, certain drugs, chemical imbalances, chemical imbalances, poisoning and head trauma .
Psychological and emotional stresses can create physical indications in an individual without noticeable bodily sickness. More tremendous disturbing stresses may cause physical infection. The illnesses that are caused by emotional or psychological factors are called psychosomatic diseases.
On the other hand, emotional stresses can also cause indicators that are similar to physical sickness that do not have fundamental physical origin. We call this somatoform which means they acquire structure inside the body. Somatoform and psychocomatic diseases have psychological causes but are different disorders.
Based from the FraserHealth (2006), the causes of seizures are multifactorial. It can be metabolic cause such as hypercalcemia, hepatic failure or renal, hyponatremia and hyperglycemia. The most often metabolic cause of seizure is hypoglycemia. Drug toxicity can also cause seizures. It includes an opioid stimulated neurotoxicity. A delayed stage unfavorable effect of seizure caused by opiod toxicity is myoclonus. Another cause of seizures is brain tumors.
Other causes of seizures are trauma, transient ischemic attack or stroke, necrosis or radiation-induced edema, seizure disorder or pre-existing epilepsy, organic brain syndrome, CNS infection intra-cerebral hemorrhage or multi-focal leukoencephalopathy, JC virus, tuberculosis, cryptococcus, HIV toxoplasmosis, hypoxia, encephalopathy, drug withdrawal (opioids, benzodiazepines, barbiturates, alcohol), creutzfeldt-jacob disease, cerebral irritability of pre-death restlessness and Alzheimer’s disease. Twitching could be a result from benign fasciculation syndrome and amyotrophic lateral sclerosis, epilepsy, Parkinson’s disease, stimulant abuse and nerve injury or pinched nerve.
Pre-Hospital care of seizures
FraserHealth (2006) provided advice to people when seizure occurs in residential settings. The patient must not bump or fall into any pointed items. People should not attempt to restrain or control the patient. It is also advised that people must not attempt to force something inside the mouth of the patient. The patients must be turned to his or her side when the seizure ends. It should be noted that the patient, after the seizure, will be sleepy but if the seizure does not end in about five to ten minutes or if one more seizure take place almost immediately subsequent to the first, require medical support. Patients cannot obey commands during seizures so people must not shout or talk to the patients.
For convulsive seizure in progress, the Epilepsy Foundation (2011) described pre-hospital treatments. To assure safety BSI precautions are followed. The first thing to do is to assess the level of awareness of the patient. Witnesses of the seizure must be asked about the length of the seizure and if any medication has been given. It must be determined if blank stare, fall, cry or shaking has occurred. The patient must be transported to the hospital if the seizure lasted more than five minutes. If no trauma is suspected, the patient must be turned to a recovery arrangement for clearing the air passage. To protect against damage, soft objects must be placed under the head of the patients. It is also essential that unnecessary bystanders must be removed to protect the privacy of patients.
Hospital Treatment of Seizures
Treatment is warranted if a seizure has taken place and repetition is expected. Seizure prophylaxis is supposed to be introduced following the initial seizure activity. The prophylactic anticonvulsant treatment for individuals with brain metastases or tumors is divisive. This treatment has not proven to offer seizure control. Clonazepam are utilized for the provisional management of seizures not restricted by current treatment. Sudden clonazepam withdrawal subsequent to lasting use may rash epilepticus taper dosage so an incremental usage is advised until the symptoms are managed .
Treatment depends on the cause of the seizure. Doctors will ask regarding the symptoms of the seizure and will verify the medical condition that caused it if the patient experienced seizure for the first time. Test such as electroencephalogram (EEG), lumbar puncture, magnetic resonance imaging (MRI), computerized tomography (CT) scan and blood tests. On the other hand, if the seizure is caused by a certain medicine or high fever, the seizure will be treated by eliminating the cause. Seizure caused by epilepsy can indicate the medication for epilepsy must be altered. Surgery could be an option if the seizure cannot be cured by medication. However, most seizures can be controlled through medication .
Rehabilitation of Seizures
The acute management of seizures, by Bhanushali and Helmers (2008), aims to avoid secondary and aspiration trauma. To attain a sensible seizure management, they utilized benzodiazepines in the company of intravenous anti-epileptic drugs. This is also used to avoid further development of status epilepticus.
It is fundamental to know the type of seizure. The patient who is aggressively seizing must be positioned in a side decubitus pose. To reduce aspiration, the head of the patient must be at a 30-degree angle. Objects that can possibly damage the patient should be put away. Access to IV must be established. Nasal cannula or facemask is used to administer oxygen. At the bedside, a bag valve mask and an oropharyngeal airway kit must be prepared.
Respiratory rate and blood oxygen saturation must be supervised personally because benzodiazepines can cause lung depression. Fingerstick is used to measure blood glucose. For patients that have a background of alcohol exploit, thiamine (100mg) must be introduced previous to glucose management. On the other hand, for hypoglycemic patients, dextrosed must be intravenously administered.
Acute treatment is not necessary for seizures that last for only two to three minutes. However, aggressive management is needed if the seizure lasts for more than five minutes, or the patient experiences more than twice of tonic-clonic seizure in one hour because it could eventually lead to status epilepticus
For pharmacologic therapy, 0.1 mg/kg of IV lorazepam is directed in 2-mg increments for two to three minutes. Lorazepam can be used intramuscularly for inaccessibility of IV. As alternative, IV diazepam (0.2 mg/kg) at a charge of 5 mg per minute may be employed. Rectal gel and intramuscular formulation is available for Diazepam.
Every patient with seizures in the hospital ought to be located under seizure safety measures to reduce the danger of physical damage. Precautionary measure must be followed and these also mean assuring that the suction, oxygen, airway and oropharyngeal must be accessible at bedside, padding the side rails and putting them up and putting the bed in the lowest location .
References
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Cleveland Clinic. (2008). What are Non-Epileptic Seizures? Cleveland: Cleveland Clinic Foundation.
Epilepsy Foundation. (2011). Epilepsy and Seizure Management. Center for Disease Control (CDC).
Epilepsy Ontario. (2002). All about Seizures. Thornhill, Ontario: Epilepsy Ontario.
FraserHealth. (2006). Hospice Palliative Care Program Symptom Guidelines: Twitching/Myoclonus/Seizures. Hospice Palliative Care.
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