Did you know that between two to five per cent of the population will suffer at least one seizure during their lifetime? (Greenwood et al. 2013) What would you do if someone had a seizure in front of you? Would you know how to describe what type of seizure it was? Would you know what to do to help the individual?
What is a Seizure?
A seizure occurs when there is a disturbance within the brain caused by abnormal electrical discharges and neuronal activity. An individual will then be diagnosed with epilepsy if they have had two or more seizures that are unprovoked and not known to be a cause of a medical condition (Epilepsy Foundation 2014).
Types of Seizures
There are two major groups of seizures: primary generalised seizures, and focal or partial seizures. Primary generalised seizures involve both hemispheres of the brain at once, whereas focal seizures involve electrical disturbances in one specific area of the brain which may then spread to other areas of the brain. Partial seizures are generally a result of head injuries, infection, stroke, or tumours, whereas primary generalised seizure causes often involve hereditary factors (Epilepsy Foundation 2013).
Focal (Partial) Seizures
Focal seizures can present in people as unusual behaviours and may appear as the person simply daydreaming. There are three types of focal seizures, including:
- Focal seizure – awareness is retained, formally known as ‘simple partial seizures’
- Focal dyscognitive seizure – awareness is altered, formally known as ‘complex partial seizures’
- Focal seizures evolving to bilateral convulsive seizure
(Epilepsy Action Australia 2016)
Because generalised seizures are a result of abnormal electrical activity in both hemispheres of the brain, the individual will generally lose consciousness at the onset of the seizure (Epilepsy Action Australia 2016). Types of generalised seizures include (Click for graphic):
- Typical: Patients will stop what they are doing and lose consciousness for the event, they will appear to have a glazed or vacant look on their faces and are totally unaware of their surroundings. These seizures will generally last for ten seconds and stop abruptly.
- Atypical absence: Sometimes during these seizures the patient’s loss of awareness is not complete. These seizures will often last longer than a typical absent seizure and the patient will have a longer recovery time.
- Absence with special features.
- Myoclonic absence: When patients experience a brief contraction of a muscle, muscle group or several muscle groups caused by cortical discharge. They generally last for a short time only (less then five seconds) however they can lead into a generalised tonic-clonic seizure.
- Clonic: Patients will experience asymmetrical jerking without any prior stiffening.
- Tonic: Patients will experience a sudden increase in muscle tone which contracts their muscles. This results in their neck extending, hands will either be clenched in a fist or flexed open, facial muscles contract opening the eyes, arms will contract and also the patients legs will extend out causing them to fall if standing. These seizures are brief and some patients will regain consciousness before they hit the floor.
- Tonic-Clonic: This type of seizure was previously know as a ‘grand mal seizure’ and is often the type of seizure most commonly envisioned. This type of seizure consists of both a tonic and clonic stage (described above). Movements characteristic of the tonic phase will occur and continue for up to thirty seconds before the seizure continues into the clonic phase. During the clonic phase the individual will experience convulsive movements, impaired breathing, excessive salivation and changes in some autonomic functions. Following this, the patient may regain consciousness slowly but may remain confused and sleep deeply.
- Atonic: Patients will experience a sudden loss of tone in their postural muscles and consciousness will be lost for a split second. If the patient is standing they will fall, however there is a quick recovery time and most patients will be able to stand up straight away.
- Myoclonic: Sporadic jerks will be experienced by the patient, usually bilaterally.
(Epilepsy Action Australia 2016; Koutoukidis et al. 2013; Wehrle 2003)
Nursing Management of Someone Having a Seizure
Patient safety is one of the main considerations during seizure activity; it is important to remember DRSABCD:
- Send for help
The nurse must stay with the patient and call for help. It is important to note the time that the seizure started and its characteristics. Protection must be given to the patient’s head, especially with any convulsive movements occurring which may injure the patient. The surrounding area must be made clear to decrease the risk of injury, however it is important not to try to physically restrict the movement of the patient’s limbs as this can cause musculoskeletal damage. You can protect the patient from harming themselves by using pillows and bed rails if needed.
Attempts can be made to turn the patient in to the recovery position. If this is not possible, then it is essential to be done when the patient’s limbs relax, to prevent aspiration due to excessive saliva production, and ensure their airway remains patent. Suction and oxygen must be available, and if possible a soft oral airway can be placed providing you don’t have to force teeth apart to place it. Monitoring of vital signs is imperative, especially respiratory function.
Following the seizure it is important to continue to monitor the patient’s airway, using suction as needed, and allow the patient to sleep. When they wake, they may need to be informed on what has occurred and reassurance given, as this can understandably be quite distressing for the patient. Frequent monitoring of vital signs and neurological observations will need to be done on the patient to monitor their condition.
(Greenwood et al. 2013; Koutoukidis et al. 2013; Wehrle 2003)
- Epilepsy Action Australia 2016, Seizure Types and Classification, Australia, viewed 5 September, https://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/seizure-types-classification
- Epilepsy Foundation 2013, Types of Seizures, Landover, MD, USA, viewed 5 September, http://www.epilepsy.com/learn/types-seizures
- Epilepsy Foundation 2014, What is a Seizure?, Landover, MD, USA, viewed 5 September, http://www.epilepsy.com/learn/epilepsy-101/what-seizure
- Greenwood, RJ, Barnes, MP, McMillan, TM & Ward, CD (eds) 2013, ‘Handbook of Neurological Rehabilitation’, 2nd edn, Psychology Press, New York, NY.
- Koutoukidis, G, Stainton, K & Hughson, J (eds) 2013, Tabbner’s Nursing Care Theory and Practice, 6th edn, Elsevier, Chatswood.
- Wehrle, L 2003, ‘Epilepsy: its presentation and nursing management’, Nursing Times, vol. 99, no. 20, pp. 30.