Seizure Types and Nursing Management
Published: 02 December 2020
Published: 02 December 2020
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 how to help them?
A seizure occurs when there is a disturbance within the brain caused by sudden, abnormal electrical and neuronal activity (Epilepsy Foundation 2019).
An individual will be diagnosed with epilepsy if they experience two or more seizures that are unprovoked and not known to be caused by a medical condition (WHO 2019).
There are three major groups of seizures: generalised onset, focal onset and unknown onset (Epilepsy Action Australia 2020).
Generalised onset seizures involve both hemispheres of the brain at once, whereas focal onset seizures involve electrical disturbances in one specific area of the brain, which may then spread to other areas. Unknown onset seizures are unable to be classified as generalised onset or focal onset, but this might change if more information becomes available. It is only in rare cases that the type of seizure remains unable to be determined, usually because there is not enough information available, or the symptoms are abnormal (Epilepsy Action Australia 2020).
Seizures may have motor or non-motor symptoms (Epilepsy Foundation 2017).
Focal onset seizures may be subtle and unnoticeable, or present as unusual behaviours. They may be mistaken for daydreaming or being intoxicated. About 60% of people with epilepsy experience focal onset seizures (Epilepsy Action Australia 2020).
There are two further subgroups of focal onset seizures:
(Epilepsy Action Australia 2020)
Because generalised seizures are the result of abnormal electrical activity in both hemispheres of the brain, the individual may lose consciousness at the onset of the seizure. Awareness is almost always affected (Epilepsy Action Australia 2020).
Types of generalised onset seizures include:
(Epilepsy Action Australia 2020; Mayo Clinic 2020)
Patient safety is one of the main considerations during seizure activity. It is important to remember DRSABCD:
(St John 2020)
The nurse must stay with the patient and call for help. It is important to time the seizure and note its characteristics. Protection must be given to the patient’s head, especially with any convulsive movements occurring that may injure the patient. You can protect the patient from harming themselves by placing something soft under their head and shoulders. The surrounding area must be made clear to decrease the risk of injury, however, do not try to physically restrict the movement of the patient’s limbs as this can cause musculoskeletal damage. Do not put anything in the patient’s mouth or attempt to move them (St John 2020).
As soon as you are able to do so, roll the patient onto their side in the recovery position to prevent aspiration due to excessive saliva production and ensure their airway remains patent. If the patient has vomited or has food or fluids in their mouth, it is crucial to do this immediately (St John 2020).
Suction and oxygen must be available. Monitoring of vital signs is imperative, especially respiratory function.
Following the seizure, manage any resulting injuries. Continue to monitor the patient’s airway, using suction as needed, and do not disturb the patient if they fall sleep. When they wake, calmly tell them where they are and that they are safe. Provide reassurance, as this can understandably be quite distressing for the patient (St John 2020).
Frequent monitoring of vital signs and neurological observations will need to be performed in order to monitor the patient’s condition.
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your organisation's policy on seizure first aid.