Seizures occur due to sudden and abnormal changes in the electrical activities of the brain. The change may be easily noticeable and dramatic or there may never be any symptoms at all. Severe seizures are characterized by shaking violently and lack of control. Non-severe seizures also pose a consequential medical problem and should never be ignored (Engel, 2013).
Seizures can either be epileptic or non-epileptic and about one percent of America’s population experience epilepsy during their lives. In addition, almost one person among twenty-six people experiences seizures which are usually recurring. In approximation, three hundred thousand people suffering from epilepsy are under 14 years of age while five hundred thousand people are over 65 years of age. Among those people, one out of 10 people will experience a seizure at least once in their lifetime (Engel, 2013).
Seizures are neurological diseases classified by their presentation and duration of symptoms. They are often abrupt and cause a noticeable change in behavior in most individuals. This neurological event may present itself as either absent, partial, or generalized tonic-clonic. An absence seizure is most likely to occur between the age of 6 or 7 and seen more commonly in girls than boys (Ferri, 2018). A person suffering from an absence seizure is unresponsive but able to perform motor movements such as blinking through a blank stare. In contrast to the various types of seizures, absence seizures do not have a post-ictal period and can be triggered by activity induced hyperventilation (Ferri, 2018). Laboratory tests are not necessary to diagnose an absent seizure.
Partial seizures are usually limited to a specific side of the brain and are classified as simple or complex by whether or not a loss of consciousness occurred (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Unlike an absence seizure, there has been no gender or age preference determined to be affected. There is a postictal period that can vary in length and causative factors must be explored. A routine blood workup is necessary including a complete blood count and comprehensive metabolic panel with special attention to blood glucose levels and electrolytes.
The most distinguishable of them all, the tonic-clonic seizure, involves a loss of consciousness, the contraction of muscles (tonic), and is followed by jerking movements (clonic). Very distinctive characteristics of a tonic-clonic, or grand-mal seizure, is the loss of bowel and bladder control along with biting of the tongue (Ferri, 2018). Due to the generalized nature of the seizure, both sides of the brain are involved and must be investigated further. Outside of a routine blood workup, a urine toxicology may also provide insight into the cause of a grand-mal seizure.
The diagnosis of seizures is made mostly by deriving data from the history of the patient provided by the observers to the patient or even the patients themselves. A doctor or nurse practitioner performs an examination generally when a patient visits the hospital to be treated for seizure for the first time. Through examination and laboratory examinations, a doctor is able to tell whether the patient’s organs such as the kidneys and liver are functioning correctly. A deep analysis of the patient’s history as related to a seizure should be undertaken. History of any member of the family has experienced seizures is important to establish whether it is genetic or not. Presence of other disorders such as infections, stroke, and tumors should be investigated since these may contribute significantly to the occurrence of seizures. Physical examination should also be undertaken to evaluate the symptoms of infections, long-term kidney or liver diseases, and other possible disorders. EEG is also an important tool to find brain electrical activities abnormalities. An in-depth examination of the neurology is important for establishing the possible areas causing the dysfunction (Petit-Pedrol et., al 2014).
An electroencephalography (EEG) is the gold standard for individuals who have presented with a seizure (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Ambulatory EEGs are common in activity induced seizures such as absence seizures. In addition to an EEG, an MRI is most commonly used to scan the brain in those who have new onset seizures. CT scans are often avoided, especially in children due to the radiation exposure (Ferri, 2018).
As stated previously, a full workup is most important after the first occurence of a seizure in order to reduce the chances of it happening again (Gavvala & Schuele, 2016). Seizures are managed by long-term anticonvulsant medication therapy. The patient in the primary care office will need to be referred to a specialist, such as a neurologist who can diagnose and tailor medication therapy to the individual. Common medications prescribed for absence seizures are: Valproic Acid (Depakote) 5-10 mg/kg/day BID up to 60 mg/day and Lamotrigine, whose dosage depends on if any other anticonvulsants are being used concurrently. Partial seizures are managed by medications such as Carbemazepine, Lacosamide, Lamotrigine, and Levetiracetam. Grand-Mal seizures are usually treated by correcting the underlying cause and medications such as Levetiracetam, and Valproic Acid except in women who are capable of childbearing (Ferri, 2018).
The goal of treating seizures is to enable patients to live a seizure-free life without limiting themselves due to recurrent seizures. The evidence-based treatment plan is meant to help health care providers to make good decisions pertaining treatment of seizures. Practically the treatment should involve a keen evaluation of the probability of future seizures, dangers associated with recurring seizures and the results they have on lifestyles, as well as the negative effects of the medication. In addition, the following should be considered: Occupation, personal preferences, age, childbearing status and averting risks. It is also important for patients to refrain from using medicine in a case where there is no possible recurrence of seizures in the absence of medications.
The evidence-based treatment plan involves utilizing the existing evidence on risks associated with recurrence of seizures, the efficiency of the drug used to prevent seizures in future not forgetting the risks associated with the treatment in adults. Seizure patients should be educated on their condition in order to equip them with knowledge on their diagnosis and treatment. This way they may be able to cooperate well and hence lead to the positive impact of the treatment (Krook-Magnuson, Armstrong, Oijala & Soltesz, 2013). Follow-up and assessment of the efficacy of the evidence-based treatment plan are necessary to ensure that the patients are fully cured. Assessment of the efficacy of the plan is done to ensure that the plan is successful and can be used for future patients to foster a positive impact on them. The follow-up can be done using the patients or their families to ensure that there is no chance that a recurrence would occur in future.
Patients who suffer from seizures must understand that they are prohibited from driving (Ferri, 2018). There are even a few states that require providers to report those with a seizure disorder to the department of transportation (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Once an established medication regimen has been shown to be effective in managing and preventing the reoccurrence of a seizure, follow-up is only necessary twice a year. Seizures can be very disruptive to the everyday flow of life so patients may also benefit from outpatient psychiatric resources. The provider is responsible for providing education on the need to change activities of daily living such as taking showers instead of baths only if another person is present in the home due to the chance of drowning (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
References:
Engel, J. (2013). Seizures and epilepsy (Vol. 83). Oxford University Press.
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing. Philadelphia: F.A. Davis company
Ferri, F. F. (2018). Ferris clinical advisor 2018: 5 books in 1. Philadelphia, PA: Elsevier.
French, J. A., Krauss, G. L., Biton, V., Squillacote, D., Yang, H., Laurenza, A. & Ilari, R. (2012). Adjunctive perampanel for refractory partial-onset seizures randomized phase III study 304. Neurology.
Krook-Magnuson, E., Armstrong, C., Oijala, M., & Soltesz, I. (2013). On-demand optogenetic control of spontaneous seizures in temporal lobe epilepsy. Nature communications.
Gavvala, J. R., & Schuele, S. U. (2016). New-Onset Seizure in Adults and Adolescents: A Review. Jama, 316(24), 2657-2668. doi:10.1001/jama.2016.18625
Petit-Pedrol, M., Armangue, T., Peng, X., Bataller, L., Cellucci, T., Davis, R. & Ritacco, D. G. (2014). Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABA A receptor: a case series, characterization of the antigen, and analysis of the effects of antibodies. The Lancet Neurology.
