Epileptic Seizures: Classification and Characteristics
A seizure is a brief, excessive discharge of electrical activity in the brain. It changes behavior. The changes that occur reflect the place in the brain where the seizure begins and the path the abnormal electrical discharge takes. Epilepsy is a disorder that is described as two or more seizures without a clear cause. Epilepsy can be inherited or acquired.
Generalized Seizures: Loss of consciousness; may be convulsive or nonconvulsive.
Tonic-clonic seizure
- The patient may cry out at the start of the seizure. This is result of breath being forcefully exhaled.
- Regular stiffening followed by jerking of arms and legs (tonic-clonic movement).
- Breathing may be shallow.
- Patient may be blue or gray around the mouth.
- There may be frothing of saliva.
- The patient may bite his tongue.
- It is possible the patient will lose bladder or bowel control.
- The seizure most often lasts between 1 and 5 minutes. It can be longer.
- There is fatigue and confusion after the seizure ends.
- There may be tiredness for up to one hour or more.
Intervention: If the patient is warned by an aura, guide him to a safe, private place. Protect him from harm by moving objects out of the way. You should remove eyeglasses, loosen clothing around the neck, and protect the head from injury. Protect the airway by turning the head to the side. Do not force anything into the mouth. When consciousness returns, comfort the patient. If the seizure lasts longer than 5 minutes, give a “rescue” medicine, e.g. Diastat® rectal gel or rectal Valium®. If the seizure persists for 5 minutes after the rescue medicine is given or if multiple seizures occur, call 911.
Absence seizure
- It begins without warning and ends all of a sudden.
- You may see a blank stare and activity stop in the patient.
- There could be a fleeting loss of consciousness.
- The seizure lasts for seconds, but it can occur many times per day.
- There is no confusion after the seizure. The patient returns to normal right away.
- If absence seizures are frequent, they may interfere with learning, concentration, and development.
Intervention: No first aid is needed unless multiple seizures occur and confusion doesn’t go away. Document and report seizure frequency to parents.
Myoclonic seizure
- There are brief shock-like muscle contractions of arms and legs or the trunk. The jerks may be single or multiple.
- The seizure lasts for seconds.
Intervention: No first aid is needed. Document and report seizure frequency to parents.
Clonic seizure
- The muscle contractions and relaxations resemble myoclonic movements. The repetition of movements is slower.
- It may last several minutes.
Intervention: No first aid is needed unless seizures repeat or go on without stopping for more than 30 minutes. Document and report seizure frequency to parents.
Tonic seizure
- There is a sudden stiffening of body, arms, and legs.
- It lasts seconds.
Intervention: Same as clonic seizures.
Atonic seizure
- There is a sudden loss of muscle tone. This causes eyes to droop or head to nod.
- The patient may drop things or fall to the ground. Injuries are common.
Intervention: If injuries occur, contact the parents for protective headgear. The child may need one-on-one help.
Partial: Focal onset. It may evolve into a generalized seizure.
Simple partial seizure
- The patient does not lose consciousness. The patient is able to answer questions. Later, she remembers what happened during the seizure.
- Motor: abnormal one-sided movement of an arm or leg.
- Sensory: abnormal smell, sound, taste, body sensation, e.g. numbness or tingling.
- Autonomic: very slow or very rapid heartbeat; increased breathing rate; skin flushing; epigastric discomfort.
- Psychic: dreamy state, déjà vu, fear.
- It lasts for seconds to minutes.
Intervention: No first aid is needed. Document and report seizure frequency to parents.
Complex partial seizure
- There is impaired consciousness.
- At times, the patient will have a blank stare with lip smacking, chewing motions, or picking at clothes.
- The patient may speak in jumbled, repetitive phrases.
- There may be motor activity, e.g. running, screaming, struggling and flailing, trying to take clothes off.
- After the seizure, confusion and amnesia are common.
- It lasts 1 – 3 minutes.
- There can be repetitive jerking of one side of the body, e.g. face, arm, hand, leg, or foot.
Intervention: Speak calmly and reassuringly. Gently guide the patient into a safe place. Restrain the patient only for her safety. Stay with the person until she is fully aware of her surroundings.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/12/2010
Copyright © 11/12/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7112
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