Seizures (Epilepsy) Nursing NCLEX: Tonic-Clonic, Generalized, Focal, Symptoms

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Seizures (epilepsy) in nursing – NCLEX review: learn about generalized vs focal (also called partial) seizures, as well as the different types and stages of seizures. Seizures occur when abnormal electrical signals are fired by neurons in the brain.

Generalized seizure types can include tonic-clonic seizures (formerly known as grand mal seizures), petit mal seizures, absence seizures, myoclonic seizures, tonic seizures, and clonic seizures.

Focal seizure types (formerly called partial seizures) can include the following: focal onset aware seizures (also called simple partial seizures) and focal impaired awareness (also called complex partial seizures).

Seizures can occurs in anyone (children and adults) due to a severe acute condition, such as a high fever, illness (especially central nervous system types), hypoglycemia, acidosis, alcohol withdraw etc. Once the condition is corrected the seizures tend to stop.

What is epilepsy? Epilepsy is when a patient experiences frequent seizure activity due to a chronic condition. This can be from a massive stroke, traumatic brain injury, congenital defect, effects of a central nervous system infection etc.

Types of generalized seizures:
Tonic-clonic (formerly called grand-mal): the patient loses consciousness and the patient may experience an aura (warning sign) before the seizure. Then the patient will experience: tonic episode: body stiffens (may bite the inside of the cheek or tongue, cry out, and experience apnea), and this is followed by the clonic episode, which is recurrent jerking of the extremities. The patient may have incontinence as well. The post ictus stage can take hours to days, and the patient may report feeling very tired, sore, have a headache etc.
Absence (petit-mal): most common in children. Hallmark is staring (patient may appear to be daydreaming). This type of seizure is very short and may go undetected by others. The post ictus stage is immediate recovery. Atonic (drop attacks): this is complete loss of muscle tone. The patient will suddenly lose muscle tone and is at risk for head injury. Patients should be advised to wear a helmet with this type of seizure.
Myoclonic: this is jerking of the muscles. The patient is aware of their surrounding during this type of seizure.
In addition, patients can experience just a tonic or clonic seizure.

Focal (partial) seizures:
Focal Onset Aware (simple partial): the patient is AWARE of their surroundings during the seizure. The signs and symptoms vary due to the specific location of the brain being affected. For instance, some patients may experience vision changes if the occipital lobe is being affected. The seizure is very short and the post ictus stage is immediate. This is sometimes referred to as an aura, and can happen prior to a complex partial seizure (focal impaired awareness).
Focal Impaired Awareness (complex partial): this is different from the other type of focal seizure because the patient is NOT aware of their surroundings and will experience motor symptoms (automatisms). Automatisms are movements performed by the patient that they are don’t know they are performing, such as hand rubbing, smacking of the lips, grasping for an object that isn’t there.

Nursing interventions for seizures (watch the video for an in-depth review of the interventions): assess for risk factors and seizure history, helping the patient prep for the seizure by lying the patient on their side with a pillow under the head, initiate seizure precautions, educating about seizure triggers, timing the actual seizure and noting its characteristics, administering anti-seizure (AEDs) etc.

This lecture also includes information on the following nursing interventions and management:
-EEG scans for seizures
-Vagus nerve stimulation
-Anti-seizure (anti-epilepsy) medication