Pathophysiology of Status Epilepticus

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    27-Oct-2014

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Legend: - Leading to * - Manifested - Signs and Symptoms Characteristic Pathophysiology of Seizure Disorder Generalized Epileptiform

Precipitating Factors: Stroke Head injury Hemorrhage Infection such as encephalitis or meningitis Flashing lights Intoxicants or adverse reactions to drugs Insufficient dosage of a medication Sudden withdrawal from a seizure medication Consumption of alcoholic beverages while on an anticonvulsant or alcohol withdrawal Starting on a new medication that reduces the effectiveness of the anticonvulsant Developing a resistance to an anticonvulsant already being used Gastroenteritis while on an anticonvulsant Metabolic disturbances Insomnia or sleep deprivation

Predisposing Factors: *Age: Less than 2 years Family history Perinatal brain injury Congenital central nervous system malformations

Excess excitation and reduced inhibition of the neurons Failure of inhibitory process Electrical signal spreads to surrounding normal brain cells

Partial Seizures Complex Partial Seizure Simple Partial Seizure

Generalized Seizures

Excess excitation of bilateral hemispheres of the brain Motor: Jerking; Stiffening of the muscles; Myoclonus Sensory: Hypersensitivi ty of the five senses (vision, hearing, smell, taste or touch

Loss of awareness

Excess excitation of temporal lobes or hippocampi

Retains awareness

Autonomic: racing heart beat, stomach upset, diarrhea, loss of bladder control

Psychological: Deja vu; Jamis vu; Fear; Euphoria; Depersonalization; Hallucinations; Anger

Absence Seizure

Atypical Absence

Tonic

Clonic

Tonic-Clonic

Atonic

Myoclonic

Blank stare

Hand motions and fluttering

Stiffening of the muscles

Repetitive, jerking movements

Unconscious ness, convulsions, muscle rigidity

General loss of muscle tone, particularly in the arms and legs

Sporadic (isolated), jerking movements

With Interventions Diagnostic tests: *Electroencephalography (EEG) Magnetic Resonance Imaging (MRI)

Without Interventions Failure of inhibitory process by the GABA Abnormal transmission of neural responses to body functions

Magnetic Resonance Spectroscopy (MRS) Positron Emission Tomography (PET) Single Photon Emission Computed Tomography (SPECT Neuropsychological Testing Wada Test Psychiatric Evaluation Laboratory Tests:v *Fecalysis *Hematology *Urinalysis

Physiologic

Psychologic Behavioral changes

Sensory disturbance Vertigo

Unpredictable seizures

Decreased function of immune system Infection

Hormonal imbalance

Metabolic imbalance Electrolyte imbalance

Risk for injury Head trauma Heart failure Respiratory failure GI upset

Medical Intervention: a. Pharmacologic Anticonvulsants: Carbamazepine Tigabine Zonisamide Lamotrigine Pregabalin Gabapentin Valproic acid Anxiolytic: *Diazepam Lorazepam Clonazepam *Phenobarbital Anti-epeleptics: Ethosuximide Hemorrhage Spread of bacteria to systemic circulation Spread of bacteria to brain Hypertrophy of brain tissue Bacterial invasion through respiratory tract

Meningeal invasion Subarachnoid space inflammation Increased CSF outflow Increased intracranial pressure

Cerebral Vasculitis

Interstitial edema

Rupture of brain tissues

Aneurism

Anti-pyretic: *Paracetamol Antibiotic: *Metronidazole *Ceftriaxone Surgery: Lobe resection Lesionectomy Corpus callostomy Functional hemispherectomy Temporal Lobe Resection Nursing interventions: 1. Monitor vital signs every 2 hours. 2. Provide sponge baths if temperature continues to rise 3. Provide safe environment by padding side rails, putting pillows on the side. 4. Do not restrain the patient during seizure. 5. Do not put anything in the patients mouth during seizure. 6. Protect the patients head during the seizure. 7. Maintain a patent airway until the patient is fully awake after a seizure. 8. Monitor for and report seizure activity and decreasing level of consciousness. 9. Keep bed in low position with side rails elevated. 10. Administer prescribed intravenous antibiotics. 11. Remind the family the importance of following medication examinations.

Sepsis

Decrease blood flow to brain Hypoxia to brain cells Brain cell death Systemic loss of body functions

DEATH

POOR PROGNOSIS

Proper management of disease Achieve optimum level of functioning GOOD PROGNOSIS

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