Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level

4.  DEFINITION
- Seizure is also termed as convulsion. Seizure is the involuntary
contraction or series of contractions of the voluntary muscles. It occurs due to
disturbance of the brain functions resulting from abnormal excessive,
immediate, unwanted electrical discharge from the brain.
- It is manifested by involuntary, motor, sensory, autonomic or psychic
phenomenon, alone or in combination. It may be associated with alteration of
level of consciousness.
 INCIDENCE
- Convulsions are more commonly found in infants and children. It is
symptom found in various diseases. The overall incidence in childhood is about
8%. It is more commonly found along with cerebral palsy (35%) and in mental
retardation (20%).

5.  Neonatal Period
• Birth asphyxia, hypoxia, birth injury, intraventricular hemorrhage.
• Hypoglycemia, hypocalemia, hypo- or hypernatremia, hypomagnesemia.
•Narcotic drug withdrawal, accidental injection of local anesthetic drug into
fetal scalp
• Septicemia, kernicterus, meningitis, tetanus neonatorum.
• Congenital malformations- microcephaly, arteriovenous fistula, porencephaly.
• Pyridoxine deficiency, inborn errors of metabolism.
• Intrauterine infections such as STORCH infection.
 In Infants and Young Children
• Febrile Convulsions
• CNS infections- meningitis, encephalitis, cerebral malaria, tetanus, Reye's
syndrome and intrauterine infections.
Seizure
Neonatal
Period
Infants &
Young
Children
Contd…
 ETIOLOGY

6. Contd…
• Postinfectious and postvaccinal encephalopathy (mumps encephalopathy, measles
encephalopathy), pertussis vaccination.
• Metabolic disturbances- dyselectrolytemia, dehydration, glycogen storage disease.
• Traumatic- accidental and nonaccidental injury.
• Space occupying lesions in the brain- brain tumor, brain abscess, tuberculoma.
• Vascular- intracranial hemorrhage, DIC (Disseminated Intravascular Coagulation)
HTN.
• Drug and Poisons- salicylates, phenothiazine, piperazine.
• Miscellaneous- heat stroke, cerebral anoxia, acute cerebral edema, breath holding
spells, degenerative disorders( e.g. Parkinson's disease)
• Idiopathic epilepsy.

7. Febrile Convulsions
-Febrile convulsions is associated with fever but excluding those
related to CNS infections.
-It is the most common cause of convulsion in early childhood.
-It is related to abrupt increase in body temperature rather than degree
of temperature rise.
 Type:
a)Typical febrile convulsions.
b)Atypical febrile convulsions.
a)Typical febrile convulsions
-These are generalized rather than focal.
-It is last for less than 10 minutes.
-It is usually found in children between 6 months to 5 years of age.
-This fits occur within 24 hours on the onset of fever and usually single per
febrile episode.
-There is no recurrence before 12 to 18 hours of attack.
-CSF study and EEG are normal after the attack.
-Family history of seizure is frequently present.
-Incidence occur in twins and children of consanguineous parents.
-May be due to immature neuronal membrane response to rise of body
temperature.

8. b)Atypical febrile convulsions
-They predispose to idiopathic epilepsy.
-May have focal convulsions of more than 20 minutes even without fever.
-There may be abnormal EEG for two weeks after the attack.
 Management:
-Aim is to control seizure and reduced increased body temperature and treat
the cause of fever, usually ARI.
-Anticonvulsive drugs like Diazepam 0.3mg/kg IV to 1mg/kg per rectum or
Phenobarbital 5mg/kg IM or sodium valporate 10-20mg/kg/day.
-The duration of therapy is 1-2 yrs or upto 5 yrs of age.
-Antipyretics(PCM, mefenamic acid) and tepid sponge.
-Hydration and Nutrition to be maintained.
-Clearing of airway and Oxygen therapy may be needed.
-Rest, comfortable position, and hygienic measures to be provided.
-Health teaching to parents along with that explanation and emotional support.
 Prognosis:
-Typical febrile convulsions prognosis is good.
-In atypical febrile convulsions have chance of developing complications like
intellectual impairment, behavioral problems and epilepsy.
-Chance of recurrence is 30-80%.

9.  DEFINITION
Epilepsy is recurrent, episodic, paroxysmal transient disturbances of
brain function due to abnormal electrical activity of the neurons.
OR
Epilepsy is a neurological condition involving the brain that makes
people more susceptible to having recurrent, unprovoked seizures.
-It is manifested as abnormal motor, sensory or psychomotor phenomena and
often with impaired or loss of consciousness. It may be idiopathic or organic.
 Incidence
-Almost 1% of all children have epilepsy with highest incidence in the
preschool years. Family history is commonly present.

10. Contd…
 PATHOPHYSIOLOGY
Seizure OR Epilepsy
Abnormal spontaneous spread electrical discharge
Lower seizure threshold
Imbalanced Release in excitatory & Inhibitory transmitters
Partial stimulation of neurotransmitter molecules
(GABA and Glutamate)
Partial depolarization (High voltage electrical discharge)
Hyperexcitabilty state of neurons
Altered integrity of neuron in the epileptogenic focus
Due to any etiological causes

11. Contd…
 CLASSIFICATION OF EPILEPSY
The International League Against Epilepsy (ILAE) differentiate 2 types
of seizures.
Generalized
Seizure
• Tonic-clonic
Seizures (Grandmal)
• Absence Seizures
• i. Typical (Petit mal)
• ii. Atypical
• Atopic Seizures
(drop attacks)
• Myoclonic Seizures
Partial/Focal
Seizures
• Simple partial
seizures
• Complex Partial
Seizures

12. Contd…
 CLINICAL MANIFESTATIONS
In generalized seizures whole Brain is involved.
Types:
-It is most frequent form of childhood epilepsy.
-Onset is abrupt and it has four stages as given below
a) Aura Phase:-
-The Child may feel coming of seizures.
-Aura may be sensory, visceral, motor or autonomic.
e.g. Dizziness, Restlessness, wrong perception.
b)Tonic phase:- Duration for 10 to 20 seconds.
• Stiff body & muscular rigidity
• pale face
• Distorted
• Fix eyes in 1 position
• Back arched
• Head turn to backward
• hands clenched
• fall on floor
• loss of consciousness
• frothy discharge
• ineffective breathing
• cyanosis
• weak pulse and irregular
• opisthotonos shape of body

13. Contd…
c) Clonic stage: Duration for upto 30 seconds.
• Rhymic jerky movement
• Incontinence of stool & urine
• tongue bite
• altered contraction & relaxation of muscles
• contraction of abdominal muscles and jaw
d) Postictal or Recovery phase:
• Usually becomes sleepy, confused or exhausted or perform automatic
actions.
• Child may not be able to recall the episode.
-It is rarely appear before 5 years of age.
-The child may loss contact with environment for a few seconds.
-staring or day dreaming.
-discontinue the activity suddenly after seizure & resume the same
activity when seizure is over.
-Rolling of eyes, nodding of head, slight hand movement.
-Child may appear normal & not aware about having the episode.
-Duration is usually 5 to 10 sec.

14. Contd…
-Sudden loss of muscle tone.
-Patient fall on floor from standing position or drop his/her head.
-Usually occurs between 3 to 8 months age.
-Almost always associated with cerebral abnormalities& mental
retardation.
-sudden Myoclonic contraction of muscles of neck, trunk & extremities.
-Duration is less than 1 minute.
-usually disappear by the age of 4 years.

15. Contd…
-Only one hemisphere of brain involved.
-also known as temporal lobe seizures.
Types:
-The child consciousness remain intact.
-The child motor activity altered.
-Perception may be altered.
- The child consciousness remain altered.
- The child motor activity altered.
- Perception may be altered.
-most common in neonatal period due to poor myelination &
incomplete dendritic arborization.
a)Subtle:
-eye blinking, fluttering, buccolingual movements.
-common causes are perinatal asphyxia, sepsis & bacterial meningitis.
b)focal clonic:
-caused by metabolic disorders like hypoglycemia, hypocalcemia and
fur to intracranial bleed.

16. Contd…
c) Tonic and Myoclonic types:
-develop due to malformations and dysgenetic state.

17. ASSESSMENT & DIAGNOSTIC EVALUATION
• History collection with description of seizures episodes.
• Physical Examination
• Neurological Examination.
• Examination of blood (CBC, Electrolytes, Blood sugar level)
• CSF analysis for any infection
• EEG
• CT, MRI, X-ray, PET, SPECT (single photon emission computed
tomography)
• Metabolic or cytogenic studies if suspected inborn error of metabolism.

18.  COMPLICATION
Cranial Nerve Palsies
Subdural Effusion
Hydrocephalus
Mental-Physical Handicaps
Learning Disabilities
Recurrence
Status Epilepticus
Raised ICP
Cerebral Palsy

19.  MANAGEMENT OF EPILEPSY/SEIZURE
-Management depend upon the identified cause.
-Management mainly done with drug therapy, diet therapy and surgery if
indicated.
-Emotional support, psychological rehabilitation and vocational guidance are
also important aspect of management.
-Long term management may continue for 1-4 years under supervision
-Selection of antiepileptic drug depends upon age, type of seizure.
1. Phenobarbital- 3 to 5mg/kg/day in 1 or 2 divided doses. Indicated in tonic-clonic,
partial and febrile convulsions. DOC in infant seizure.
2. Diphenylhydantoin- 5 to 8 mg/kg/day in 2 divided doses. Indicated in tonic-clonic,
partial seizures.
3. Carbamazepine- 10 to 20mg/kg/day in 2 to 3 divided doses. Indicated in tonic-
clonic, partial seizures. DOC of Seizures.
4. Diazepam- 0.2mg/kg/dose IV or per rectal is indicated in status epilepticus.
5. Sodium Valporate- 15 to 20 mg/kg/day in 3 to 4 divided doses. Indicated as broad-
spectrum anticonvulsive agent.
6. Ethosuximide- 10 to 20 mg/kg/day in 2 divided doses. DOC in absence Seizures.

20. Contd…
7. Phenytoin sodium: Used in all types of seizures except petitmal seizure.
Side effect: Gum Hyperplasia- risk of bleeding.
Ataxia
Nausea and Vomiting
Megaloblastic anemia
-Ketogenic diet for patient with intractable epilepsy who do not
respond to medication or when surgery is not an option.
-Diet include the calculated amount of protein and fat (90%) with less
amount carbohydrates (10%).
-Diet makes the child ketotic as fat is used for energy production
rather than carbohydrates. Ketones may inhibit the seizures.
Mechanism:
-unknown
-Research is looking into the role of glucose during seizure, the role of
GABA and neuroprotective effects of the diet.
Uses:
-Usually started on three months trial and continued for upto 3 years if
seizures have shown down or stopped.
-mostly see improvement within first 10 weeks of starting diet.

21. Contd…
Side Effect:
Constipation
Kidney Stone
Dehydration
Nausea
Lethargy
vomiting

22. -Neurosurgery is indicated in some cases of convulsive disorder,
especially in brain tumor, hematoma.
-The Possible Surgical interventions include-
• Corpus callosotomy:
- A separation of two hemispheres of the brain which serves the
neuronal connection between the right and left halves of the brain.
• Lobectomy:
- Remove the part of the brain which causes Seizure.
• Vagus Nerve Stimulation:
-A generator is implanted under the clavicle. The device is connected to the
Vagus nerve in the CNS area, where it deliver electrical signal to brain to
control and reduced seizure activity.
Side Effect:
• Hoarseness
• pain or discomfort in throat
• change in voice

23.  To control and manage Seizure recurrence.
 To provide safety
 To provide good Nutrition
 To maintain normal electrolytes
 To improve daily activities of the patient.
 To maintain fluid balance
 To improve sleep Pattern
 To reduced the anxiety of the family.
 To provide the emotional and psychological support to family member.

25. Ineffective breathing pattern related to spasms
of respiratory muscles as evidenced by shallow
breathing, increased RR
Interventions:
 Monitor respiratory rate, rhythm, depth, and effort of
respirations.
 Assess client’s ability to cough effectively.
Maintain in lying position, flat surface; turn head to side during
seizure activity.
 Loosen clothing from neck or chest and abdominal areas.
 Provide and insert plastic airway or soft roll as indicated and
only if the jaw is relaxed.
 Suction as needed.
 Supervise supplemental oxygen or bag ventilation as needed.
 Get ready for or assist with intubation, if indicated.

26. Altered self esteem related to lack of control
over seizures, stigma associated with the
condition, social role changes as evidenced by
changed lifestyle, change in behavior pattern.
Intervention:
 Explore feelings about diagnosis, the perception of threat to self.
 Encourage expression of feelings.
 Analyze possible or anticipated public reaction to the condition
 Discuss with child current and past successes and strengths.
 Refrain from over protecting the child
 encourage activities, providing supervision and monitoring when
indicated.

27. Deficient knowledge related to information
misinterpretation, long term care of seizure
disorder as evidenced by parents asking
frequently doubts.
Intervention:
 Assess child and family for level of knowledge, specific to health
problems or concern.
 Explain pathology and prognosis of condition and lifelong need
for treatments as indicated.
 Develop teaching plan about present health problem for the child
and family.
 Provide opportunity for child and family to ask question to
discuss about problem and to observe demonstration of care.

28. Risk for trauma or suffocation related to weakness,
poor vision, loss of large or small muscle coordination,
reduced sensation, altered consciousness.
Intervention:
 Determine factors related to the individual situation.
 Explore seizure warning signs (if appropriate) and usual seizure pattern. Teach to
determine and familiarize warning signs and how to care for the Child during and
after seizure attack.
 Use and pad side rails with the bed in lowest position or place bed up against
wall and pad floor if rails not available.
 Avoid using thermometers that can cause breakage. Use a tympanic thermometer
when necessary to take the temperature.
 Do not leave the patient during and after a seizure.
 Turn head to side and suction airway as indicated. Insert plastic bite block only if
jaw relaxed.
 Support head, place on soft area or assist to the floor if out of bed. Do not
attempt to restrain.
 Reorient patient following seizure activity.

29. A. seizure
• provide preventive measures to protect the child from injury by
removal of hard objects, sharp things or toys from the child and placing
child on floor or bed.
• Side rails of the bed or crib to be padded.
• Removing secretions by suction and turning head to one side.
• Oxygen Therapy to be given and all emergency equipment kept ready.
• Close observation and frequent monitoring to child condition for vital
signs, airway, breathing patterns, presence of aura, type of movements
during seizure, site of contractions, eye movements, pupil size, bladder
incontinence, tongue bite, frothy discharge, level of consciousness,
neurological status.
• Administer medication as indicated.
• Follow special instructions about diet, rest and activities.
• Loosen the cloths around neck and placing the child on flat.
• Avoid restraining the child and not to give anything between teeth or
mouth (if jaw is fixed).
• Clear airway, remove secretions, turn head to one side during seizures
and on side lying position in postictal stage.
• Record the events in details.

30. • Take adequate rest for 8-9 hours at night time and 2-3 hours in day time.
• Provide quit and calm environment for child.
• Provide good ventilation to the child.
• Avoid family member to meet the child during sleep time.
• provide comfortable position during sleep and rest time.
• Maintain personal hygiene.
• Take daily bath, clean groin area and keep dry & change cloths daily.
• Hand washing techniques should demonstrated to child and parents.
• wash your hands, face, legs after playoff.
• Daily active and passive exercises
• Avoid exercises which causes more breathing.
• Child should get balanced diet, which contain high fat and low calculated
amount of protein and carbohydrates.
• Diet should be easily digestable.

31. Contd…
• Diet should be as per child like and dislike and variety of food should be
there.
• Medication should be take on time as doctor prescribed.
• Do not discontinue medication if child feel better.
• Try to avoid double dose or overdose of medication.
• If any unusual behavior seen after medicine administration, immediate
contact with health care person.
• Bed at lower position
• side rails should be raise.
• provide pillow to prevent head injury.
• Don’t leave child alone at anywhere.
• Identity card should always with child with proper information specially id
proof and emergency contact detail.
• School Teacher should know about child condition.
• Restriction for some games like climbing, swimming.
• Instruct the parents to allow the child to perform normal life as possible
• if pregnant then regular ANC checkup, treatment if infection during ANC
period.

32.  Parul Datta, “Pediatric Nursing, 3rd Edition, Jaypee
Brothers, Pp No:370-374.”
 Ghai, “Essential Pediatrics, 9th Edition, CBS Publishers,
Pp No:553-560.”
 Mosby’s, “Nursing Drug Reference, ELSEVIER.”