Seizures represent one of the most acute neurological emergencies: a sudden and uncontrolled burst of electrical activity in the brain that can manifest in a myriad of ways. This surge can lead to a range of symptoms depending on the area of the brain involved, from convulsions and loss of consciousness to more subtle signs such as brief lapses in attention or muscle twitches. Understanding seizures is crucial for nursing students, as it lays the foundation for recognizing, managing, and caring for patients experiencing these intense episodes, ensuring they receive timely and appropriate medical intervention.

Seizure triggers vary widely among individuals. Strong emotions and intense exercise are known to heighten the risk, as can disturbances in sensory inputs such as flashing lights, strong smells, or loud sounds. Physiological changes or conditions, including menstrual periods, lack of sleep, pregnancy, and stress from illness or fever, can also serve as catalysts. Furthermore, metabolic imbalances, undermedication, or withdrawal from medications, alongside alcohol consumption, can significantly disrupt the brain's electrical stability, leading to seizures.

Seizure Stages

• The prodromal stage, occurring days before, is a precursor phase where individuals may experience subtle changes or warning signs - depression, anger, anxiety, GI issues - indicating an impending seizure event.
• Aura, which acts as a prelude to a seizure, is a sensory warning that is not always present and can manifest through altered vision, hearing, experiences of déjà vu, sudden changes in taste or smell, dizziness, or a temporary inability to speak.
• The ictus phase represents the actual seizure event, typically not exceeding 3 minutes; however, if it persists for more than 5 minutes, it escalates to status epilepticus, a dangerous condition requiring immediate medical intervention to halt the seizure.
• The post-ictal stage is characterized by extreme fatigue, a desire to sleep, confusion, headache, and potential post-injury symptoms such as biting the tongue or cheeks, necessitating a recovery period of rest and sleep for the patient.

Seizure Treatment - Medications

• Phenobarbital (Luminal)
• Phenytoin (Dilantin)
• Benzodiazepines: diazepam or lorazepam
• Valproic acid
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Levetiracetam (Keppra, Spirtam)
• Carbamazepine (Tegretol)
• Topiramate (Topamax)

Seizures are broadly categorized into two types: focal and generalized seizures, each with distinct characteristics, symptoms, and implications for patient care.

Focal Seizures

Focal seizures, also called partial seizures, originate in a specific area of the brain and are subdivided into two categories: focal aware seizures and focal impaired awareness seizures. Focal aware seizures occur when the individual remains conscious and aware throughout the episode, potentially experiencing alterations in smell, taste, sound, vision, or emotional state. On the other hand, focal impaired awareness seizures involve a change or loss of consciousness, where the individual may appear dazed and engage in repetitive, unintentional movements such as blinking, twitching, or walking in circles. Focal aware seizures can turn into impaired ones. The symptoms will vary depending on which area of the brain is affected.

Generalized Seizures

Generalized seizures affect both hemispheres of the brain simultaneously and always lead to loss of consciousness. This category encompasses several types of seizures, including absence seizures (brief lapses in awareness, often mistaken for daydreaming), tonic-clonic seizures (formerly known as grand mal seizures, featuring a loss of consciousness, body stiffening, and shaking), and myoclonic seizures (sudden, brief jerks of muscles or muscle groups).

Grand mal seizures, known for their intensity, manifest with dramatic symptoms such as moaning, groaning, cyanosis (turning blue due to lack of oxygen), biting, and foaming at the mouth. Immediate action is crucial: position the patient on their side to prevent self-injury and gently lower them to the ground to avoid head trauma. These seizures, the most common type, can be preceded by an aura—a sensory warning sign—and typically last between 1 to 3 minutes, requiring prompt and knowledgeable intervention to ensure patient safety.

Absence seizures, also known as "petit mal," are more prevalent in children and present with subtle symptoms. These seizures are characterized by brief episodes of staring into space, accompanied by impaired consciousness. During an episode, the child appears unresponsive to verbal communication and may exhibit automatic behaviors such as lip-smacking or biting. Unlike more intense seizure types, there is no post-ictal confusion, allowing for immediate recovery. Although absence seizures are less dramatic than others, their frequency and impact on a child's daily activities, such as learning and social interaction, underscore the importance of recognition and management.

Understanding the intricate nature of seizures—from the warning signs, to the various stages—is essential for nursing students preparing for the Nurse Practitioner Board Exams. Understanding seizures, including their varied triggers and symptoms, is vital in providing immediate care. "The Cohen Review" offers an in-depth exploration of seizures among other crucial topics for board exam success, providing students with the tools and confidence needed to excel. We encourage you to deepen your understanding with us and join a community committed to excellence in nursing practice. For more information or to share your thoughts, please comment below or contact us directly. We are eager to support your journey towards becoming a certified nurse practitioner.