Question

J. G. is a 34-year old P1 G1 woman who underwent an emergency cesarean delivery after a prolonged labor, during which she exhibited a sudden change in neurologic functioning and started seizing. Since that time, she has experienced 3 tonic-clonic (grand mal) seizures, diagnosed as having a basal ganglion hematoma with infarct, and was started on phenytoin. Postdelivery, J. G. demonstrated dyskinesia, resulting in frequent falls with ambulation. When the seizure disorder appeared to be under control, she was transferred to a rehabilitation facility for evaluation, and 2 weeks of intensive physical therapy. She is now home, where she is doing quite well but still has occasional falls and is receiving physical therapy 3 times a week in her home. She remains on phenytoin and has had no seizures since her release from the rehabilitation facility. As case manager for J. G.’s HMO, you visit her and her family at home for evaluation of long-term, follow-up care.

1. A seizure is not a disease in itself but a symptom of a disease. What is the term for chronically recurring seizures?
2. Does J. G. have epilepsy?
3. The 3 main phases of a seizure are the preictal, ictal, and postictal. Differentiiate between the 3 phases, and list clinical symptoms you may observe when a patient is having a seizure.
4. What is the pathophysiology of a seizure?
5. J. G. had grand mal, or tonic-clonic, seizures. Describe this type of seizure. List 5 other types of seizures.
6. Some patients know they are about to have a seizure. What is this preseizure warning called, and what form does it take?
7. Besides the brain injury, what are some other possible conditions that could be contributing to J. G.’s lowered seizure threshold?
8. List 5 classifications of antizeisure medications.
9. J. G’s husband comes to visit and asks you what he should do if she has a seizure at home. What would you tell him?
10. Her husband states that he is afraid for J. G. to take care of the baby. What would you say to him?
11. J. G.’s husband tells you that his wife is not good at remembering to take medication. What are some strategies that you should review with J. G. and her husband to increase the likelihood of compliance?
12. J. G. asks, “If I get my blood level under control will it stay at the same level as long as I take my medicine?” How would you answer her question?
13. J. G.’s husband asks if the drugs could harm his wife in any way. What general information would you give them about anticonvulsants?
14. J. G.’s husband says, “I was watching ‘Emergency’ last night and they showed this guy who just kept on having a seizure. That doctor had to give him lost of medicine before he came out of it. What is that called?” How would you explain status epilepticus, and why is it a medical emergency?

J. G. is a 34-year old P1 G1 woman who underwent an emergency cesarean delivery after a prolonged labor, during which she exhibited a sudden change in neurologic functioning and started seizing. Since that time, she has experienced 3 tonic-clonic (grand mal) seizures, diagnosed as having a basal ganglion hematoma with infarct, and was started on phenytoin. Postdelivery, J. G. demonstrated dyskinesia, resulting in frequent falls with ambulation. When the seizure disorder appeared to be under control, she was transferred to a rehabilitation facility for evaluation, and 2 weeks of intensive physical therapy. She is now home, where she is doing quite well but still has occasional falls and is receiving physical therapy 3 times a week in her home. She remains on phenytoin and has had no seizures since her release from the rehabilitation facility. As case manager for J. G.’s HMO, you visit her and her family at home for evaluation of long-term, follow-up care.

1. A seizure is not a disease in itself but a symptom of a disease. What is the term for chronically recurring seizures?
2. Does J. G. have epilepsy?
3. The 3 main phases of a seizure are the preictal, ictal, and postictal. Differentiiate between the 3 phases, and list clinical symptoms you may observe when a patient is having a seizure.
4. What is the pathophysiology of a seizure?
5. J. G. had grand mal, or tonic-clonic, seizures. Describe this type of seizure. List 5 other types of seizures.
6. Some patients know they are about to have a seizure. What is this preseizure warning called, and what form does it take?
7. Besides the brain injury, what are some other possible conditions that could be contributing to J. G.’s lowered seizure threshold?
8. List 5 classifications of antizeisure medications.
9. J. G’s husband comes to visit and asks you what he should do if she has a seizure at home. What would you tell him?
10. Her husband states that he is afraid for J. G. to take care of the baby. What would you say to him?
11. J. G.’s husband tells you that his wife is not good at remembering to take medication. What are some strategies that you should review with J. G. and her husband to increase the likelihood of compliance?
12. J. G. asks, “If I get my blood level under control will it stay at the same level as long as I take my medicine?” How would you answer her question?
13. J. G.’s husband asks if the drugs could harm his wife in any way. What general information would you give them about anticonvulsants?
14. J. G.’s husband says, “I was watching ‘Emergency’ last night and they showed this guy who just kept on having a seizure. That doctor had to give him lost of medicine before he came out of it. What is that called?” How would you explain status epilepticus, and why is it a medical emergency?

Answer 1

A seizure is not a disease in itself but a symptom of a disease. What is the term for chronically recurring seizures?

Answer:The chronically recurring seizure is epilepsy. It is characterized by mild muscle jerks to severe convulsions.

Does J. G. have epilepsy?

Answer: Yes J.G have the chronically recurring disease called epilepsy.

The 3 main phases of a seizure are the preictal, ictal, and postictal. Differentiiate between the 3 phases, and list clinical symptoms you may observe when a patient is having a seizure.

Answer: The seizure have three main phases

1. Preictal phase: It is the beginning stage. It is the time before the seizure. It is a warning stage. All persons some times not experience any symptoms on this phase.
2. Ictal phase: It is the middle stage of the seizure. That is from the appearance of first symptom to the end of the seizure activity. During the time intense electrical activities are takesplace in the brain.
3. Postictal phase: It is the stage after the seizure activity. During that time altered state of consciousness may occur. It is usually lasts 5 to 30 minutes. But the time duration becomes more in severe type of seizure.

Clinical symptoms

• The clinical symptoms include:
• A staring spell
• Temporary confusion
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness
• Fear and anxiety

What is the pathophysiology of a seizure?

Answer:

• Due to excessive excitation or loss of inhibition.
• The paroxysmal discharges are arises from the groups of neurons.
• This will alter the brain physiology and seizure occurs.
• The spread of excitability to subcortical, thalamic, brainstem and spinal cord structures corresponds with the tonic phase of the seizure.

J. G. had grand mal, or tonic-clonic, seizures. Describe this type of seizure. List 5 other types of seizures.

Answer:

Mainly seizures are two types

Focal seizure and Generalised seizure. Focal seizure starts in the particular point of brain. Generalised seizure occurs when nerve cells on both side of brain. They causes muscle spasm and fall.

Tonic-clonic or Generalised seizure: It is a type of generalised seizure. It lasts for 1 to 3 minutes. This causes body stiffness, jerks, shakes, loss of consciousness, breathing problems and tongue bite.

Other types of seizures are

1. Clonic seizure
2. Tonic seizure
3. Atonic seizure
4. Myoclonic seizure
5. Absence or petit mal seizure

Some patients know they are about to have a seizure. What is this preseizure warning called, and what form does it take?

Answer: The seizure warning sign is called as auras. It range from headache to seeing colors. Some patients may experience unusual smell and taste.

Besides the brain injury, what are some other possible conditions that could be contributing to J. G.’s lowered seizure threshold?

Answer:

• Brain infection or injury
• Congenital brain defects
• Brain tumor
• Drug abuse
• Epilepsy
• Abnormal levels of sodium or glucose in the blood.

List 5 classifications of antizeisure medications.

Answer: The antiseizure medications are

1. Carbamazepine
2. Phenytoin
3. Valproic acid
4. Pregabalin
5. Phenobarbital

J. G’s husband comes to visit and asks you what he should do if she has a seizure at home. What would you tell him?

Answer:

Advice that

• During the time of seizure cushion the person's head
• Loosen any tight neckwear
• Turn the person on his or her side
• Do not place anything in the mouth or try to pry the teeth apart.

Her husband states that he is afraid for J. G. to take care of the baby. What would you say to him?

Answer: Advice regarding the measures that how to keep the baby safe

• While on feeding, sit on floor with back well supported to avoid fall.
• Do not provide bath to the baby by the sick mother alone.
• Place the bay on floor rather than table for all the actions.
• If the mother have loss of memory or consciousness, make a note of antileptic medications name, time etc.
• Donot give care to the baby soon after seizure.

J. G.’s husband tells you that his wife is not good at remembering to take medication. What are some strategies that you should review with J. G. and her husband to increase the likelihood of compliance?

Answer: If the patient is forget to take the medication

Once in a day: take the forgotten dose as soon as remember it

Twice a day: Take the forgotten dose within six hours of due. Otherwise don't take forgotten dose. take the next dose at the due time.

J. G. asks, “If I get my blood level under control will it stay at the same level as long as I take my medicine?” How would you answer her question?

Answer: The blood sugar level increases. The benzodiazepines and steroid causes increase in blood sugar level.

J. G.’s husband asks if the drugs could harm his wife in any way. What general information would you give them about anticonvulsants?

Answer:

• Avoid alcohol and drugs.
• Get plenty of sleep.
• Avoid the activities such as driving, climbing, and swimming
• Involve in recreational activities and manage the stress level.

J. G.’s husband says, “I was watching ‘Emergency’ last night and they showed this guy who just kept on having a seizure. That doctor had to give him lost of medicine before he came out of it. What is that called?” How would you explain status epilepticus, and why is it a medical emergency?

Answer: It is called status epilepticus.

Status epilepticus is a single seizure lasting more than five minutes or two or more periods of seizure withn five minutes without returning the person to the normal stage in between them.

It is considered as a medical emergency. Because the status epilepticus lasts for 5 minutes and it may lead to permanent brain damage or death.