Case Study 1: Seizure Disorder

The answer to question 1:

During seizure activity, there are major assessments that the nurse should make. The first thing a nurse should do is to assess what happens in each phase of the seizure. He/she may assess the phases by asking those who observed the seizure. The nurse can enquire about what the person was doing before the seizure event if there were any changes in behavior or mood before the seizure occurred, and whether there was any warning sign right before the seizure happened. He/she should note the time and the dates of the prodromal period. Apart from that, the nurse should also inquire if there have been any previous seizures or any other medical conditions of the patient. He should also check if there are epilepsy risk factors, and if the patient is on current medication which could predispose him/her to seizure (Heck et al., 2014).

The answer to question 2

Electroencephalogram (EEG) remains a primary study for patients with seizure disorder. This is because the development of seizure may be accompanied by the appearance of epileptiform discharges like spikes, periodic lateralized discharge (PLED), or sharp waves. Studies show that a PLED indicates strongly about the occurrence of sharp seizures (Ramgopal et al., 2014). Spikes predict highly about the seizure disorder while sharp waves have a lower predictive value. Sharp waves can occur even when the patients do not have a seizure; thus, caution should be taken. EEG may manifest in non-convulsive epilepticus in some circumstances. If such happens, particular attention is required, and the best diagnosis is to study the pattern of repeated seizures with incomplete recovery. If the study of EEG shows a regular pattern for repetitive seizures, then it can confirm that a patient has a seizure disorder, even without defined sharp waves or spikes.

References

Heck, C. N., King‐Stephens, D., Massey, A. D., Nair, D. R., Jobst, B. C., Barkley, G. L., … & Skidmore, C. (2014). Two‐year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia, 55(3), 432-441.

Ramgopal, S., Thome-Souza, S., Jackson, M., Kadish, N. E., Fernández, I. S., Klehm, J., …&Loddenkemper, T. (2014). Seizure detection, seizure prediction, and closed-loop warning systems in epilepsy. Epilepsy & behavior, 37, 291-307.

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