DOWNLOAD
Grand Canyon University
Alterations in Neurological Functioning
Study Guide
Course: NUR513/NUR 513 Pediatric Nursing
, Alterations in Neurological Functioning:
Seizure Disorders
Seizures: periods of abnormal electrical discharge (excessive concurrent firing) in the brain that
cause involuntary movement, behavior, and sensory alterations.
-Common disorder (1 out of every 10 children will endure at least one seizure in childhood.
Epilepsy: chronic disorder characterized by recurrent, unprovoked seizures secondary to an
underlying brain abnormality. Highest rate of onset occurs during the first 12 months of life.
Etiology & Pathophysiology:
A seizure is a clinical event in which abnormal discharges of electrical activity occur within the
brain. When an excessive number of neurons become overexcited, they discharge abnormally.
-May result from: a CNS disorder, a CNS structural defect, or a disorder that affects CNS
functioning, such as- brain injury, infection, electrolyte disturbance, endocrine dysfunction,
toxins, and brain tumor. Genetic factors or familial predisposition. Some have no known cause
-Partial or focal seizures are caused by abnormal electrical activity in one hemisphere or a
specific are of the cerebral cortex, most often the temporal, frontal, or parietal lobes. The
symptoms displayed depend on the region of the cerebral cortex affected.
-Generalized seizures are the result of diffuse electrical activity that begins in both
hemispheres of the brain simultaneously, and spreads throughout the cortex into the
brainstem. Movements & spasms displayed by the child are bilateral, symmetrical, and
consciousness is impaired.
-Febrile seizures convulsions that occur in connection with a fever greater than 39°C (102.2°F)
during an associated acute illness. Child has no evidence of intracranial infection or systemic
metabolic disorder, but a genetic predisposition may be present.
-Usually seen in children between 9 months and 5 years of age.
-Simple febrile seizures last less than 15 minutes and do not recur during the same illness.
-CM: characterized by generalized tonic-clonic movements and rolling back of the eyes
lasting a few seconds to less than 15 minutes. Followed by a brief postictal period
-Complex febrile seizures last 15 min or longer & recur within 24 hours; may have greater risk
for developing epilepsy
-CM: look like a simple febrile seizure but additionally have focal signs and last longer
than 10-15 min
-Newborn seizures usually occur because of primary CNS disease (intraventricular or other
hemorrhage in the brain), CNS infection, inborn errors of metabolism, asphyxia, electrolyte
disorder, drug withdrawal or toxicity, kernicterus, or other underlying disease.
, -CM: may be subtle with roving eye movements, repetitive blinking, sucking, lip
smacking, tongue thrusting, swimming movements of the arms, leg pedaling movements, and
apnea or tachycardia.
-Status epilepticus is a prolonged continuous seizure of 15 minutes or evidence of intermittent
seizures noted from clinical signs or ECG tracings lasting more than 15 min without full
recovery of consciousness between seizures.
-Risk factors: low levels of antiepileptic medications, fever, infection, & a recent change in
medical condition are the most common. -Highest incidence occurs in first 12 months of life.
-10% of children with epilepsy will have at least one episode of status epilepticus.
-The length of a seizure episode is important bc airway may be compromised, leading to
cerebral hypoxia and death of some neurons.
-Basal metabolic rate rises during the peak of seizure activity. This change increases the
demand for oxygen & glucose.
Clinical Manifestations: Symptoms depend on type & duration of seizure
Two types: Partial (focal) seizures & generalized seizures.
-Seizure characteristics & patterns may change as the child’s nervous system grows & matures.
-Seizures in infants may be subtle, older child may present w full body presentation of tonic-
clonic movements. As neurons and their connections throughput cortex develop, neurons fire
in repetitive high-frequency bursts, leading to more sustained & organized seizures.
Type of Seizure & Etiology Clinical Manifestations
Partial Seizures- often start w an Onset: any age
aura or abrupt unprovoked
alteration in behavior. When child No loss of consciousness, lasts less than 30 seconds, no
recognizes pattern, may have time post-seizure confusion, may occur many times a day
to avoid injury by laying down on
the floor No aura (a visual, auditory, taste, or motor sensation
preceding a seizure or migraine headache)
Simple partial seizures
Signs depend on section of brain affected: motor
(focal seizures) responses -twitching or loss of muscle tone (one
extremity, part of one, or ipsilateral extremities w eyes
Focal damage- arise from a and head turning in opposite direction) or
localized area of one cerebral
hemisphere (cerebral palsy) Paresthesia- decreased sensation or tingling; auditory,
olfactory, or visual sensations;
Tumors or lesions
May progress to a generalized seizure
Arteriovenous malformation
(congenital tangling of blood
, vessels in the brain)
Brain abscesses
Complex partial seizures Onset: 3 years to adolescence
(psychomotor seizures) Consciousness is impaired immediately; lasts 30 seconds
to 5 mins; post-seizure amnesia or confusion
Lesions, cysts, or tumors
Aura frequently present
Perinatal trauma
May have abnormal motor activity, twitching, loss of tone
Focal sclerosis (e.g., scarring of the or posturing; automatisms- involuntary, repetitive body
medio temporal lobe from movements without purpose- lip smacking, lip chewing,
prolonged febrile seizures) rapid eye blinking
Vascular anomalies (e.g., May have sensory changes such as tingling or numbness,
arteriovenous malformations) feeling of anxiety, fear or déjà vu
Brain trauma May progress to a generalized seizure
Abdominal pain
Generalized seizures -often begin Onset: any age, rare before 6 months of age
with tonic phase (unconsciousness,
continuous muscular contraction, & Abrupt-onset seizure, 1 to 2 min loss of consciousness,
sustained stiffness) – followed by pos-seizure confusion (few minutes to hours)
clonic phase (alternating muscular
contraction & relaxation as a Aura may or may not be present
rhythmic repetitive jerking) Body becomes stiff and rigid when all muscles contract
(tonic phase), followed by rhythmic jerking motions
Tonic-clonic seizures (clonic phase)
(grand mal seizures) Eyes roll upward or deviate to one side; pupils dilate
Cerebral damage from perinatal Drooling or foaming at the mouth as secretions are not
trauma, brain trauma, tumors, swallowed
structural lesions, metabolic and
neuromuscular degenerative Abdominal or chest wall rigidity with leg, head, and neck
disorders extended, and arms flexed or contracted
Genetic predispositions Brief apnea & cyanosis may occur
Many are idiopathic
Grand Canyon University
Alterations in Neurological Functioning
Study Guide
Course: NUR513/NUR 513 Pediatric Nursing
, Alterations in Neurological Functioning:
Seizure Disorders
Seizures: periods of abnormal electrical discharge (excessive concurrent firing) in the brain that
cause involuntary movement, behavior, and sensory alterations.
-Common disorder (1 out of every 10 children will endure at least one seizure in childhood.
Epilepsy: chronic disorder characterized by recurrent, unprovoked seizures secondary to an
underlying brain abnormality. Highest rate of onset occurs during the first 12 months of life.
Etiology & Pathophysiology:
A seizure is a clinical event in which abnormal discharges of electrical activity occur within the
brain. When an excessive number of neurons become overexcited, they discharge abnormally.
-May result from: a CNS disorder, a CNS structural defect, or a disorder that affects CNS
functioning, such as- brain injury, infection, electrolyte disturbance, endocrine dysfunction,
toxins, and brain tumor. Genetic factors or familial predisposition. Some have no known cause
-Partial or focal seizures are caused by abnormal electrical activity in one hemisphere or a
specific are of the cerebral cortex, most often the temporal, frontal, or parietal lobes. The
symptoms displayed depend on the region of the cerebral cortex affected.
-Generalized seizures are the result of diffuse electrical activity that begins in both
hemispheres of the brain simultaneously, and spreads throughout the cortex into the
brainstem. Movements & spasms displayed by the child are bilateral, symmetrical, and
consciousness is impaired.
-Febrile seizures convulsions that occur in connection with a fever greater than 39°C (102.2°F)
during an associated acute illness. Child has no evidence of intracranial infection or systemic
metabolic disorder, but a genetic predisposition may be present.
-Usually seen in children between 9 months and 5 years of age.
-Simple febrile seizures last less than 15 minutes and do not recur during the same illness.
-CM: characterized by generalized tonic-clonic movements and rolling back of the eyes
lasting a few seconds to less than 15 minutes. Followed by a brief postictal period
-Complex febrile seizures last 15 min or longer & recur within 24 hours; may have greater risk
for developing epilepsy
-CM: look like a simple febrile seizure but additionally have focal signs and last longer
than 10-15 min
-Newborn seizures usually occur because of primary CNS disease (intraventricular or other
hemorrhage in the brain), CNS infection, inborn errors of metabolism, asphyxia, electrolyte
disorder, drug withdrawal or toxicity, kernicterus, or other underlying disease.
, -CM: may be subtle with roving eye movements, repetitive blinking, sucking, lip
smacking, tongue thrusting, swimming movements of the arms, leg pedaling movements, and
apnea or tachycardia.
-Status epilepticus is a prolonged continuous seizure of 15 minutes or evidence of intermittent
seizures noted from clinical signs or ECG tracings lasting more than 15 min without full
recovery of consciousness between seizures.
-Risk factors: low levels of antiepileptic medications, fever, infection, & a recent change in
medical condition are the most common. -Highest incidence occurs in first 12 months of life.
-10% of children with epilepsy will have at least one episode of status epilepticus.
-The length of a seizure episode is important bc airway may be compromised, leading to
cerebral hypoxia and death of some neurons.
-Basal metabolic rate rises during the peak of seizure activity. This change increases the
demand for oxygen & glucose.
Clinical Manifestations: Symptoms depend on type & duration of seizure
Two types: Partial (focal) seizures & generalized seizures.
-Seizure characteristics & patterns may change as the child’s nervous system grows & matures.
-Seizures in infants may be subtle, older child may present w full body presentation of tonic-
clonic movements. As neurons and their connections throughput cortex develop, neurons fire
in repetitive high-frequency bursts, leading to more sustained & organized seizures.
Type of Seizure & Etiology Clinical Manifestations
Partial Seizures- often start w an Onset: any age
aura or abrupt unprovoked
alteration in behavior. When child No loss of consciousness, lasts less than 30 seconds, no
recognizes pattern, may have time post-seizure confusion, may occur many times a day
to avoid injury by laying down on
the floor No aura (a visual, auditory, taste, or motor sensation
preceding a seizure or migraine headache)
Simple partial seizures
Signs depend on section of brain affected: motor
(focal seizures) responses -twitching or loss of muscle tone (one
extremity, part of one, or ipsilateral extremities w eyes
Focal damage- arise from a and head turning in opposite direction) or
localized area of one cerebral
hemisphere (cerebral palsy) Paresthesia- decreased sensation or tingling; auditory,
olfactory, or visual sensations;
Tumors or lesions
May progress to a generalized seizure
Arteriovenous malformation
(congenital tangling of blood
, vessels in the brain)
Brain abscesses
Complex partial seizures Onset: 3 years to adolescence
(psychomotor seizures) Consciousness is impaired immediately; lasts 30 seconds
to 5 mins; post-seizure amnesia or confusion
Lesions, cysts, or tumors
Aura frequently present
Perinatal trauma
May have abnormal motor activity, twitching, loss of tone
Focal sclerosis (e.g., scarring of the or posturing; automatisms- involuntary, repetitive body
medio temporal lobe from movements without purpose- lip smacking, lip chewing,
prolonged febrile seizures) rapid eye blinking
Vascular anomalies (e.g., May have sensory changes such as tingling or numbness,
arteriovenous malformations) feeling of anxiety, fear or déjà vu
Brain trauma May progress to a generalized seizure
Abdominal pain
Generalized seizures -often begin Onset: any age, rare before 6 months of age
with tonic phase (unconsciousness,
continuous muscular contraction, & Abrupt-onset seizure, 1 to 2 min loss of consciousness,
sustained stiffness) – followed by pos-seizure confusion (few minutes to hours)
clonic phase (alternating muscular
contraction & relaxation as a Aura may or may not be present
rhythmic repetitive jerking) Body becomes stiff and rigid when all muscles contract
(tonic phase), followed by rhythmic jerking motions
Tonic-clonic seizures (clonic phase)
(grand mal seizures) Eyes roll upward or deviate to one side; pupils dilate
Cerebral damage from perinatal Drooling or foaming at the mouth as secretions are not
trauma, brain trauma, tumors, swallowed
structural lesions, metabolic and
neuromuscular degenerative Abdominal or chest wall rigidity with leg, head, and neck
disorders extended, and arms flexed or contracted
Genetic predispositions Brief apnea & cyanosis may occur
Many are idiopathic
