GCC Nursing Guide — Epilepsy & Seizure Management

Seizure Type	Key Features	Duration	Post-ictal State
Tonic-Clonic (GTCS)	Cry, rigidity (tonic), rhythmic jerking (clonic), cyanosis, urinary incontinence, tongue biting	1–3 min	Prolonged confusion, drowsiness, headache, myalgia
Absence	Brief staring, unresponsive, eye flutter, no post-ictal state, abrupt onset and offset	5–30 sec	None — immediate return to baseline
Myoclonic	Brief, sudden jerks — arms/shoulders/face. Often on waking. Patient may be aware.	<1 sec	Minimal or none
Atonic (Drop)	Sudden loss of muscle tone — collapse/fall, head drop. High injury risk.	Seconds	Brief confusion
Focal Aware	Motor, sensory, autonomic, or psychic symptoms; patient aware and may remember	Seconds–2 min	Variable
Focal Impaired Awareness	Automatisms (lip-smacking, picking), staring, post-ictal confusion, patient unaware	30 sec–3 min	Confusion, fatigue, amnesia for event

Feature	Epileptic Seizure	Syncope	PNES (Pseudoseizure)
Onset	Sudden, no warning or brief aura	Usually preceded by prodrome (dizziness, nausea, greying)	Gradual, stress-related trigger often present
Duration	Usually <3 min	Seconds to <1 min	Often prolonged (>5 min)
Tongue biting	Lateral tongue bite (pathognomonic)	Tip of tongue only (rare)	Rare; may bite lip
Incontinence	Common	Uncommon	Can occur
Colour change	Cyanosis during ictus	Pallor (vasovagal)	Normal or flushed
Post-ictal	Prolonged confusion, headache, fatigue	Rapid recovery (<30 sec)	Variable — often crying, no true confusion
EEG	Ictal/inter-ictal abnormality	Normal	Normal during event on video-EEG
Nursing tip	Document full seizure details	Check lying/standing BP; ECG	Non-judgmental care; psychiatric referral

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Status Epilepticus Definition: Seizure lasting >5 minutes OR two or more seizures without full recovery of consciousness between them. A neurological emergency with mortality up to 20% if not treated promptly.

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NICE/GCC SE Management Protocol — Staged Approach

0–5 min

Stage 1 — First Aid

5–20 min

Stage 2 — Benzodiazepine

20–40 min

Stage 3 — 2nd Line AED

>40 min

Stage 4 — Refractory SE

Time the seizure — note exact start time
Position: lateral (recovery) if possible to protect airway; do NOT force mouth open
Protect from injury — padding, remove hazards; do NOT restrain limbs
Supplemental oxygen via face mask 15 L/min
Airway adjunct only if airway compromised — Guedel oropharyngeal airway if tolerated
IV access — establish if not already in situ
Blood glucose — check immediately (hypoglycaemia is reversible cause)
Call for medical help — if seizure at 5 minutes, call emergency team

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IV access available: Lorazepam 4mg IV (adults) — administer over 2 min. May repeat once after 10 min if no response. Child: Lorazepam 0.1 mg/kg IV.

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No IV access: Buccal midazolam 10mg (adults) — first choice in community/no IV. OR Rectal diazepam 10–20mg. Child: Buccal midazolam 0.3 mg/kg (max 10mg).

Monitor SpO2 continuously — benzodiazepines cause respiratory depression
Be prepared to support airway with BVM if apnoea occurs
Continue oxygen; reassess every 5 minutes
Diazepam IV: 10–20mg at 2–5mg/min (less preferred — respiratory depression risk)

Levetiracetam IV (preferred)

Dose: 60 mg/kg IV (max 4500mg) over 10 minutes

Advantages: Fewer drug interactions, no cardiac monitoring required, safe in liver disease

Increasing first choice in GCC hospitals due to safety profile

Phenytoin / Fosphenytoin IV

Dose: Phenytoin 20 mg/kg IV at max 50 mg/min

Monitoring required: Continuous ECG, BP every 5 min — hypotension, bradycardia, arrhythmia risk

Fosphenytoin preferred where available (less local toxicity, faster infusion)

Sodium Valproate IV

Dose: 40 mg/kg IV over 10 min (max 3000mg)

Avoid in pregnancy, liver disease. Effective for generalised and focal SE.

Lacosamide IV

Dose: 200–400mg IV over 15 min

Emerging option; cardiac monitoring for PR prolongation. Used in some GCC tertiary centres.

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Refractory SE requires ICU admission, intubation, and general anaesthesia. Call ITU/anaesthetics immediately.

Propofol

1–2 mg/kg IV bolus then 2–10 mg/kg/h infusion. ICU only. Risk of propofol infusion syndrome (PRIS) with prolonged use — monitor triglycerides, lactic acidosis.

Midazolam Infusion

0.2 mg/kg bolus then 0.05–2 mg/kg/h infusion. Widely available in GCC ICUs. Accumulates with prolonged use.

Thiopental / Pentobarbital

Used for super-refractory SE. Requires EEG monitoring for burst-suppression. Significant haemodynamic side-effects.

Continuous EEG (cEEG) monitoring required in RSE

Target: burst-suppression pattern. Neurologist/epileptologist must be involved. Consider treatable causes: autoimmune encephalitis (anti-NMDA receptor), NCSE (non-convulsive SE).

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Airway Management During Seizure

Do NOT put anything in the mouth — do not force airways or objects between teeth during convulsion
Recovery position as soon as tonic-clonic phase ends — left lateral decubitus
High-flow O2 15 L/min via non-rebreathe mask
Suction secretions once safe — soft suction catheter only
Guedel airway only if mouth relaxed (post-ictally) and gag reflex absent
Prepare BVM and intubation equipment if seizure prolonged or airway compromised
SpO2 and EtCO2 monitoring continuously

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Post-Status Nursing Bundle

Complete within 30 minutes of seizure termination:

Neurological observations: GCS, pupil response, limb movement (15-min intervals)

Blood glucose — treat if <4 mmol/L (50 mL 50% dextrose IV or Glucagon IM)

Electrolytes: Na, K, Ca, Mg — hyponatraemia and hypomagnesaemia are seizure triggers

12-lead ECG — exclude cardiac cause, post-phenytoin monitoring

Temperature — hyperthermia common post-SE; actively manage

ABG — assess post-ictal lactic acidosis (expected), persistent acidosis concerning

Document full seizure record and interventions in notes

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Seizure Duration & Status Epilepticus Timer Tool

Enter seizure time details below

Seizure Start Time (HH:MM or HH:MM:SS)

Current / End Time (HH:MM or HH:MM:SS — leave blank for NOW)

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Never stop AEDs suddenly — abrupt discontinuation risks rebound seizures and status epilepticus. Always taper under neurology supervision.

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Common AEDs — Nursing Considerations

AED	Indication	Key Nursing Points	Monitoring	Teratogenicity
Levetiracetam (Keppra)	Focal, generalised, adjunct	Monitor for behavioural changes — irritability, aggression, depression (5–10%). Ensure renal dose adjustment. IV and oral bioequivalent.	Renal function (dose-adjusted). Routine levels not required.	Low — Category C. Often preferred in pregnancy.
Sodium Valproate (Epilim)	Generalised epilepsies (first choice), focal, absence, myoclonic	Take with food — GI side-effects. Monitor weight gain, hair thinning. Pancreatitis risk. Liver function monitoring. MHRA/GCC guidance on use in women of child-bearing age.	LFTs (first 6 months), FBC, ammonia if encephalopathic. Drug levels useful.	HIGH — Category D. Neural tube defects (spina bifida), autism spectrum disorder, developmental delay. Avoid in women of child-bearing age unless no alternative.
Lamotrigine (Lamictal)	Focal, generalised, absence, Lennox-Gastaut	Slow titration essential to reduce SJS risk. Report any rash immediately — risk of Stevens-Johnson Syndrome (SJS) especially with rapid dose escalation. Levels increase in pregnancy.	Clinical monitoring for rash. Levels in pregnancy (requires dose increase).	Moderate — Category C. Preferred AED in pregnancy among available options. May increase risk of oral cleft at high doses.
Carbamazepine (Tegretol)	Focal epilepsy, trigeminal neuralgia	Enzyme inducer — multiple drug interactions (contraceptives, warfarin, phenytoin). Hyponatraemia monitoring. HLA-B*1502 testing before starting in patients of Han Chinese/Thai origin (SJS risk).	FBC, LFTs, Na at baseline and 6 months. Drug levels useful (trough). ECG in elderly.	HIGH — Neural tube defects. Avoid in pregnancy if possible.
Phenytoin (Dilantin)	Focal, tonic-clonic, IV acute SE	Narrow therapeutic index — toxicity at levels just above therapeutic. Signs: nystagmus, ataxia, diplopia, confusion. IV: monitor ECG, BP. Gingival hyperplasia with chronic use. Zero-order kinetics — small dose increase can cause large rise in levels.	Drug levels: therapeutic 10–20 mg/L (total); 1–2 mg/L (free). ECG during IV administration. LFTs, FBC.	HIGH — Category D. Fetal hydantoin syndrome. Avoid in pregnancy.

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Sodium Valproate — GCC Safeguarding Context

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GCC-specific concern: High birth rates across GCC (UAE TFR ~1.4, Saudi Arabia ~2.4, Qatar ~1.8) mean valproate prescribing in women of child-bearing age carries substantial population-level teratogenic risk.

Valproate Pregnancy Prevention Programme (VPPP) mandatory — UK/EU model increasingly adopted
Female patients must receive annual risk acknowledgement documentation
Discuss effective contraception at every consultation
Folic acid 5mg daily if pregnancy anticipated
Nurse's role: document counselling, ensure patient understanding, escalate non-compliance concerns
If patient becomes pregnant on valproate: do NOT stop suddenly — urgent neurology referral same day

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AED Compliance & Patient Counselling

Key Messages — Never Stop Suddenly

Stopping AED suddenly risks breakthrough seizures and status epilepticus
If a dose is missed: take as soon as remembered; do not double-dose next time
Alcohol lowers seizure threshold — discuss harm reduction
Sleep deprivation is a major trigger — sleep hygiene counselling
Reporting: any change in seizure frequency, side-effects, new medications

Driving Restrictions (see Tab 4 for full GCC details)

Must be seizure-free for the legally required period before driving. Patient is legally obliged to notify licensing authority. Nurse documents this education in notes.

Ramadan Fasting — AED Timing Adjustments

Consult neurologist/pharmacist before Ramadan. Once-daily AEDs: take at Iftar or Suhoor. Twice-daily: split between Iftar and Suhoor. Avoid long fasting gaps with phenytoin (erratic levels). Ensure hydration — hyponatraemia triggers seizures. Levetiracetam and lamotrigine are most flexible for Ramadan scheduling.

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Phenytoin — Narrow Therapeutic Index Management

Therapeutic Range

Total phenytoin10–20 mg/L

Free phenytoin1–2 mg/L

Trough sampling timeJust before next dose

Toxicity Signs (levels >20 mg/L)

Nystagmus (>20 mg/L)
Ataxia, diplopia (>30 mg/L)
Dysarthria, confusion (>40 mg/L)
Seizures paradoxically worsen at toxic levels
Hypotension, bradycardia during IV infusion

Special Situations Affecting Levels

Hypoalbuminaemia — free fraction increases (use corrected level formula)
Renal failure — use free level monitoring
Pregnancy — levels fall (volume of distribution increases)
Enzyme inducers (carbamazepine, rifampicin) reduce levels
Enzyme inhibitors (fluconazole, omeprazole) increase levels

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Epilepsy Safety Advice — Patient & Family Education

Water Safety

Never swim alone — always with a seizure-aware companion
Shallow baths only — fill to minimum; do not lock bathroom door
Shower preferred over bath for epilepsy patients
Jacuzzi/hot tub: avoid (vasodilatory trigger + drowning risk)
Inform lifeguard of epilepsy diagnosis

Kitchen & Cooking

Use back hobs on cooker — prevents pan dragging
Microwave preferred over gas/electric hob
Kettle tipper device; use small amounts of boiling water
Sit to cook when possible; use a stool at kitchen counter
Non-slip mats; avoid sharp implements when alone

Heights & Machinery

Avoid working at heights (ladders, scaffolding, roofs)
No operating heavy machinery or power tools when uncontrolled
Stairs: use handrail; carpeted stairs preferred
Sports: contact sports, cycling — helmet always; swimming rules above
Occupation risk assessment required — document and refer

GCC Driving Regulations for Epilepsy (2025)

GCC Country	Seizure-Free Period Required	Authority	Notes
UAE	2 years seizure-free (private vehicles)	RTA / Emirates Authority	Neurology clearance letter required; re-assessment annually
Saudi Arabia	1–2 years (varies by condition)	MOCI / Moroor (Traffic Authority)	Consultant neurology report mandatory
Qatar	2 years seizure-free	Ministry of Interior (Traffic)	Annual medical review; commercial vehicles prohibited
Kuwait	2 years seizure-free	MOI Traffic Department	Neurologist clearance; HGV/PSV lifetime ban
Bahrain	2 years seizure-free	General Directorate of Traffic	Medical report from treating neurologist
Oman	2 years seizure-free	Royal Oman Police (Traffic)	Annual review; inform insurer

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Vagal Nerve Stimulator (VNS) — Nursing Considerations

VNS is an adjunctive neuromodulation therapy for drug-resistant epilepsy. A subcutaneous device implanted in the left chest wall delivers intermittent electrical pulses to the left vagus nerve.

Nursing Points:

Device settings programmed externally — a magnet swiped over device activates an on-demand stimulation to abort a seizure
Teach patient and carers magnet use — abortive therapy during aura or onset
Voice hoarseness, cough, and throat discomfort are common side-effects (vagus nerve stimulation)
MRI: VNS patients require specific MRI protocols — notify radiology before any scan
Diathermy: avoid in surgical patients — must inform surgical team
Document VNS presence clearly in nursing notes and medication chart
No chest compressions directly over device — use only if life-threatening emergency

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Rescue Medication Education for Carers

Buccal Midazolam (first choice in community)

Adult dose: 10mg; Child dose: by weight (0.3 mg/kg, max 10mg)

Route: Squirt between gum and cheek using applicator syringe; half each side

When to give: Seizure lasting >5 minutes OR third seizure in 24 hours without recovery

Rectal Diazepam (alternative)

Adult dose: 10–20mg; Child: 0.5 mg/kg

Less socially acceptable in GCC cultural context — buccal midazolam is strongly preferred for community and school settings

Call 999/emergency if:

Seizure does not stop 5 minutes after rescue medication given
Person does not wake up after seizure stops
Another seizure occurs shortly after
Injury has occurred during seizure

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Seizure Triggers — Identification & Avoidance

Lifestyle Triggers

Environmental Triggers

GCC-Specific Considerations

Ramadan fasting — disrupted sleep patterns, dehydration, electrolyte changes
Extreme summer heat (40–50°C) — dehydration trigger
High incidence of genetic/structural epilepsies related to consanguinity
Traditional herbal remedies (may interact with AEDs)
Encourage seizure diary — Arabic language apps available

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Epilepsy in Pregnancy

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Women with epilepsy (WWE) have higher risk of SUDEP, complications of pregnancy, and AED teratogenicity. Requires specialist multidisciplinary management from pre-conception.

Folic acid 5mg daily: Start pre-conception; continue through first trimester (high-dose due to AED folate depletion)
AED choice: Avoid valproate; lamotrigine or levetiracetam preferred; all AEDs carry some risk
Seizure risk in pregnancy: Increases due to altered drug metabolism, sleep deprivation, stress; do NOT stop AEDs without specialist review
Lamotrigine levels fall in pregnancy — may require dose increases up to 100%; monitor levels monthly
SUDEP risk increases if seizures uncontrolled during pregnancy
Vitamin K 10mg orally from 36 weeks (AED enzyme inducers reduce neonatal vitamin K)
Breastfeeding: generally safe with most AEDs; valproate and lamotrigine transferred in low amounts

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Paediatric Epilepsy

Febrile Seizures vs Epilepsy

Feature	Febrile Seizure	Epilepsy
Trigger	Fever (>38°C) — usually viral	Not fever-related (or afebrile)
Age	6 months – 6 years	Any age
Recurrence	30% risk of further febrile seizure; <5% develop epilepsy	By definition recurrent unprovoked
EEG	Usually normal	Typically abnormal
Treatment	Manage fever; rectal diazepam rescue; no long-term AED	AED after second unprovoked seizure

Ketogenic Diet Nursing

High-fat, low-carbohydrate diet for drug-resistant paediatric epilepsy
Nursing: monitor weight, urine ketones (aim 3–4+ ketones), blood glucose, lipid profile
Constipation, kidney stones, and dyslipidaemia are common side-effects
All medications must be sugar-free — check every drug formulation
Families require extensive dietitian support; cultural adaptation for GCC Arabic diets needed

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Elderly Epilepsy

New-onset epilepsy in the elderly (>65 years) is the most common age group for new diagnosis. Stroke is the most common aetiology (30%).

Polypharmacy Drug Interactions — Key AED Risks:

Carbamazepine: interacts with warfarin (INR reduced), statins, antihypertensives
Phenytoin: interacts with warfarin, NSAIDs, proton pump inhibitors, antibiotics
Valproate: increases free warfarin; inhibits lamotrigine metabolism
Levetiracetam: minimal interactions — often preferred in elderly
Lamotrigine: minimal interactions — also suitable in elderly

Geriatric Considerations:

Reduced renal clearance — levetiracetam dose adjustment required
Increased fall risk with all AEDs — assess gait and balance
Hyponatraemia from carbamazepine especially in frail/cardiac patients
Cognitive side-effects more pronounced — topiramate and phenobarbitone should be avoided

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Post-Traumatic Epilepsy (PTE)

Epilepsy developing after traumatic brain injury (TBI). Risk increases with severity of TBI, intracranial haemorrhage, depressed skull fractures, and penetrating head injuries.

Classification:

Immediate (<24h)Impact seizure — does not predict PTE

Early (1–7 days)Treat with AED prophylaxis (7 days); levetiracetam preferred

Late (>7 days)True PTE — long-term AED therapy required

GCC Context — RTAs & TBI:

GCC has among the world's highest road traffic accident (RTA) rates. Saudi Arabia, UAE, and Oman have significant TBI burdens. Nurses in trauma/neuro ICUs must be alert to early post-traumatic seizures and prophylaxis protocols.

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Epilepsy in the GCC — Consanguinity & Genetic Syndromes

Consanguinity-Related Epilepsy

Consanguineous marriage rates in GCC remain among the highest globally (25–55% in Saudi Arabia, Qatar, UAE). This increases the prevalence of autosomal recessive epilepsy syndromes:

Dravet Syndrome (SCN1A mutations) — severe myoclonic epilepsy of infancy
Lennox-Gastaut Syndrome — multiple seizure types, cognitive impairment
Progressive myoclonic epilepsies (Lafora disease, Unverricht-Lundborg)
Metabolic epilepsies — pyridoxine-dependent, glucose transporter deficiency
Tuberous Sclerosis Complex (TSC)

Family Education — GCC Considerations

Genetic counselling referral for families with epilepsy syndrome diagnosis
Explain recessive inheritance risk to parents sensitively
Extended family often involved in care decisions — include them in education
Arabic language materials essential for low-literacy families
Religious framing: emphasise this is a medical condition, not spiritual punishment
Epilepsy stigma remains significant in GCC — address directly with patient and family

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In GCC: genetic epilepsy syndromes are disproportionately common. Nursing assessment should include family history of seizures, consanguinity, and developmental delay in siblings.

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SUDEP — Sudden Unexpected Death in Epilepsy

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SUDEP occurs in approximately 1 in 1000 adults with epilepsy per year. It is the leading cause of death in people with uncontrolled epilepsy. Risk is highest in young adults with uncontrolled tonic-clonic seizures, especially during sleep.

Risk Factors for SUDEP

Frequent generalised tonic-clonic seizures (highest risk)
Nocturnal seizures — sleeping alone
Male sex; young adult age
Drug-resistant epilepsy; poor AED compliance
Prone sleeping position during/after seizure
Alcohol use

Protective Factors

Seizure freedom (especially GTCS)
AED compliance; optimal treatment
Not sleeping alone — nocturnal supervision
Seizure detection devices and alarms
Breathing monitor / seizure alarm mattress

Nursing Role — Counselling

SUDEP counselling is part of every epilepsy nurse consultation
Use SUDEP Action resources; document counselling given
Sensitive framing: focus on risk reduction, not fatalism
Advise on safe sleeping position (lateral/supine); avoid prone
GCC context: living in family home = natural supervision — discuss openly as protective

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GCC Exam Focus: High-yield content for DHA (Dubai), DOH (Abu Dhabi), SCFHS (Saudi Arabia), QCHP (Qatar), MOH Bahrain/Kuwait/Oman licensing examinations for nurses. These topics recur frequently in neurology sections.

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Status Epilepticus — Exam Drug Protocol

Time	Stage	First-Line Drug	Dose (Adult)	Route
0–5 min	Stage 1	Airway + O2 + BGL	Supportive only	—
5–20 min	Stage 2	Lorazepam (IV access)	4mg IV over 2 min — repeat once after 10 min	IV
5–20 min	Stage 2	Midazolam (no IV)	10mg buccal or IM	Buccal / IM
20–40 min	Stage 3	Levetiracetam IV (preferred)	60 mg/kg (max 4500mg) over 10 min	IV
20–40 min	Stage 3	Phenytoin IV (alternative)	20 mg/kg at max 50 mg/min + ECG monitoring	IV
20–40 min	Stage 3	Sodium Valproate IV	40 mg/kg over 10 min (max 3000mg)	IV
>40 min	Stage 4 — RSE	Propofol / Midazolam infusion	ICU — anaesthesia + intubation + cEEG	IV infusion

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AED Classification Table — Exam Format

AED	Mechanism	Epilepsy Type	Key Side-Effect (Exam Favourite)
Levetiracetam	SV2A binding (vesicle release inhibition)	Focal + Generalised	Behavioural changes, irritability
Sodium Valproate	Na channel + GABA enhancement + anti-glutamate	Generalised (1st line), Focal	Teratogenicity (HIGHEST), weight gain, tremor, hair loss
Lamotrigine	Na channel (voltage-gated); glutamate release inhibition	Focal + Generalised, Absence	Stevens-Johnson Syndrome (with rapid titration)
Carbamazepine	Na channel blockade	Focal epilepsy (NOT absence)	Hyponatraemia (SIADH), diplopia, ataxia, SJS (HLA-B*1502)
Phenytoin	Na channel blockade (use-dependent)	Focal + Tonic-Clonic; IV SE	Gingival hyperplasia, nystagmus, zero-order kinetics
Ethosuximide	T-type Ca channel blockade	Absence ONLY (first-line)	GI upset, headache
Phenobarbitone	GABA-A enhancement	Focal + Generalised	Sedation, dependence, enzyme inducer

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DHA / DOH / SCFHS / QCHP High-Yield Questions

Q1. A patient has been seizing for 8 minutes with IV access. Which is the MOST appropriate first drug to give?

A: Lorazepam 4mg IV over 2 minutes. This is the Stage 2 drug of choice with IV access. Buccal midazolam is the alternative without IV access.

Q2. A nurse observes a patient having a generalised tonic-clonic seizure. What is the FIRST nursing action?

A: Note the exact start time and ensure patient safety (remove hazards, protect head, lateral position if possible). Do NOT put anything in the mouth. Call for help if seizure continues beyond 5 minutes.

Q3. Which AED is CONTRAINDICATED in absence seizures and may worsen them?

A: Carbamazepine (and also phenytoin and vigabatrin). These are sodium-channel drugs that can exacerbate absence seizures. Ethosuximide is the first-line treatment for pure absence epilepsy.

Q4. A woman of child-bearing age is on sodium valproate. What is the nurse's primary responsibility?

A: Ensure she has received counselling about teratogenic risks, document the counselling, confirm she is on effective contraception, and ensure she is enrolled in the Valproate Pregnancy Prevention Programme (VPPP). Annual risk acknowledgement form must be completed.

Q5. What is the definition of status epilepticus?

A: A seizure lasting more than 5 minutes, OR two or more discrete seizures without full recovery of consciousness between them. The operational definition for treatment purposes is 5 minutes (NICE/ILAE current guidelines).

Q6. After a generalised tonic-clonic seizure, a patient has right-sided arm weakness. What is this called and how long does it last?

A: Todd's paresis (Todd's paralysis). Focal neurological weakness after a focal or generalised seizure, lasting minutes to hours (rarely up to 48h). It is a post-ictal phenomenon and resolves spontaneously — but must be differentiated from acute stroke (brain imaging needed if prolonged).

Q7. Which AED has zero-order kinetics and a narrow therapeutic index requiring serum level monitoring?

A: Phenytoin. Zero-order kinetics mean a small dose increase can cause a disproportionately large rise in serum level, risking toxicity. Therapeutic range: 10–20 mg/L total. Signs of toxicity: nystagmus, ataxia, diplopia, confusion.

Q8. A patient with refractory epilepsy has a VNS device. What must the nurse alert before any MRI scan?

A: Alert the radiology team and MRI radiographer about the VNS device. VNS requires specific MRI-conditional protocols. Standard MRI may be contraindicated. The device details (model, lead configuration) must be checked before scanning.

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Seizure Documentation Template

      SEIZURE EPISODE DOCUMENTATION

      Date: __________   Time started: __________   Time ended: __________   Duration: ____ min ____ sec

      Witnessed by: ____________________   Location: ____________________

      SEIZURE DESCRIPTION:

      Type: [ ] Tonic-Clonic  [ ] Absence  [ ] Focal Aware  [ ] Focal Impaired  [ ] Myoclonic  [ ] Atonic  [ ] Unknown

      Onset side: [ ] Left  [ ] Right  [ ] Generalised  [ ] Unknown

      Eye deviation: [ ] Left  [ ] Right  [ ] None   Head deviation: [ ] Left  [ ] Right  [ ] None

      Colour change: [ ] Cyanosis  [ ] Pallor  [ ] None   Incontinence: [ ] Yes  [ ] No

      Tongue bite: [ ] None  [ ] Lateral  [ ] Tip   Automatisms: [ ] None  [ ] Lip-smacking  [ ] Picking  [ ] Other

      POST-ICTAL STATE:

      GCS: E__V__M__   Confusion: [ ] None  [ ] Mild  [ ] Moderate  [ ] Severe

      Todd's paresis: [ ] None  [ ] Left arm  [ ] Right arm  [ ] Left leg  [ ] Right leg

      Blood glucose: _______ mmol/L   SpO2: _______ %   Temperature: _______°C

      INTERVENTION:

      Rescue medication given: [ ] None  [ ] Buccal midazolam ___mg at ______  [ ] Rectal diazepam ___mg at ______

      Emergency team called: [ ] Yes time ______  [ ] No   O2 given: [ ] Yes ___L/min  [ ] No

      Nurse signature: ____________________   Designation: ____________________   Date: __________

ILAE Seizure Classification (2017)

Seizure Type Reference

Seizure vs Syncope vs PNES — Differentiation

Pre-ictal, Ictal & Post-ictal Phases

Seizure Observation & Documentation Guide