Seizure Disorders Before and during a seizure, the following are assessed and documented 1. Circumstances before seizure (visual, auditory, or olfactory stimuli, etc.) 2. The first thing a patient does in a seizure – where the movements or the stiffness starts, conjugate gaze position, and the position of the patient’s head at the beginning of the seizure. This information gives clues to the location of the epileptogenic focus of the brain. Important to document whether or not beginning of seizure was observed. 3. The type of movements in the part of the body involved. 4. Areas of body involved (turn back bedding and expose patient). 5. Pupil size. Are eyes open? Did eyes or head turn to one side? 6. Presence or absence of automatisms (involuntary motor activity, such as lip smacking or repeated swallowing). 7. Incontinence or urine or stool. 8. Duration of each phase of the seizure. 9. Unconsciousness, if present, and duration. 10. Any obvious paralysis or weakness of arms or legs after the seizure. 11. Inability to speak after the seizure. 12. Movements at the end of the seizure. 13. Whether or not the patient sleeps afterward. 14. Cognitive status (confused or not) after the seizure.
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