II. Definitions
- Seizure
- Excessive synchronous, abnormal cortical Neuron electrical activity resulting in transient findings
- Epilepsy
- Two or more unprovoked, afebrile Seizures more than 24 hours apart OR
- One unprovoked first Seizure with a 60% risk of second Seizure in 10 years (based on risk factors)
III. Epidemiology
- Seizure lifetime risk: 10%
- Epilepsy diagnosis lifetime risk: 3.9%
- U.S. Prevalence: 1% (since Seizure Disorder does not persist in many, e.g. children)
- Gender: Males slightly more than females
- More common in low and middle income countries (account for 80% of worldwide cases)
- Worldwide, associated with socioeconomic deprivation and lack of access to healthcare
- More common in regions with higher rates of congenital conditions, intracranial infection, Head Injury
- Heaney (2002) BMJ 325(7371): 1013-6 [PubMed]
- Age: Bimodal Peak Onset
- Infants
- Older adults (ages 55 to 75 years)
IV. Causes
- See Seizure Causes
V. Types
- Secondary Seizures (provoked, Situation-Related Seizures) due to underlying lesion (40% of cases)
- See Seizure Causes (includes Drug Induced Seizure and Seizure Differential Diagnosis)
- More common in older patients (whereas unprovoked Seizures are more common in younger patients)
- Most common causes
- Primary Generalized Seizures
- See Status Epilepticus
- Generalized Tonic Clonic Seizure (Grand Mal Seizure, generalized motor Seizure)
- Absence Seizure (Petit Mal Seizure, generalized, non-motor Seizure)
- Primary Focal Seizures (Partial Seizures, single hemisphere)
- Awareness
- Focal Seizure Without Impairment of Awareness (Simple Partial Seizure)
- Focal Seizure with impaired awareness (Complex Partial Seizure)
- Subtypes
- Motor Seizures (focal motor activity)
- Sensory Seizures
- Autonomic Seizures (e.g. sweating)
- Common Focal Seizure syndromes
- Awareness
- Other types
- Epileptic spasms (e.g. Infantile Spasms)
VI. Signs
- Limb jerking movements
- Muscle stiffness or rigidity
- Head Turning
- Eye Rolling
- Drooling
- Altered Level of Consciousness
- Altered breathing pattern
- Tongue Biting
- Urinary Incontinence
- Vital Sign abnormalities
VII. Differential Diagnosis
VIII. Labs
- See First Seizure Evaluation
- See Status Epilepticus
- Bedside Glucose
- Drug level monitoring indications
- Establish therapeutic concentrations when adequate Seizure control reached
- Clinical toxicity suspected
- Noncompliance suspected
- Expected variability in Pharmacokinetics
- Extremes of age
- Change of drug formulation
- Pregnancy
- References
IX. Imaging: Structural study
X. Evaluation
- See Seizure Evaluation (includes Single Seizure Evaluation)
XI. Management: General
- See Status Epilepticus
-
Seizure Prophylaxis
- See Seizure Prophylaxis for indications
- See specific Seizure types for optimal management
- Generalized Seizure (includes Generalized Tonic Clonic Seizure, Myoclonic Seizure)
- Absence Seizure
- Focal Seizure (includes simple and Complex Partial Seizure)
- Other adjuncts
- Ketogenic Diet (high fat, low Carbohydrate, low Protein)
- Associated with gastrointestinal side effects (Vomiting, Abdominal Pain, altered stool consistency)
- Risk of high Uric Acid, renal stones, decreased Calcium, Magnesium, QT Prolongation, Cardiomyopathy
- Poor level of evidence for support
- Martin (2016) Cochrane Database Syst Rev (2): CD001903 [PubMed]
- Vagus Nerve Stimulation
- Indicated for over age 12 years with medically refractory Epilepsy who are not surgical candidates
- Battery-powered stimulator/Pacemaker with leads at Vagus Nerve
- Morris (2013) Neurology 81(16): 1453-59 [PubMed]
- Responsive neurostimulation
- Similar to Vagus Nerve stimulator, but leads are inserted into the actual Seizure focus
- In response to sensing abnormal electrical activity, neurostimulator delivers electrical stimulation
- Risk of implant site infection, Headache, dysesthesia
- Bergey (2015) Neurology 84(8): 810-7 [PubMed]
- Ketogenic Diet (high fat, low Carbohydrate, low Protein)
XII. Management: Special topics
-
Epilepsy in Pregnancy
- See Epilepsy in Pregnancy
-
Contraception is key
- Estrogen-based Contraception is less effective in those on antiepileptic drugs
- Plan pregnancy on non-Teratogenic agents
- Major birth defects occur in 4-7% of those born to mothers on Seizure Prophylaxis monotherapy
- Driving
- Most U.S. states require no driving for 3-12 months since last Seizure
- Exact duration of non-driving varies by state
-
Physical Activity
- Physical Activity is recommended in Epilepsy (may decrease Seizure frequency)
- Most sports are not contraindicated in well controlled patients (e.g. biking, Contact Sports, swimming)
- Avoid high risk sports (e.g. hang gliding, Scuba Diving, free climbing)
- Screen for comorbid neuropsychiatric disorders
- Cognitive Impairment and Mood Disorders are common in Seizure Disorder (which may affect compliance)
XIII. Management: Surgery for Medically refractory Epilepsy
- Seizures continue despite antiepileptic drug prophylaxis in 30% of patients
- Surgical resection of Seizure focus results in Seizure resolution in 76% of cases
- Predictors of Seizure-free after surgery
- Seizures without loss of consciousness
- Complete or extensive Seizure focus resection
- Prolonged Febrile Seizures
- Predictors of continued Seizures after surgery
- Non-structural Epilepsy
- Normal MRI
- Generalized Tonic-Clonic Seizures
- Infantile Spasms
- Tonic Seizures
- Invasive EEG monitoring to identify Seizure focus
- Complications
- Neurologic deficits (5%)
- Verbal memory deficits occur with Temporal Lobe resection (44% with left-sided resection)
- Medical complications (e.g. CSF Leak, Hydrocephalus, Aseptic Meningitis)
- Operative mortality (<0.5%)
- Neurologic deficits (5%)
- References
XIV. Complications
- Todd's Paralysis
- Sudden Unexplained Death in Epilepsy (SUDEP)
- Idiopathic Epilepsy related death (no other cause identified)
- More common in nocturnal Seizures
- Effective Seizure Prophylaxis lowers risk
- Typically in young adults (rare in children)
- Incidence: 9 per 1000 with Epilepsy (up to 1 in 150 for poorly controlled Seizures)
- Surges (2012) Curr Opin Neurol 25(2): 201-7 [PubMed]
XV. References
- Nocera, Valente, Amanullah (2018) Crit Dec Emerg Med 32(11): 3-9
- Wilfong (2017) Epilepsy in Children, UpToDate, accessed 7/17/2017
- Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]
- Rowland (2022) Am Fam Physician 105(5): 507-13 [PubMed]
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Related Studies
| Definition (MEDLINEPLUS) |
Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness. Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown. Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy. NIH: National Institute of Neurological Disorders and Stroke |
| Definition (SCTSPA) | Trastorno caracterizado por convulsiones recurrentes |
| Definition (SNOMEDCT_US) | A disorder characterized by recurrent seizures |
| Definition (NCI) | A brain disorder characterized by episodes of abnormally increased neuronal discharge resulting in transient episodes of sensory or motor neurological dysfunction, or psychic dysfunction. These episodes may or may not be associated with loss of consciousness or convulsions. |
| Definition (NCI_NCI-GLOSS) | A group of disorders marked by problems in the normal functioning of the brain. These problems can produce seizures, unusual body movements, a loss of consciousness or changes in consciousness, as well as mental problems or problems with the senses. |
| Definition (MSH) | A disorder characterized by recurrent episodes of paroxysmal brain dysfunction due to a sudden, disorderly, and excessive neuronal discharge. Epilepsy classification systems are generally based upon: (1) clinical features of the seizure episodes (e.g., motor seizure), (2) etiology (e.g., post-traumatic), (3) anatomic site of seizure origin (e.g., frontal lobe seizure), (4) tendency to spread to other structures in the brain, and (5) temporal patterns (e.g., nocturnal epilepsy). (From Adams et al., Principles of Neurology, 6th ed, p313) |
| Definition (CSP) | brain disorder characterized by recurring excessive neuronal discharge, exhibited by transient episodes of motor, sensory, or psychic dysfunction, with or without unconsciousness or convulsive movements. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D004827 |
| ICD9 | 345.9 |
| ICD10 | G40 , G40.9, G40.909 |
| SnomedCT | 155045005, 271788002, 267593008, 267698007, 155036009, 193026007, 84757009, 313307000, 246545002, 128613002 |
| LNC | MTHU020586, MTHU020809, LA16985-6 |
| English | Epilepsies, Epilepsy, EPILEPSY, Epileptic Seizures, Epilepsy NOS, Epilepsy, unspecified, Epileptic Seizure, Seizure, Epileptic, Seizures, Epileptic, SEIZURE DIS, epilepsia, epilepsy (diagnosis), seizure disorder (diagnosis), seizure disorder, epilepsy, Seizure Disorder, Seizure Disorders, Epileptic convulsions NOS, Epileptic fits NOS, Epileptic seizures NOS, Epilepsy [Disease/Finding], epilepsis, disorder epilepsy, disorder seizures, seizure epileptic, seizures syndromes, disorders epileptic, epileptic seizures, Seizure;epileptic, convulsion epileptic, epileptic attack, attacks epileptic, disorders seizure, disorders seizures, epilepsy types, epileptics, seizure disorders, epileptic, epileptic fit, epileptic fits, disorder seizure, seizure syndrome, seizures syndrome, epilepsies, syndrome seizure, Seizure disorder NOS, Epilepsy NOS (disorder), (Epilepsy) or (epileptic attack) (disorder), (Epilepsy) or (epileptic attack), Attack - epileptic, Epileptic seizure, Epileptic fit, EF - Epileptic fit, EP - Epilepsy, Epileptic, Epilepsy (disorder), Epileptic attack, Epileptic convulsions, Epileptic disorder, Epileptic fits, Epileptic seizure (finding), Epileptic seizures, Seizure disorder (disorder), Seizure disorder, caducus; morbus, cerebral; epileptic, convulsions; epileptic, epilepsy; cerebral, epilepsy; cortical, epilepsy; fit, epilepsy; seizure, epileptic; convulsions, epileptic; syndrome, fit; epileptic, morbus; caducus, seizure; epileptic, syndrome; epileptic, Epilectic attack, NOS, Epilepsy, NOS, Epileptic convulsions, NOS, Epileptic disorder, NOS, Epileptic fits, NOS, Epileptic seizures, NOS, Epileptic attack, NOS, epileptic seizure |
| French | EPILEPSIE, Epilepsie SAI, Epilepsie, non précisée, Crise épileptique, Convulsion épileptique, Épilepsie |
| Portuguese | EPILEPSIA, Epilepsia NE, Crise epiléptica, Ataque epiléptico, Transtorno Convulsivo, Crises Epilépticas, Ataque Epilético, Convulsão Epilética, Convulsões Epilépticas, Crise Epiléptica, Crises Epiléticas, Ataque Epiléptico, Convulsões Epiléticas, Distúrbio Convulsivo, Ataques Epiléticos, Crise Epilética, Convulsão Epiléptica, Ataques Epilépticos, Epilepsia |
| Spanish | EPILEPSIA, Epilepsia no especificada, Crisis epiléptica, Ataque epiléptico, Epilepsia NEOM, Crisis Epilépticas, epilepsia, SAI, Epilepsy NOS, epilepsia, SAI (trastorno), Crisis Epiléptica, Ataque Epiléptico, Ataques de Epilepsia, Convulsión Epiléptica, Convulsiones Epilépticas, Ataques Epilépticos, Trastorno de Crisis Convulsiva, ataque epiléptico, convulsiones epilépticas, convulsión epiléptica (hallazgo), convulsión epiléptica, crisis epiléptica (hallazgo), crisis epiléptica, epilepsia (trastorno), epilepsia, trastorno convulsivo (trastorno), trastorno convulsivo, trastorno epiléptico, Epilepsia, Trastorno Convulsivo |
| German | EPILEPSIE, Epilepsie NNB, epileptischer Krampfanfall, Epilepsie, unspezifisch, epileptischer Anfall, Epilepsie, nicht naeher bezeichnet, Epilepsie, Anfallsleiden, Anfälle, epileptische, Epileptische Anfälle |
| Italian | Epilessie, Epilessia NAS, Crisi epilettica, Epilessia, non specificata, Crisi convulsiva epilettica, Disturbi convulsivi, Attacchi epilettici, Epilessia |
| Dutch | epilepsie NAO, epileptisch insult, niet-gespecificeerde epilepsie, epileptische convulsie, aanval; epileptisch, caducus; morbus, cerebraal; epilepsie, convulsie; epilepsie, epilepsie; aanval, epilepsie; cerebraal, epilepsie; convulsie, epilepsie; corticaal, epilepsie; syndroom, epilepsie; toeval, morbus; caducus, syndroom; epileptisch, toeval; epilepsie, Epilepsie, niet gespecificeerd, epilepsie, Convulsie, Epilepsie, Epileptische aanval, Insult |
| Japanese | てんかんＮＯＳ, てんかん発作, てんかん、詳細不明, ﾃﾝｶﾝ, ﾃﾝｶﾝNOS, ﾃﾝｶﾝｼｮｳｻｲﾌﾒｲ, ﾃﾝｶﾝﾎｯｻ, 潜伏てんかん, 癲癇, てんかん-潜伏, てんかん, 原因不明性てんかん |
| Swedish | Epilepsi |
| Czech | epilepsie, Epilepsie, Epileptický záchvat, Epilepsie NOS, Epilepsie, blíže neurčená, morbus divinus, padoucí nemoc, morbus sacer, padoucnice |
| Finnish | Epilepsia |
| Russian | EPILEPSIIA, ЭПИЛЕПСИЯ |
| Korean | 상세불명의 간질, 간질 |
| Croatian | EPILEPSIJA |
| Polish | Epilepsja, Padaczka |
| Hungarian | Epilepsia, nem meghatározott, Epilepsiás görcsroham, Epilepsia k.m.n., Epilepsia, Epilepsiás roham |
| Norwegian | Epilepsi, Epileptiske anfall |
Ontology: Seizures (C0036572)
| Definition (CHV) | the most dramatic type of seizure |
| Definition (CHV) | the most dramatic type of seizure |
| Definition (CHV) | the most dramatic type of seizure |
| Definition (MEDLINEPLUS) |
Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. When people think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably. Not all seizures cause convulsions. There are many types of seizures and some have mild symptoms. Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides of the brain. Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. However, it is a medical emergency if seizures last longer than 5 minutes or if a person has many seizures and does not wake up between them. Seizures can have many causes, including medicines, high fevers, head injuries and certain diseases. People who have recurring seizures due to a brain disorder have epilepsy. NIH: National Institute of Neurological Disorders and Stroke |
| Definition (NCI_NCI-GLOSS) | Convulsion; a sudden, involuntary movement of the muscles. |
| Definition (NCI) | Sudden, involuntary skeletal muscular contractions of cerebral or brain stem origin. |
| Definition (NCI_CTCAE) | A disorder characterized by a sudden, involuntary skeletal muscular contractions of cerebral or brain stem origin. |
| Definition (MSH) | Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder." |
| Definition (CSP) | the most dramatic type of seizure, characterized by tonic and clonic contraction of most skeletal muscles. |
| Concepts | Sign or Symptom (T184) |
| MSH | D012640 |
| ICD9 | 780.3 |
| ICD10 | R56.9 |
| SnomedCT | 206738002, 206732001, 206735004, 91175000, 313290005, 32631004, 158142009, 158141002, 271788002, 158138006, 312078006 |
| LNC | LA7472-9, LA15899-0 |
| English | Seizures, CONVULSIONS, FITS NOS, SEIZURE, [D]Fit, Convulsion NOS, [D]Convulsion NOS (context-dependent category), [D]Convulsions (context-dependent category), [D]Fit (context-dependent category), [D]Convulsion NOS, [D]Convulsions, [D]Seizure NOS, Seizure NOS, seizure (physical finding), convulsions, seizure, convulsions (symptom), Fits - convulsions, Convulsion (NOS), Convulsions NOS, Fits NOS, Fit, NOS, Seizure, NOS, Unspecified convulsions, Fit NOS, Seizures [Disease/Finding], convulsion, convulsions nos, fitted, seizures, sz, Fit(s), fit's, seizure d, [D]Convulsions (situation), [D]Fit (situation), Fits - convulsions (disorder), [D]Convulsion NOS (situation), Fit - convulsion (finding), Convulsion (disorder), SEIZURES, CONVULSION, Seizure, Convulsion, Fit, Fitting, Fit - convulsion, Seizure (finding), fit, Convulsion, NOS, Convulsions, fits |
| French | CONVULSIONS, Crises SAI, Convulsions SAI, Convulsion SAI, Crises, Crise, Convulsions, CRISES MOTRICES NON PRECISEES, Convulsion, Crises d'épilepsie, Crises épileptiques |
| Portuguese | CONVULSOES, Convulsão NE, Convulsões NE, Convulsões, CRISES NE, Ataque Convulsivo, Ataques Sensoriais, Crises Convulsivas Parciais Sensitivas, Crises Focais, Ataque (Convulsivo), Crises Motoras, Ataques (Convulsivos), Ataques Focais, Ataques Generalizados, Ataques Motores, Convulsões Focais, Crises Sensitivas, Convulsões Generalizadas, Crises Parciais Sensitivas, Convulsão |
| Spanish | CONVULSIONES, Convulsiones NEOM, Crisis, Crisis NEOM, Ataque, Convulsión (NEOM), [D]convulsiones (categoría dependiente del contexto), [D]acceso convulsivo (categoría dependiente del contexto), [D]convulsión SAI (categoría dependiente del contexto), Convulsiones, CRISIS NO ESPECIFICADAS, [D]convulsión SAI, [D]acceso convulsivo (situación), [D]convulsiones, [D]acceso convulsivo, [D]convulsiones (situación), convulsiones, convulsión (concepto no activo), [D]convulsión SAI (situación), Accesos (Convulsivos), Crisis Convulsivas Parciales Sensitivas, Acceso (Convulsivo), Accesos Convulsivos, Ataque Convulsivo, Crisis Focales, Ataques Focales, Ataques Generalizados, Acceso Convulsivo, Convulsiones Generalizadas, Crisis Sensitivas, Ataque (Convulsivo), Ataques Motores, Ataques (Convulsivos), Ataques Sensoriales, Crisis Motoras, ataque, convulsión (hallazgo), convulsión, Convulsión |
| German | KONVULSIONEN, Anfaelle NNB, Konvulsion (NNB), Krampfanfall, Konvulsionen NNB, Anfall, Anfall erleidend, Krampfanfaelle, Konvulsionen, KRAMPFANFAELLE NNB, Konvulsion, Anfälle |
| Italian | Convulsione, Convulsione (NAS), Convulsioni NAS, Crisi convulsiva, Crisi, Crisi convulsive, Crisi NAS, Convulsioni, Attacchi |
| Dutch | convulsies, insult NAO, insulten, convulsies NAO, insult, convulsie (NAO), convulsie, Convulsies, Epileptische aanval, Insult, Aanval, epileptische |
| Japanese | 発作, 発作ＮＯＳ, 痙攣（ＮＯＳ）, 痙攣ＮＯＳ, ｹｲﾚﾝ, ﾎｯｻ, ﾎｯｻNOS, ｹｲﾚﾝNOS, 発作-けいれん性, 発作-痙攣性, 痙攣性発作, 全身痙攣, 全身けいれん, けいれん, 痙攣, 全身間代性けいれん, てんかん-感覚性, 感覚性てんかん, けいれん性発作, ｹｲﾚﾝﾎｯｻ, 痙攣発作 |
| Swedish | Anfall |
| Czech | záchvaty, Záchvaty NOS, Křeče NOS, Křeč, Záchvat, Křeč (NOS), Záchvaty, Křeče, křeče |
| Finnish | Kohtaukset |
| Russian | PRISTUPY BOLEZNI, PRIPADKI, PAROKSIZMY, SUDOROGI, ПАРОКСИЗМЫ, ПРИПАДКИ, ПРИСТУПЫ БОЛЕЗНИ, СУДОРОГИ |
| Croatian | NAPADAJI |
| Polish | Napad drgawkowy, Drgawki |
| Hungarian | Convulsiók k.m.n., Görcsroham, Convulsio, Convulsio (k.m.n.), Görcsölés, Görcsrohamok, Görcsrohamok k.m.n., Convulsiók |
| Norwegian | Konvulsjoner, Kramper, Anfall |
