Neurology Book

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Seizure

Aka: Seizure, Convulsion, Epilepsy, Seizure Disorder
  1. See Also
    1. Single Seizure Evaluation
    2. Status Epilepticus
    3. Febrile Seizure
    4. Newborn Seizure
    5. Infantile Spasms
    6. Pediatric Spells
    7. Epilepsy in Pregnancy
    8. Epilepsy in Women
    9. Epilepsy in the Elderly
    10. Psychogenic Nonepileptic Seizure
  2. Definitions
    1. Seizure
      1. Excessive synchronous, abnormal cortical Neuron electrical activity resulting in transient findings
    2. Epilepsy
      1. Two or more unprovoked, afebrile Seizures more than 24 hours apart OR
      2. One unprovoked first Seizure with a 60% risk of second Seizure in 10 years (based on risk factors)
  3. Epidemiology
    1. Seizure lifetime risk: 10%
    2. Epilepsy diagnosis lifetime risk: 3.9%
    3. U.S. Prevalence: 1% (since Seizure Disorder does not persist in many, e.g. children)
    4. Gender: Males slightly more than females
    5. More common in low and middle income countries (account for 80% of worldwide cases)
      1. Worldwide, associated with socioeconomic deprivation and lack of access to healthcare
      2. More common in regions with higher rates of congenital conditions, intracranial infection, Head Injury
      3. Heaney (2002) BMJ 325(7371): 1013-6 [PubMed]
    6. Age: Bimodal Peak Onset
      1. Infants
      2. Older adults (ages 55 to 75 years)
  4. Causes
    1. See Seizure Causes
  5. Types
    1. Secondary Seizures (provoked, Situation-Related Seizures) due to underlying lesion (40% of cases)
      1. See Seizure Causes (includes Drug Induced Seizure and Seizure Differential Diagnosis)
      2. More common in older patients (whereas unprovoked Seizures are more common in younger patients)
      3. Most common causes
        1. Cerebrovascular Accident
        2. CNS Infection
        3. Traumatic Brain Injury
        4. Congenital (e.g. Cerebral Palsy)
    2. Primary Generalized Seizures
      1. Generalized Tonic Clonic Seizure (Grand Mal Seizure, generalized motor Seizure)
      2. Absence Seizure (Petit Mal Seizure, generalized, non-motor Seizure)
    3. Primary Focal Seizures (Partial Seizures, single hemisphere)
      1. Awareness
        1. Focal Seizure Without Impairment of Awareness (Simple Partial Seizure)
        2. Focal Seizure with impaired awareness (Complex Partial Seizure)
      2. Subtypes
        1. Motor Seizures (focal motor activity)
        2. Sensory Seizures
        3. Autonomic Seizures (e.g. sweating)
      3. Common Focal Seizure syndromes
        1. Rolandic Epilepsy
    4. Other types
      1. Epileptic spasms (e.g. Infantile Spasms)
  6. Signs
    1. Limb jerking movements
    2. Muscle stiffness or rigidity
    3. Head Turning
    4. Eye Rolling
    5. Drooling
    6. Altered Level of Consciousness
    7. Altered breathing pattern
    8. Tongue Biting
    9. Urinary Incontinence
    10. Vital Sign abnormalities
  7. Differential Diagnosis
    1. See Seizure Differential Diagnosis
  8. Labs
    1. See First Seizure Evaluation
    2. See Status Epilepticus
    3. Bedside Glucose
    4. Drug level monitoring indications
      1. Establish therapeutic concentrations when adequate Seizure control reached
      2. Clinical toxicity suspected
      3. Noncompliance suspected
      4. Expected variability in pharmacokinetics
        1. Extremes of age
        2. Change of drug formulation
        3. Pregnancy
      5. References
        1. Tomson (2007) Cochrane Database Syst Rev (1):CD002216 [PubMed]
  9. Imaging: Structural study
    1. See Seizure Indications for Neuroimaging
  10. Evaluation
    1. See Seizure Evaluation (includes Single Seizure Evaluation)
  11. Management: General
    1. See Status Epilepticus
    2. Seizure Prophylaxis
      1. See Seizure Prophylaxis for indications
      2. See specific Seizure types for optimal management
        1. Generalized Seizure (includes Generalized Tonic Clonic Seizure, Myoclonic Seizure)
        2. Absence Seizure
        3. Focal Seizure (includes simple and Complex Partial Seizure)
    3. Other adjuncts
      1. Ketogenic diet (high fat, low Carbohydrate, low Protein)
        1. Associated with gastrointestinal side effects (Vomiting, Abdominal Pain, altered stool consistency)
        2. Risk of high Uric Acid, renal stones, decreased Calcium, Magnesium, QT Prolongation, Cardiomyopathy
        3. Poor level of evidence for support
        4. Martin (2016) Cochrane Database Syst Rev (2): CD001903 [PubMed]
      2. Vagus Nerve Stimulation
        1. Indicated for over age 12 years with medically refractory Epilepsy who are not surgical candidates
        2. Battery-powered stimulator/Pacemaker with leads at Vagus Nerve
        3. Morris (2013) Neurology 81(16): 1453-59 [PubMed]
      3. Responsive neurostimulation
        1. Similar to Vagus Nerve stimulator, but leads are inserted into the actual Seizure focus
        2. In response to sensing abnormal electrical activity, neurostimulator delivers electrical stimulation
        3. Risk of implant site infection, Headache, dysesthesia
        4. Bergey (2015) Neurology 84(8): 810-7 [PubMed]
  12. Management: Special topics
    1. Epilepsy in Pregnancy
      1. See Epilepsy in Pregnancy
      2. Contraception is key
        1. Estrogen-based Contraception is less effective in those on antiepileptic drugs
      3. Plan pregnancy on non-Teratogenic agents
        1. Major birth defects occur in 4-7% of those born to mothers on Seizure Prophylaxis monotherapy
    2. Driving
      1. Most U.S. states require no driving for 3-12 months since last Seizure
      2. Exact duration of non-driving varies by state
        1. http://www.epilepsy.com/driving-laws
    3. Physical Activity
      1. Physical Activity is recommended in Epilepsy (may decrease Seizure frequency)
      2. Most sports are not contraindicated in well controlled patients (e.g. biking, Contact Sports, swimming)
      3. Avoid high risk sports (e.g. hang gliding, Scuba Diving, free climbing)
    4. Screen for comorbid neuropsychiatric disorders
      1. Cognitive Impairment and Mood Disorders are common in Seizure Disorder (which may affect compliance)
  13. Management: Surgery for Medically refractory Epilepsy
    1. Seizures continue despite antiepileptic drug prophylaxis in 30% of patients
    2. Surgical resection of Seizure focus results in Seizure resolution in 76% of cases
    3. Predictors of Seizure-free after surgery
      1. Seizures without loss of consciousness
      2. Complete or extensive Seizure focus resection
      3. Prolonged Febrile Seizures
    4. Predictors of continued Seizures after surgery
      1. Non-structural Epilepsy
      2. Normal MRI
      3. Generalized Tonic-Clonic Seizures
      4. Infantile Spasms
      5. Tonic Seizures
      6. Invasive EEG monitoring to identify Seizure focus
    5. Complications
      1. Neurologic deficits (5%)
        1. Verbal memory deficits occur with Temporal Lobe resection (44% with left-sided resection)
      2. Medical complications (e.g. CSF Leak, Hydrocephalus, Aseptic Meningitis)
      3. Operative mortality (<0.5%)
    6. References
      1. Jobst (2015) JAMA 313(3): 285-93 [PubMed]
  14. Complications
    1. Todd's Paralysis
    2. Sudden Unexplained Death in Epilepsy (SUDEP)
      1. Idiopathic Epilepsy related death (no other cause identified)
      2. More common in nocturnal Seizures
      3. Effective Seizure Prophylaxis lowers risk
      4. Typically in young adults (rare in children)
      5. Incidence: 9 per 1000 with Epilepsy (up to 1 in 150 for poorly controlled Seizures)
      6. Surges (2012) Curr Opin Neurol 25(2): 201-7 [PubMed]
  15. References
    1. Nocera, Valente, Amanullah (2018) Crit Dec Emerg Med 32(11): 3-9
    2. Wilfong (2017) Epilepsy in Children, UpToDate, accessed 7/17/2017
    3. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]
    4. Rowland (2022) Am Fam Physician 105(5): 507-13 [PubMed]

Epilepsy (C0014544)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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