Seizure
Seizure
search
Seizure
, Convulsion, Epilepsy
See Also
Single Seizure Evaluation
Status Epilepticus
Febrile Seizure
Newborn Seizure
Infantile Spasms
Pediatric Spell
s
Epilepsy in Pregnancy
Epilepsy in Women
Epilepsy in the Elderly
Psychogenic Nonepileptic Seizure
Definitions
Seizure
Excessive synchronous, abnormal cortical
Neuron
electrical activity
Epilepsy
Two or more unprovoked, afebrile Seizures
Epidemiology
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
Age: Most common in Infants and older adults
Causes
See
Seizure Causes
Types
Secondary Seizures (provoked) due to underlying lesion
See
Seizure Causes
Primary
Generalized Seizure
s
Generalized Tonic Clonic Seizure
(
Grand Mal Seizure
, generalized motor Seizure)
Absence Seizure
(
Petit Mal Seizure
, generalized, non-motor Seizure)
Primary
Focal Seizure
s (
Partial Seizure
s, 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
Rolandic Epilepsy
Other types
Epileptic spasms (e.g.
Infantile Spasms
)
Signs
Jerking movements
Muscle stiffness or rigidity
Eye Rolling
Drooling
Altered Level of Consciousness
Altered breathing pattern
Incontinence
Vital Sign
abnormalities
Differential Diagnosis
See
Seizure Differential Diagnosis
Labs
See
First Seizure Evaluation
See
Status Epilepticus
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
Tomson (2007) Cochrane Database Syst Rev (1):CD002216 [PubMed]
Imaging
Structural study
See
Seizure Indications for Neuroimaging
Evaluation
See
Seizure Evaluation
(includes
Single Seizure Evaluation
)
Management
Gene
ral
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]
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-
Teratogen
ic 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
http://www.epilepsy.com/driving-laws
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 Sport
s, swimming)
Avoid high risk sports (e.g. hang gliding,
Scuba Diving
, free climbing)
Screen for comorbid neuropsychiatric disorders
Cognitive
Impairment
and
Mood Disorder
s are common in Seizure disorder (which may affect compliance)
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 Seizure
s
Predictors of continued Seizures after surgery
Non-structural Epilepsy
Normal MRI
Gene
ralized 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%)
References
Jobst (2015) JAMA 313(3): 285-93 [PubMed]
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]
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]
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