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INTRODUCTION
DIFFERENCE BETWEEN SEIZURE AND
EPILEPSY-
1. SEIZURE- Occurrence of signs and/or symptoms due to
abnormal, excessive or synchronous neuronal activity in the
brain
2. EPILEPSY- Tendency to have unprovoked seizures.
Simple terminology for seizures
1. GENERALISED SEIZURE
2. FOCAL (PARTIAL) SEIZURE
3. CONVULSIVE SEIZURES
4. NON CONVULSIVE SEIZURES
5. STATUS EPILEPTICUS
GENERALISED SEIZURES- Involvement of the whole
cerebral cortex and therefore abnormalities may be seen in
the whole body. Consciousness is always impaired.
FOCAL (PARTIAL) SEIZURE- Involvement of a focus of the
cerebral cortex and therefore abnormalities seen in one part
of the body. Consciousness may be retained (simple partial
seizures) or impaired (complex partial seizures). A focal
seizure may lead on to a generalised seizure.
CONVULSIVE SEIZURES- Tonic-clonic, tonic and clonic.
NON CONVULSIVE SEIZURES- eg. Absence seizure
STATUS EPILEPTICUS- Prolonged seizure for more than
30 minutes.
CAUSES OF SEIZURES
1.In Young adults( 18-35 yrs)-
Trauma,
Alcohol withdrawal
Illicit drug use
Brain tumour
Idiopathic.
2.In older adults (>35 yrs)-
Cerebrovascular disease
Brain tumour
Alcohol withdrawal
Metabolic disorders(uremia, hepatic failure, electrolyte
abnormalities, hypoglycemia, hyperglycemia)
Alzheimer's disease and other degenerative CNS diseases.
Idiopathic
DIFFERENTIAL DIAGNOSIS OF
SEIZURES
1.Syncope
2. Psychological disorders(Panic attack, Psychogenic
seizures)
3. Metabolic disturbances(Alcoholic blackouts, hypoxia)
4. Migraine
5. TIA
6. Sleep disorders(Narcolepsy)
7.Movement disorders(Tics)
FEATURES DISTINGUISHING A SEIZURE
FROM A SYNCOPE
FEATURES SEIZURE SYNCOPE
Status
epilepticus
Management
Initial
Ensure airway is patent, give Oxygen to prevent
cerebral hypoxia and secure i.v access
Draw blood for glucose, urea, electrolytes including
Ca, Mg and LFT and store a sample for future analysis
(drug misuse)
Give diazepam 10mg I.v or rectally or lorazepam 4mg I.v
repeat once only after 15mins
Transfer to intensive care area, monitor neurological
condition, B.P, respiration , blood gases, intubate and
ventilate the patient if appropriate
ongoing
If seizures continue after 30 mins:
iv infusion with cardiac monitoring with one of:
phenytoin 15mg/kg at 50 mg/min
fosphenytoin 15 mg/kg at 100 mg/min
phenobarbitol 10 mg/kg at 100 mg/min
If seizures still continue after 30 -60 mins
start treatment for refractory status with
intubation,ventilation,and general anaesthesia using propofol
or thiopental
Once controlled,
Commence long term antiepileptics medication with
one of:
1.Sodium valproate 10mg/kg i.v over 3-5 mins, then 800-
2000 mg/day
2.Phenytoin loading dose of 15 mg/kg, infuse at <50
mg/min,then 300 mg/day
3.Carbamazepine 400 mg by naso gastric tube, then 400-
1200 mg/day
Investigate the cause
Electrophysiological confirmation must be done.
MANAGEMENT OF SEIZURE
DISORDER
IMMEDIATE MANAGEMENT
Move person away from danger(fire, water, machinery,
etc); Don’t put anything in mouth
After convulsions cease, turn into semi prone, “recovery”
position
Maintain and monitor – ABC
Give oxygen to prevent cerebral hypoxia
If convulsions are continuous or repeated – treat as Status
Epilepticus
Investigate cause
Do not leave patient till complete recovery
Trigger Factors
Sleep deprivation
Alcohol/drug withdrawal
Physical/mental fatigue
Infections
Metabolic disturbances
Flickering lights
Hot water
Loud noise
ANTIEPILEPTIC THERAPY
Is it required? Depends on:
Frequency of seizures
Cause of seizure
Risk profile (place of work, driving)
Recurrent seizures with unknown etiology
Known cause that cannot be reversed
GUIDELINES
Start with single 1st line drug. Start at low dose and gradually increase
Try combination of 1st and 2nd line drugs –DO NOT USE MORE
THAN TWO DRUGS AT A TIME
Check compliance
Reconsider diagnosis
SEIZURE TYPE 1st LINE 2nd LINE
Status epilepticus
Todd’s Paralysis
PROGNOSIS
Generalised seizures are more readily controlled than partial
seizures
Presence of structural lesion makes complete control
unlikely
40-old increased risk of Sudden Unexplained Death in
EPilepsy (SUDEP)
General prognosis:
50% seizure free for 5 yrs without drugs
30% continue to have seizures in spite of antiepileptic therapy
REFERENCES
Harrison’s principles of Internal Medicine 19th edition
Hutchison’s Clinical Methods
Davidson’s principles and practice of medicine
M3 Manual
THANK YOU!!