What to do when faced with a seizure
GOALS
- Define a seizure
- Diagnosing a seizure
- Determine the etiologies
- Managing a seizure
Plan
- DEFINITION
- GENERALITIES
- CLASSIFICATION
- CLINICAL DIAGNOSIS
- ADDITIONAL EXAMINATIONS
- ETIOLOGIES
- TREATMENT OF CONVULSIVE CRISIS
- STATUS CONVULSIVE
- CONCLUSION
What to do when faced with a seizure
1.DEFINITION AND GENERALITIES
– Generalized convulsive seizure is a disturbance of the brain’s electrical activity that manifests itself externally as a loss of consciousness and/or a fixed gaze accompanied by uncontrolled muscular movements of the whole body (generalized convulsion)
- It affects all ages: infants, children (6 months to 5 years) and adults
- The crisis is benign in children
- A convulsion is the sudden and involuntary contraction (spasm) of one or more muscles, one or more limbs, or even the entire body.
- It reflects suffering in the nerve centers (brain or spinal cord) and is accompanied by a loss of consciousness.
– Epilepsy: is a chronic disease or condition in which epileptic seizures recur. (A subject with an isolated seizure or convulsion should not be considered epileptic)
2. CLASSIFICATION
– Generalized convulsive seizures are characterized by an initial loss of consciousness, tonic clonic seizures are the most frequent.
– partial or focal seizures, they reflect the involvement of a localized electrical focus or cerebral suffering, they are either motor or complex
3. POSITIVE DIAGNOSIS
A- QUESTIONING of the patient and those around him/her:
– Family history: epileptic or other.
– (Medical) personnel
-Age of the patient
-Type of crisis.
-Associated disorders: neurological, psychological; general, fever.
The epileptic seizure is characterized by:
Muscle spasms
eye rolling;
loss of consciousness;
numbness of a limb (or tingling);
loss of urine;
visual, auditory, taste or olfactory hallucinations
B-THE PHYSICAL EXAMINATION :
Neurological and general examination to look for associated disorders: disorders of consciousness, motor disorders (paralysis), tone disorders, etc.
C- ELECTROENCEPHALOGRAM (EEG) : confirms the crisis
What to do when faced with a seizure
4. DIFFERENTIAL DIAGNOSIS
1-psychogenic or neuropathic crises: the classic hysterical crises triggered by emotions, disordered nature of the convulsions
no falling, crying fits.
2-lipothymia and syncope:
• Lipothymia is a common fainting spell caused by an emotion, heat can be accompanied by a fall of nausea.
• Syncope is a cerebral ischemia of cardiac origin. The pulse is weak, sometimes cardiac arrest (Atrioventricular Block)
3-transient ischemic attacks (TIA): carotid arteries cause brief loss of consciousness
5. ETIOLOGICAL DIAGNOSIS
a-Epilepsy or epileptic syndrome: seizures recur e.g. following discontinuation of treatment
b-Suspected epilepsy: requiring an etiological assessment
c- occasional convulsions:
1-febrile seizures in infants and children: look for an etiology
2-post-traumatic convulsions: EX: brain trauma…
3-Tumor causes: meningiomas, glioblastomas……(Hemeplegia, headaches)
4-LATE EPILEPSY: epilepsy after 25 years of age should be looked for:
tumors (10%), stroke, aneurysms, degenerative diseases, dementia (Alzheimer’s disease)
5- Infectious syndrome: meningitis and encephalitis
6-metabolic encephalopathies:
• Severe hypoglycemia,
Hypo and hyperkalemia
• Hypo and hyper natremia, hypocalcemia
• Renal failure
• Toxic encephalopathies: (mercury, lead) Drug poisoning
alcohol intoxication
• convulsive syncope, during transient cerebral anoxia.
What to do when faced with a seizure
6. ADDITIONAL EXAMINATIONS
- A complete biological assessment:
FNS, VS, CRP, blood sugar, renal function, ionogram, liver function, etc.
- In case of fever: lumbar puncture
- EEG: confirm the crisis
- Brain scan
- Brain MRI
- Angiography and MRI angiography
7. TREATMENT
management of convulsive crises: an intravenous route
1- benzodiazepines: -DIAZEPAM (valium 1mg/kg),
-Rivotril (clonazepam 0.006mg/kg IVD),
2 – If the crisis does not subside: – Phenobarbital (Gardenal): 200-300 mg by infusion, – – Valproic acid (Depakine) by electric syringe
3- Resuscitation
4- Oxygen therapy
5-Etiological RT in case of symptomatic crises
– If the epilepsy is idiopathic, antiepileptic treatment must be given.
STATUS CONVULSIVE
1. Definition and generalities
– Status epilepticus is defined as an epileptic seizure that persists for a prolonged period or is repeated sufficiently to prevent recovery of consciousness between episodes.
– The 30-minute limit is set as a sufficient duration to cause irreversible brain damage in tonic-clonic status epilepticus
Their incidence in comatose patients is difficult
- The majority of status epilepticus identified in studies are:
- convulsive status epilepticus (33.1%)
- simple partials (18.1%)
- or complex partials (26.7%).
62.7% are symptomatic and 2.9% are idiopathic
Status epilepticus occurs in an epileptic context in less than 50% of cases.
-The recidivism rate is approximately 18%
– The most frequent etiologies of status epilepticus are stroke (25%) , tumors
– An insufficient rate of antiepileptics (20%) in known epileptics.
What to do when faced with a seizure
2. TREATMENT
-Benzodiazepines are the treatment of choice for the early management of status epilepticus.
– Phenobarbital (loading dose)
- -Sodium valproate as second-line treatment is possible with good clinical tolerance , because this drug is not very sedative
- Barbiturates
- Midazolam by continuous intravenous infusion,
- Propofol used in intensive care
- Intubation is necessary if this fails.
8. CONCLUSION
-Status epilepticus is a medical emergency
- Prompt and aggressive treatment to prevent irreversible brain damage.
- First-line or choice treatment for seizures and
status epilepticus remains Benzodiazepines.
What to do when faced with a seizure
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