General Approach to Seizure


Background

Etiologies

Metabolic
  • Electrolyte abnormality
    • Na, Ca, Mg
    • Hypoxia
    • Hepatic failure
    • Renal failure/post dialysis
  • Endocrine
    • DKA, hyperosmolar coma, thyrotoxicosis
Toxin
  • Drug withdrawal
    • EtOH, anticonvulsants, barbiturates
  • Drug induced
    • TCAs, theophylline
    • Amphetamine, cocaine, PCP
    • Lead
    • Lidocaine
Vascular
  • CVA, TIA, thrombosis, vasculitis
  • Hypertensive encephalopathy
  • Arrhythmia
Traumatic
  • Can be an early & late result
  • Subdural hematoma, contusion, laceration, hemorrhage, birth injury
  • 75% within first yr post trauma
Infectious
  • Meningitis/encephalitis
  • Abscess
  • Slow virus (SSPE, Jakob-Creutzfeld)
  • Febrile
Neoplastic
  • Primary & metastatic
  • <1% of all childhood seizures
  • Approximately 10% of all new adult seizures
Congenital
  • Sturge-Weber, Tuberous sclerosis
Primary epilepsy

Differential etiology relative to age

Diagnosis

Treatment

See also Pediatric Seizures treatment

Acute Management

  1. Goal: prevent prolonged or recurrent seizures to reduce CNS damage
  2. ABC's: IV, O2, monitor
  3. Quick scan for trauma, remove glasses, dentures (unless seizing)
  4. Glucose & thiamine
  5. If seizing, place in lateral decubitus position, position to minimize risk of trauma
  6. If seizure lasts >5 min
  7. Dilantin 15-20 mg/kg IV, max to 30 mg/kg
  8. Phenobarbital  30 to 60 mg boluses to maximum 15 mg/kg (stop infusion if seizure stops)
  9. Consultation with PMD to increase anti-convulsant dosing
  10. If seizure >30 min see status epilecticus

Maintenance Therapy

  1. Generalized & Partial
  2. Absence: ethosuximide, valproate