Seizures

“transient occurrence of signs and/or symptoms due to

abnormal excessive or synchronous neuronal activity

in the brain” [1]

Causes•Metabolic•Neoplasm•Cerebral pathology•Medications•CVA

•Infection•Idiopathic•Trauma•Eclampsia•Withdrawal

Types…a LOT!• Self limiting seizure types

• Generalized seizures

• Tonic-clonic seizures (includes variations beginning with a clonic or myoclonic phase)

• Clonic seizures (with and without tonic features)

• Typical absence seizures

• Atypical absence seizures

• Myoclonic absence seizures

• Tonic seizures

• Spasms

• Myoclonic seizures

• Massive bilateral myoclonus

• Eyelid myoclonia (with and without absences)

• Myoclonic atonic seizures

• Negative myoclonus

• Atonic seizures

• Reflex seizures in generalized epilepsy syndromes

• Seizures of the posterior neocortex

• Neocortical temporal lobe seizures

• Focal seizures

• Focal sensory seizures

• Focal motor seizures

• Gelastic seizures

• Hemiclonic seizures

• Secondarily generalized seizures

• Refl ex seizures in focal epilepsy syndromes

• Continuous seizure types

• Generalized status epilepticus

• Generalized tonic-clonic status epilepticus

• Clonic status epilepticus

• Absence status epilepti cus

• Tonic status epilepti cus

• Myoclonic status epilepticus

• Focal status epilepti cus

• Epilepsia partialis continua of Kojevnikov

• Aura continua

• Limbic status epilepticus (psychomotor status)

• Hemiconvulsive status with hemiparesis

Focal Seizures•Simple focal•Complex focal•Jacksonian march

Simple Focal• Focused area such as temporal lobes or hippocampi• Fear, anger, sadness, happiness or nausea• Sensation of falling or movement• Unusual feelings or sensations• Altered senses• Derealisation or depersonalisation• Spatial distortion• Déjà vu or jamais vu • Laboured speech or inability to speak

Complex Focal•Unilateral cerebral hemisphere involvement•+/- simple partial as aura preceding•Automatisms•Amnesia•Altered consciousness• Impairment of awareness

Jacksonian March• Abnormal electrical activity

within the primary motor cortex• Travel through the primary

motor cortex in succession

Generalised Seizures•Tonic-clonic •Tonic •Clonic•Myoclonic •Absence•Atonic

Status Epilepticus•>5 minutes of continuous seizure activity

[2]

•Seizures >5 mins need aggressive management

Treatment of seizures•Airway•Breathing•Circulation•Pharmacological interventions

References1. Fisher R, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J (2005). "Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)". Epilepsia 46 (4): 470–2. PMID 15816939.

2. Ajith Cherian and Sanjeev V. Thomas1. Status epilepticus Ann Indian Acad Neurol. 2009 Jul-Sep; 12(3): 140–153. PMCID: PMC2824929

Further reading/learning

neuroems.com

Epilepsy Foundation Online Learning

prehospitalresearch.eu/?p=1828

bit.ly/1nhtvar