Seizures

Classification:

• • Partial Sz:

    • Simple partial sz: no impairment of consciousness

      • Motor sz (hand jerking)

      • Somatosensory sz (focal tingling)

      • Autonomic sz (stomach churning)

      • Psychic sz (deja vu)

    • Complex partial sz: altered consciousness with postictal confusion

      • Temporal: Automatisms such as lip-smaking, staring spells, behavior arrest

      • Frontal: hypermotor behaviors, bicycling, pelvic thrusting, automatism

      • Occipital: unformed images, visual hallucinations

  • Generalized Sz: generalized tonic-clonic motor activity, with LOC.

    • May begin as generalized or partial seizures with secondary generalization.

      • Tonic

      • Clonic

      • Tonic-clonic

      • Atonic

      • Absence sz

      • Myoclonic sz

      • Absence

Causes of Seizures:

• • CNS infections

  • Fever

  • Hypoxic brain injry

  • Stroke (ischemic or H'gic)

  • Tumors

  • Head injury

  • Eclampsia

  • Hyperthyroidism

  • Congenital brain malformations

  • Genetics (phenylketonuria, Sturge-Weber, tuberous sclerosis, etc.)

  • Toxic metabolic (porphyria, uremia, liver failure)

  • Drug withdrawal (alcohol, barbiturates, benzodiazepines, antiepileptics)

  • Drug intoxication (TCAs, cocaine, amphetamine)

  • Electrolyte abnormalities

    • Hyponatremia

    • Hypocalcemia

    • Hypomagnesemia

    • Hypoglycemia/hyperglycemia

Drugs that cause seizures:

• • Psychotropic drugs: TCA, SSRI, Neuroleptic agents (phenothiazines, haloperiodol, clozapine); Lithium, Bupropion, Methylxanthines (theophylline).

  • Narcotic analgesics (meperidine, propoxyphene)

  • Antimicrobials: Penicillins, cephalosporins in high dose Imipenem Isoniazid Antimalarials Cyclosporine Nalidixic acid

  • Chemotherapeutic agents (methotrexate, chlorambucil)

  • General anesthetics (ketamine, enflurane) Local anesthetics (lidocaine - in toxic doses, disopyramide, bupivicaine)

  • Stimulants (amphetamines, cocaine)

  • Antiarrhythmics (verapamil intoxication, mexiletine, procainamide, propranolol overdose)

  • Antihistamines (diphenydramine)

  • Baclofen Antiemetics (chlorpromazine)

H&P: FH of epilepsy, developmental delay, trauma, pre-existing medical conditions, current and discontinued meds. OTC, herbal, ingestions, drug allergies, substance abuse. Prodrome, aura. Witnessed sz. Incontinence, tongue biting. How the patient behaved after the event, post-ictal state.

DDx: convulsive syncope, pseudosz, toxic-metabolic encephalopathy, tremors, dyskinesias, hypoxic encephalopathy, rigors.

Diagnosis of epilepsy is made after two or more unprovoked seizures.

AED Tx is started after the 2nd seizure. In Europe it is started after 1st sz.