APPROACH TO SEIZURES Flashcards
Seizure DDx
Syncope (with myoclonic activity)
Arrythmias
Breath Holding Spells
Pseudo-seizures
History & Physical
Ask About:
Pre:
Presence of an Aura
Change in Behaviour
Automatisms
During:
Type and Duration of movement
Loss of Consciousness
Ocular / Head Deviation
Tongue Biting
Age Appropriate Incontinence
After:
Length of post-ictal period
Focal Abnormalities
Timing / Triggers:
Trauma (accidental or unintentional)
Drug / Toxic Ingestion
Fever, current systemic illness
Recent immunization
History of seizures
History of neurological disease
Patient history of same
Anti-epileptic meds
Check for:
CORE TEMPERATURE!!!:
Fever the most common cause of seizures
Sign of head trauma
Signs of non-accidental trauma
Complete Neuro Exam
Head Circumference
Dysmorphic Features
Bulging Fontanelle
Papilledema
Minigeal Signs
Hepatosplenomegally
Skin for lesions
Investigations: First Afebrile Seizure
POC glucose
POC glucose
POC glucose
CBC
Sodium
Calcium
Magnesium
VBG / ABG
lactate
CRP
CK
Blood cultures
Urine culture
+/- LP
AED Level
Pregnancy in post menarchal
ECG in first time seizures: check for arrythmia as seizure mimic
CONSIDER:
Metabolic: serum amino acid
ammonia
urine organic acids
Toxin: serum and urine tox
CT Head: Rarely required for non focal seizure
EEG as an outpatient
Neurology Consult
Indications for a CT Head
Fever
AMS
Focal Deficits
Persistent Headache
Focal Onset of Seizure
Recent Head Trauma
Toxic Appearance
Bleeding Disorder
VP Shunt
Immunocompromized
Malignancy
Seizure etiology for infants
Trauma (intentional or not)
Infection: meningitis, sepsis
Inborn error of metabolism, Hypoxic Ischemic Encephalopathy
Intraventricular Hemorrhage, Congenital Malformation
Seizure etiology Adolescents
Trauma (accidental or unintentional) Drug (intoxication or withdrawl) Infection Metabolic disturbance Tumor Stroke Epilepsy
Seizure etiology Children
Trauma (accidental or intentional) Infection (meningitis, sepsis), Febrile Seizure Metabolic disturbance Congenital Malformation Epilepsy
Breath Holding Spells: Epi and Clinical Features
Children 6 - 18 months
Event preceeded by emotional distress or pain
Followed by pallor and occasionally LOC
Pseudoseizures: Epi and Clinical Features
MC in adolescents
Side to side head, arm or leg movements (especially bicycling movements)
Eyes closed
If eyes open movements are normal (not deviant)
Clinical Features of Syncope
Triggering Factor Distince Prodrome 'Convulsion' after Loss of Consciousness & < 15 sec A short duration A quick recovery Ongoing lethargy but no confusion
Complications of Status Epilepticus
hyperthermia
rhabdomyolysis
lactic acidosis
