Seizures

Question 1

What is a seizure?

Answer 1

• A seziure is a sudden, uncontrolled excessive electrical activity in the brain

Question 2

What are the possible causes of a seizure?

Answer 2

• abnormal levels of sodium or glucose in the blood
• brain injury (such as stroke or HI)
• Congenital brain defects
• Brain tumour or bleeding in the brain
• Dementia, such as alziemhers disease
• high fever
• infections that affect the brain, such as meningitis, encaphalitis, neuropyphillis or AIDS
• Kidney or liver idsease
• Phenylketonuria (PKU) - causes seizures in infants
• Illicit substances
• alcohol or drug withdrawal
• eclampsia/pre-eclampsia

Question 3

Explain the term ‘Generalised convulsive status epilepticus’

Answer 3

• formall generalised TC seizures are the most common and best known type of generalised seizure
• they begin with stiffening of the limbs (tonic) followed by jerking of the limbs and face (clonic)

Question 4

Recite the AV CPG for seizures (adults)

Answer 4

Question 5

Recite the AV CPG for seizures

Question 6

Explain the term ‘post ictal’

Question 7

When can you apply the ‘treat and refer’ guideline for seizures? and what are the contras?

Answer 7

Single Seizure with full recovery.
Contraindications:
- Incomplete recovery (to normal conscious state)
- Suspected non epileptic cause (stroke, hypoxia, OD, hypo)
- First presentation seizure/non-diagnosed
- Different to usual presentation (prolonged, more frequent, concurrent illness eg infection)
- Injury, Aspiration, Immersion sustained
- Patient has been administered MIDAZOLAM (other than patients own)
- Seizure was unwitnessed
- Risk of recurrent seizure if left on scene
ie. Hx of multiple seizures
- pt has feeling impending seizure
- pt is unable to be monitored by responsible adult
- Pregnancy.

ACTION
- Provide patient/carer with self care advice and hand out sheet.
- Encourage to see health provider within 24 hours.
- Use patients own management plan for guidance if available
- Confirm patient and carer understand advice before departing scene.

Question 8

What is a convulsion?

Answer 8

• an episode of excessive and abnormal motor activity. Involving rapid contraction and relaxation of mucles

Question 9

What is epilepsy and how is it caused?

Answer 9

• a condition that is characterised by recurrent seizures
• it is caused by excessive cortical nerve cell activity and most commonly presents as GTC seizures

Question 9

What is epilepsy and how is it caused?

Answer 9

• a condition that is characterised by recurrent seizures
• it is caused by excessive cortical nerve cell activity and most commonly presents as GTC seizures

Question 10

What are the different types of seizures?

Answer 10

• Generalised onset
• Focal onset
• Unknown onset

Question 11

What is a generalised onset seizure?

Answer 11

• a seizure that affects both cerebral hemispheres from the beginning of the seizure

Question 12

What is a myoclonic seizure?

Answer 12

• a rapid, breif contractions of bodily muscles, which usually occur at the same time on both sides of the body
• occassionally occuring in one arm or foot

Question 13

What is an Atonic seizure?

Answer 13

• sudden loss of muscle tone
• “drop attacks”
• they produce head drops, loss of postural or sudden collapse
• abrupt, without any warning

Question 13

What is an Atonic seizure?

Answer 13

• sudden loss of muscle tone
• “drop attacks”
• they produce head drops, loss of postural or sudden collapse
• abrupt, without any warning

Question 14

What is an absensce seizure?

Answer 14

• lapses of awareness, sometimes staring, that begin and end abruptly, lasting only a few seconds
• commonly occuring in children

Question 15

What are focal onset seizures?

Answer 15

• also known as partial seizures
• caused by an electrical disurbance that commences in a specificarea of one cerebral hemisphere
• it may spread to both hemispheres
• usually lasts < 2 min

Question 16

What is a pseudoseizure?

Answer 16

• a contraversial diagnosis known as pseudoseizures or non-epileptic seizures
• patients who have seizures but do not have an abnormal EEG
• it implies that the origin of the seizure is psychological rather than organic

Question 17

What is status epilepticus?

Answer 17

• seizures that are prolonged or occur in a series
• defined as a seizure lasting 30 minutes, or episodes without regain in consciousness
  - AV refers to status epilepticus as seizures lasting > 5 mins or multiple seizures without full recovery of consciousness (back to baseline) between seizures

Question 18

What is subtle status epilepticus?

Answer 18

• may develop from prolonged or uncontrolled GCSE, it is characterised by coma and ongoing electrographical seizure activity with or without subtle convulsive movements (e.g. rhythmic muscle twitches or tonic eye deviation)
• can be difficult to diagnose in the prehospital environment

Question 19

What is post-ictal?

Answer 19

• a period of decreased consciousness following a seizure (generalised)
• this is when the brain is recovering from the seizure
• lasting 5-30 mins (sometimes longer)

Question 20

What are the doses of midazolam for adults and children experiencing a seizure?

Answer 20

Question 21

What do you do if a patient refuses transport post a seizure?

Answer 21

If Pt has a past history of seizures, and refuses transport, leave them in the care of a responsible third person. Advise the person of the actions to take for immediate continuing care if symptoms reoccur, and the importance of early contact with their primary care physician for follow-up.

Question 22

Can you given midazolam in pregnant patients having a seizure?

Answer 22

Pregnancy – seizures may be a result of epilepsy, eclampsia or another cause. Eclamptic seizures are rare and usually self limiting. It should be noted that Midazolam crosses the placenta and may cause adverse effects to the baby. SE is a life-threatening condition and Midazolam is still indicated in pregnant women.