Seizures

Question 1

Seizures

Answer 1

Seizures
A seizure is a clinical event caused by a transient disturbance of brain function due to an abnormal paroxysmal neuronal discharge in the brain. If these episodes are recurrent without an identifiable cause, they are commonly described as epilepsy. The term status epilepticus is used for repeated seizures, which occur without the patient regaining consciousness between attacks. (See section on ‘Epilepsy and Status epilepticus’).
The clinical presentation depends on the part of the brain affected. Patients may sometimes describe the warning signals (termed a prodrome or aura), which they experienced before the event. A detailed description by a witness is key.
General anaesthesia and ventilation may be required in severe cases and where high doses of anticonvulsants are required.

Question 2

Causes

Answer 2

Causes
y Congenital, prenatal or perinatal injury
y Fevers, especially in children aged 6 months to 6 years (febrile
convulsion)
y Cerebral malaria
y Infections e.g. meningitis, TB, HIV, abscesses in the brain
y Metabolic causes: hypoglycaemia, hypocalcaemia, hyponatraemia,
hyperosmolar diabetic state, uraemia, hepatic failure
y Idiopathic epilepsy (See section on ‘Epilepsy’)
y Eclampsia
y Vascular diseases: hypertensive encephalopathy, stroke, myocardial
infarction
y Space occupying lesions: tumour or malformations of the brain
y Head trauma
y Drugsandtoxins:alcohol,antidepressants,metronidazole,drugand
alcohol withdrawal
y Degenerative diseases e.g. dementia
y Psychogenic: (See section on ‘Psychogenic Seizures’)

Question 3

Signs and Symptoms

Answer 3

Symptoms
y Loss of consciousness
y Tongue biting
y Foaming at the mouth
y Incontinence of stool and/or urine
y Aura (may include a strange gut feeling, somatosensory
manifestations - visual, olfactory, gustatory or auditory e.g. strange
smells/flashing lights)
y Muscletwitchingandmovementswhichmaybefocalorgeneralized y Afteraseizure,thepatientmaybeconfused(post-ictalconfusion)or
may sleep for some time (post-ictal sleep)

Signs
y Aprodromeoraurawithautomatism(lipsmacking,pickingatitems) y Muscletwitchingandmovementswhichmaybefocalorgeneralized y Post-ictal sleep
y Post-ictal confusion
y Todd’s paralysis (stroke-like weakness) may rarely occur
y Examine carefully for evidence of neurological localizing signs, tongue laceration and evidence of trauma to the face or other parts
of the body

Question 4

Investigations

Answer 4

Investigations
y FBC, ESR
y Blood glucose
y BUE
y Calcium
y LFTs
y Chest X-ray
y Electroencephalogram (EEG) y CT scan (head)

Question 5

Treatment
STG page 197

Answer 5

Treatment
Treatment objectives
y To stop the seizure
y To treat underlying cause y To prevent injury
Non-pharmacological treatment
y Move sharp objects, fire etc. away from patient during seizures
y Ensure clothing around the neck is loose
y Ensuretheairwayisclear,wipeorsuctionanysecretionsorvomitus
from the mouth or nose.
y Do not force a spoon or tongue depressor into mouth!
y Remove false teeth if present
y After convulsions cease, turn the patient into semi-prone position
by turning the patient on the side, with one leg bent and the other
leg straight
y Monitor fits (fits chart)

Answer 6

Referral Criteria
If seizures remain uncontrolled within 30 minutes after they began, refer immediately for specialist attention. Note that oxygenation should be continued during transfer.