Seizures

Question 1

New onset seizure management

Answer 1

(majority resolve spontaneously w/in 2 min)

IV access: 2-4mg Ativan or 0.2mg/kg Versed
IM - 10mg Versed
rectal diazepam

Question 2

Conditions that mimic seizures?

key differentiating points?

Answer 2

Migraine - slow neurologic progression; visual symproms prominent.
- in basilar migraine: confusion/stupor/bilateral blindness, HA may be absent

PNES - psych hx. eyes usually closed, out-of-phase thrashing limb movements/pelvic thrusting. Refractory to tx

Syncope - a few muscle jerks (convulsive syncope) 2/2 hypoxia

Question 3

Status Epilepticus

• definition
• management

Answer 3

> 5min continuous or >2 discrete seizures w/out recovery of consciousness in between

Tx - ABC’s, Dextrose (IV thiamine and Dextrose for possible reversible causes)

• IV benzo and non benzo AED (fosphenytoin/keppra)
• if refractory -> versed/propofol/phenobarbital