Seizures

Learning objectives

Defined as a sudden, uncontrolled burst of electrical activity in the brain and is characterized by changes in behavior, movements, feelings, and levels of consciousness
Outward effects vary from:
- Uncontrolled shaking movements involving much of the body with loss of consciousness (tonic-clonic seizure)
- Shaking movements involving only part of the body with variable levels of consciousness (focal seizure)
- oOr a subtle momentary loss of awareness (absence of seizure)
Loss of bladder control may occur during the seizure
After the active portion of a seizure, there is typically a period of confusion called the postictal period, before a normal level of consciousness returns
Seizures can be provoked (see causes or) unprovoked (without a known cause) and may be exacerbated by stress or sleep deprivation
Most seizures last from 30 seconds to two minutes
Any seizure lasting longer than five minutes should be treated as status epilepticus and is a medical emergency
Epilepsy is characterized by recurrent (2 or more) seizures which means that having a single seizure does not mean that a patient also has epilepsy
Approximately 8–10% of people will experience an epileptic seizure during their lifetime

Classification

Metabolic	Dehydration Hypoxemia hypercarbia Hyponatremia Hypernatremia Hypoglycemia Hyperosmolar nonketotic hyperglycemia Hypocalcemia Hypomagnesemia Uremia Hepatic encephalopathy Porphyria Dialysis disequilibrium syndrome
Structural	Carcinoma Arteriovenous malformation Abscess Intracranial tumor Cerebral edema Stroke
Medications	Medication or drug overdoses: antidepressants, antipsychotics, cocaine intoxication, insulin, local anesthetic systemic toxicity (LAST) Alcohol withdrawal syndrome Delirium tremens
Infections	Encephalitis Meningitis Sepsis
Other	Hypertension (hypertensive encephalopathy) Pre-eclampsia Amniotic fluid embolism Hyperthermia Head trauma Celiac disease Shunt Multiple sclerosis Concussion Febrile seizures Dementia Stress Epilepsy

Place the person experiencing a seizure in the recovery position
Maintain airway, breathing, and circulation
If needed, hand ventilate with 100% O2 but DO NOT hyperventilate
Administer anticonvulsant if seizure last more than 2 min:
- Benzodiazepines (first-line treatment)
  - Midazolam 0.05 mg/kg or 1 mg at a time, titrate to effect
  - Diazepam 0.1-0.4 mg/kg IV, 0.04-0.2 mg/kg PR
  - Lorazepam 1-2 mg at a time, titrate to effect
- Propofol 0.5 mg/kg at a time, titrate to effect
- Phenytoin 20 mg/kg total loading dose at a rate of 50 mg/min, watch for hypotension & arrhythmias
- Barbiturates:
  - Phenobarbital 20 mg/kg infused at a rate of 50 mg/minute
  - Thiopental 25-100 mg dose
  - Pentobarbital 10 mg/kg infused at a rate of up to 100 mg/minute
  - Valproic acid IV 30 mg/kg over 15 min
Ongoing anti-epileptic medications are only recommended after a second seizure has occurred
Intubate in case of no response to medication and respiratory compromise