Recurrent Seizures

Main causes
1. Neoplastic disease
  1. Tumors, especially rapidly growing ones, occupy space and increase intracranial pressure
  2. Perinatal hypoxia
2. Pediatric disorders
  1. Rapid increases in body temp causing febrile seizures
3. Metabolic disorders
4. Trauma
5. Infectious diseases, such as meningitis and encephalitis
What is a seizure?
1. disturbance in the normal electrical activity in the brain; can stay in one area or spread to other areas of the brain
2. Triggers include strobe/flickering lights or the occurrence of small fluid & electrolyte imbalances.
  1. Occurs more often when pt. is sleep deprived
3. Differential Diagnosis
  1. Pseudo-seizure
    1. physical reactions to mental or psychological stress
  2. Syncope
4. Convulsions
  1. Convulsion refers to the involuntary, violent spasms of the large skeletal muscles
    1. All convulsions are seizures but not all seizures are convulsions
Signs & Symptoms
1. Amnesia
2. Paralysis
3. Aphasia
4. Aura
5. Falling down/ injuring one's self
6. getting stiff muscles
Types
1. Determining cause of recurrent seizures is important for appropriate drug selection
2. Partial
  1. Simple
    1. fully conscious, but experience a motor contraction or abnormal sensation
  2. Complex
    1. Alteration of consciousness. Amnesia, anxiety, incoherent speech
3. Generalized
  1. Absence (petit mal)
    1. transient loss in awareness, usually in children
      1. May be misdiagnosed as ADHD or daydreaming
  2. Atonic (drop attacks)
    1. Falling/stumbling for no reason; lasts a couple of secs
  3. Tonic-clonic (grand mal)
    1. Preceding aura
      1. Intense muscle contraction (tonic phase), followed by alternating contraction and relaxation (clonic phase)
        Disorientation & deep sleep after seizure
        Crying at beginning; loss of bowel/bladder control;
        jerking movements are seen; Contraction of respiratory muscles (sounds)
4. Special
  1. Febrile
    1. Tonic-conic activity lasting 1-2 min; rapid return to consciousness.
      1. Mostly in children between 3 months & 5 yrs old
  2. Myoclonic
    1. Large jerking movement of major muscle group
      1. falling from sitting or dropping object being held
      2. less severe than tonic clonic, patient usually conscious
  3. Status epilepticus
    1. Medical emergency
    2. Continuous seizure activity that can lead to coma & death
can develop into
1. Epilepsy
  1. central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.
Management
1. Antiepileptic drugs
  1. Tonic-clonic and focal seizure drugs
    1. Carbamazepine
    2. Lamotrigine
    3. Levetiracetam
    4. Phenytoin
    5. Valporate
  2. Myoclonic seizure drugs
    1. clonazepam
    2. lamotrigine
    3. valporate
  3. Absence seizure drugs
    1. Ethosuximide
    2. Lamotrigine
    3. Valporate
  4. Back-up and adjunctive drugs
    1. Felbamate
    2. Gabapentin
    3. Lacosamide
    4. Retigabine
    5. Vigabatrin
  5. Overall side-effects
    1. Antiseizure drugs decrease effectiveness of birth control
    2. Moat antiseizure drugs are pregnancy category D
    3. A lot of them might cause Stevens-johnson syndrome
Diagnosis/ Investigations
1. EEG
  1. type of waves found in EEG
    1. Beta Waves
      1. dominant during mental activities
    2. Alpha Waves
      1. dominant when someone is awake but at rest
    3. Gamma Waves
      1. dominant during light sleep
    4. Delta Waves
      1. dominant during deep sleep
2. Physical Examination
  1. pay attention to bruises and tongue bites
3. Proper History taking
  1. ask about history of
    1. stroke
    2. Head trauma
    3. Potential triggers
    4. Tumors/ infections

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Recurrent Seizures

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