Seizure, Adult

Seizure, Adult is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Generalized seizures:
    • Classically tonic–clonic (grand mal)
    • Begin as myoclonic jerks followed by loss of consciousness
    • Sustained generalized skeletal muscle contractions
    • Nonconvulsive generalized seizures:
      • Absence seizures (petit mal); alteration in mental status without significant convulsions or motor activity
  • Partial seizures:
    • Simple:
      • Brief sensory or motor symptoms without loss of consciousness (i.e., Jacksonian)
    • Complex:
      • Mental and psychological symptoms
      • Affect changes
      • Confusion
      • Automatisms
      • Hallucinations
      • Associated with impaired consciousness
  • Status epilepticus:
    • Variable definitions:
      • Seizure lasting longer than 5–10 min
      • Recurrent seizures without return to baseline mental status between events
    • Life-threatening emergency with mortality rate of 10–12%
    • Highest incidence in those <1 yr and >60 yr of age
  • At least one-half of patients presenting to the ED in status do not have a history of seizures.
  • Alcohol withdrawal seizures (“rum fits”):
    • Peak within 24 hr of last drink
    • Rarely progress to status epilepticus
  • Patients with a single seizure have a 35% risk of recurrent seizure within 5 yr

Pediatric Considerations
Febrile seizures are generalized seizures occurring between 3 mo and 5 yr of age:
  • Typically lasts <15 min
  • Associated with a rapid rise in temperature
  • Without evidence of CNS infection or other definitive cause

Etiology

  • Hypoxia
  • Hypertensive encephalopathy
  • Eclampsia
  • Infection:
    • Meningitis
    • Abscess
    • Encephalitis
  • Vascular:
    • Ischemic stroke
    • Hemorrhagic stroke
    • Subdural hematoma
    • Epidural hematoma
    • Subarachnoid hemorrhage
    • Arteriovenous malformation
  • Structural:
    • Primary or metastatic neoplasm
    • Degenerative disease (i.e., multiple sclerosis)
    • Scar from previous trauma
  • Metabolic:
    • Electrolytes
    • Hypernatremia
    • Hyponatremia
    • Hypocalcemia
    • Hypo/hyperglycemia
    • Uremia
  • Toxins/drugs:
    • Lidocaine
    • Tricyclic antidepressants
    • Salicylates
    • Isoniazid
    • Cocaine
    • Alcohol withdrawal
    • Benzodiazepine withdrawal
  • Congenital abnormalities
  • Idiopathic
  • Trauma

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