5-Minute Emergency Consult
Seizure, Adult
Seizure, Adult is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
- Simple:
- 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
- Variable definitions:
- 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
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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Basics
Description
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
- Simple:
- 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
- Variable definitions:
- 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
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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Citation
Rosen, Peter, et al., editors. "Seizure, Adult." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult.
Seizure, Adult. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult. Accessed January 24, 2020.
Seizure, Adult. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult
Seizure, Adult [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 January 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult.
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