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:
- Abnormal neuronal activity in both cerebral hemispheres
- Classically tonic–clonic (grand mal) seizures: Impaired awareness, muscle rigidity (tonic), rhythmic jerking movements (clonic)
- Absence (petit mal) seizures: Altered consciousness but no postural tone change; can have brief twitches (myoclonus)
- Focal (partial) seizures:
- Usually involves one cerebral hemisphere preserving consciousness, may spread to involve both hemispheres and cause altered sensorium
- More likely to be secondary to localized structural lesion
- No longer classified as simple partial (i.e., Jacksonian) and complex partial (consciousness or mentation affected)
- Status epilepticus:
- Seizure lasting longer than 5 min (classically defined as at least 30 min) or recurrent seizures without return to baseline mental status between events
- Nonconvulsive status epilepticus may present in >9% of hospitalized patients with prolonged decreased mental status
- Life-threatening emergency, mortality approaching 30% if seizure lasts >1 hr
- At least one-half of patients presenting to ED in status do not have a history of seizures
- Special populations:
- HIV: Mass lesions, encephalopathy, herpes zoster, toxoplasmosis, Cryptococcus, neurosyphilis, meningitis
- Neurocysticercosis: CNS infection of tapeworm Taenia solium, MCC of provoked seizures in developing world
- Pregnancy beyond 20 wk of gestation: Eclampsia (hypertension, edema, proteinuria, seizures)
- Alcohol withdrawal seizures: Peak within 24 hr of last drink, rarely progress to status epilepticus
- 8–10% lifetime risk of symptomatic seizure
- Patients with a single seizure have a 35% risk of recurrent seizure within 5 yr
- In 2011:
- 1.6 million ED visits for seizures
- 400,000 with new-onset seizures
Pediatric Considerations
Simple febrile seizures (self-limited and benign)
- Age 6 mo–6 yr
- Generalized convulsions
- Typically lasts <15 min
- Do not recur within 24 hr
- No CNS infection or other neurologic disease
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 (e.g., multiple sclerosis)
- Lesion 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:
- Abnormal neuronal activity in both cerebral hemispheres
- Classically tonic–clonic (grand mal) seizures: Impaired awareness, muscle rigidity (tonic), rhythmic jerking movements (clonic)
- Absence (petit mal) seizures: Altered consciousness but no postural tone change; can have brief twitches (myoclonus)
- Focal (partial) seizures:
- Usually involves one cerebral hemisphere preserving consciousness, may spread to involve both hemispheres and cause altered sensorium
- More likely to be secondary to localized structural lesion
- No longer classified as simple partial (i.e., Jacksonian) and complex partial (consciousness or mentation affected)
- Status epilepticus:
- Seizure lasting longer than 5 min (classically defined as at least 30 min) or recurrent seizures without return to baseline mental status between events
- Nonconvulsive status epilepticus may present in >9% of hospitalized patients with prolonged decreased mental status
- Life-threatening emergency, mortality approaching 30% if seizure lasts >1 hr
- At least one-half of patients presenting to ED in status do not have a history of seizures
- Special populations:
- HIV: Mass lesions, encephalopathy, herpes zoster, toxoplasmosis, Cryptococcus, neurosyphilis, meningitis
- Neurocysticercosis: CNS infection of tapeworm Taenia solium, MCC of provoked seizures in developing world
- Pregnancy beyond 20 wk of gestation: Eclampsia (hypertension, edema, proteinuria, seizures)
- Alcohol withdrawal seizures: Peak within 24 hr of last drink, rarely progress to status epilepticus
- 8–10% lifetime risk of symptomatic seizure
- Patients with a single seizure have a 35% risk of recurrent seizure within 5 yr
- In 2011:
- 1.6 million ED visits for seizures
- 400,000 with new-onset seizures
Pediatric Considerations
Simple febrile seizures (self-limited and benign)
- Age 6 mo–6 yr
- Generalized convulsions
- Typically lasts <15 min
- Do not recur within 24 hr
- No CNS infection or other neurologic disease
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 (e.g., multiple sclerosis)
- Lesion 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. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult. Accessed July 6, 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 (5th edition). Lippincott Williams & Wilkins. Retrieved July 06, 2020, 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 July 06]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult.
* Article titles in AMA citation format should be in sentence-case
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