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    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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    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 April 25, 2019.
    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 2019 April 25]. 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
    TY - ELEC T1 - Seizure, Adult ID - 307574 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307574/all/Seizure__Adult PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -