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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 -