Seizures

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Clinical Description

A seizure is a clinical manifestation of an abnormal and excessive discharge of a group of neurons in the brain. It can be convulsive or non-convulsive. When neuronal dysfunction involves a specific area within a brain hemisphere, it is termed as a focal seizure. When neuronal dysfunction generates from a specific area within a brain hemisphere and then spreads to involve both brain hemispheres, it is termed as a generalized seizure. Seizure generalization can occur at the onset of the seizure or as the seizure progresses with time.

Causes:

  • Febrile convulsion with intercurrent illness e.g., malaria, viral or bacterial infection, (Febrile convulsions usually occur in children 6 months - 6 years, consider other causes in different age groups)
  • Cerebral malaria
  • Intracranial infections: Meningitis, Cerebral Abscess, Encephalitis
  • Hypoxia of any cause
  • Hypoglycaemia of any cause
  • Other electrolyte or metabolic disturbances
  • Cerebrovascular accidents
  • Head Injury
  • Seizure disorder (Epilepsy)
  • Hypertensive encephalopathy
  • Poisoning e.g., alcohol, tricyclic antidepressants, OPP poisoning
  • Genetic causes

Common causes of convulsions in neonates include:

  • Hypoglycemia
  • Birth asphyxia
  • Intracranial infection
  • Intracranial hemorrhage
  • Focal ischaemic injury

Clinical FeaturesSIGNS AND SYMPTOMS

  • Transient altered consciousness
  • Patients may experience abnormal body movements (head, limbs or trunk)
  • Altered sensation
  • Autonomic changes
  • Psychic events

INVESTIGATIONS

  • Random Blood glucose, FBC, Urea, electrolytes, and creatinine, urine dipstick, microscopy, and culture, blood culture, lumbar puncture, electroencephalogram (EEG), CT or MRI brain

TreatmentNON-PHARMACOLOGICAL 

  • Assess and manage Airway, Breathing and Circulation.
  • Assess the patient for any possible causes of seizures or precipitating factors as stated above.
  • Patients with underlying risk factors that predispose them to seizure recurrence might require long term antiepileptic therapy.

PHARMACOLOGICAL

Check glucose and treat hypoglycemia

In Adults:

  • Give Diazepam 5-10 mg IV slowly. Repeat once after 10 minutes.
  • If convulsions continue for another 10 minutes or are repeated more than 3 times without patient gaining consciousness between seizures, treat as status epilepticus.
  • Assess the patient for any possible causes of seizures or precipitating factors as stated above
  • Patients with underlying risk factors that predispose them to seizure recurrence might require long term If repeated seizures, consider antiepileptic therapy.
  • Diazepam IM absorbs slowly and unreliably: IV or rectal routes are preferable

In children and neonates

  • See seizure management in chapter 1

Complications 

  • Aspiration
  • Hypoxic brain injury
  • Rhabdomyolysis

REFERRAL

Seizures not responding to treatment