Seizures

Paul Hammerness

Acute management

ABC’s, neuro exam, EKG, IV access/labs.

lorazepam 2mg IV q2min x5 (ativan 0.1 mg/kg)

or diazepam 5mg IV q3min x4.

Elements of history

prior to seizure: aura

during seizure: behavior during seizure, tongue-biting, incontinence

postictal: length/nature of postictal period, including confusion or focal deficits (Todd’s paralysis)

past history/precipitants: prior seizures, febrile seizures as child, head trauma, recent illness, recent alcohol or drugs, sleep deprivation, relation to menses.

Differential Diagnosis

Young children: breathholding, syncope, parasomnia, benign vertigo, tics/habits, rage.

Adolescent/Adult: myoclonus, migraine, syncope/CV, panic, narcolepsy/apnea, hypoglycemia, amnesia, acute confusional state, pseudoseizure

“Pseudoseizures”

(often occur in patients with “true” seizures as well)

Characteristics: gradual onset, nonspecific warning period, bizarre/unusual behaviors, asynchronous limb thrashing, side-to-side head movements, speech during episode. Rarely associated with tongue biting, incontinence or injury. No postictal state. No abnormal neuro signs in sleep, rare night sz. EEG, CPK,PRL all normal.

Temporal Lobe Epilepsy (complex or simple partial sz.):

Interictal changes are controversial (hyperreligious, hypergraphic, hyposexual, viscous)

Source: Flaherty A (1998) MGH Handbook of Neurology.

Seizure Risk from Antidepressants and Antipsychotics

Antidepressants

Antipsychotics

source: Allredge BK (1999) Neurology 53 (suppl 2): S68-S75.