Seizure

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Definition frown emoticon seizure): A seizure is a paroxysmal event due to abdominal excessive, hyper synchronous discharges from an aggregate of central nervous system (CNS) neurons or A seizure is a clinical event caused by an abnormal electrical discharge in the brain.

Classification of seizure:

(a)Partial seizure:
1) Simple partial seizures (with motor, sensory, autonomic or psychic sign).
2) Complex partial seizure.
3) Partial seizure with secondary generalization.
(b)Primarily generalized seizures:
1) Absence (Petit Mal)
2) Tonic-Clonic (Grand mal)
3) Tonic.
4) Atonic.
5) Myoclonic.
(c)Unclassified seizures:
a) Neonatal seizures.
b) Infantile spasms.
• Generalized seizure means bilateral abdominal electrical activity, with bilateral motor manifestations and impaired consciousness.
• A partial (focal) seizure means the electrical abnormality is localized to one part of the brain:
a. Simple without loss of awareness.e.g.One limb jerking (Jacksonian seizure)
b. Complex with loss of awareness.e.g.a temporal lobe attack.

Common cause of seizure:

1) Genitic: Inborn errors of metabolism,storage disease
2) Tumours: Primary and secondary
3) Trauma: Head injury
4) Vascular: Intracerebarl hemorrhage,Cerebral infraction
5) Infection: Meningitis,AIDS
6) Inflammation: Sarcoidosis,Vasculitis
7) Metabolic: Hypercalcaemia,Hyponatraemia
8) Drugs,Alcohol and Toxins: Heavy metals
9) Degenerative: Alzheimer’s disease

Generalized tonic-clonic seizure(Management)

1) It may be preceded by an aura which can take various forms.
2) The patient then goes rigid and becomes unconscious,falling down heavily,if standing and often sustaining injury.
3) During this phase,respiration is arrested and central cyanosis may occur.
4) After a few moments,the rigidity is periodically relaxed,producing clonic jerks.
5) The patient then gradually regains consciousness but is in a confused and disorientated state for half an hour or more after regaining consciousness.
6) During the attack,urinary incotinence and tongue-biting may occur.

Management of status epilepticus:

[A] Initial management:

1) Ensure airway is patent give oxygen to prevent cerebral hypoxia and secur intervenous access.
2) Draw blood for glucose,urea and electrolytes (Including Ca and Mg) and liver function.
3) Give diazepam 10mg i.v (or rectally) or lorazepam 4mg i.v repeat once only aftre 15 mins.
4) Transfer to intensive care area, monitiring neurological condition, blood pressure,respiration patient if appropriate

[B] Ongoing treatment if seizures continue after 30 mins:
I.V infusion(With cardiac monitoring) with one of:
• Phenytoin: 15 mg/kg at 50 mg/min
• Fosphenytoin: 15 mg/kg at 100 mg/min
• Phenobarbital: 10 mg/kg at 100 mg/min

[C] If seizure still continue aftre 30-60 mins:
• Start treatment for refractory status with intubation,ventilation and general anaesthesia using propofol or thiopental.

[D] Once status controlled;

(a) Commence longer-term anticonvulsant medication with one of:
• Sodium valproate 10 mg/kg i.v over 3-5 mins,then 800-2000 mg/min
• Phenytion: Give loading dose (if not alreday used as above) of 15 mg/kg,infuse at <50 mg/min then 300 mg/day.
• Carbamazepine 400 mg by nasogastric tube,then 400-12000 mg/day
(b) Investigate cause

Anti-epileptic therapy in a case of single seizure:

1) Start with one first-line drug.
2) Star at a low dose;gradully increase dose until effective control of seizure is achieved or side effects develop.
3) Optimize compliance(use minimum numberof dose per day)
4) If frist drug fails (seizure continue or side effects develop),start second first-line drug whilst gradually with drawing first.
5) If second drug fails, start second-line drug in combination with perferred first-line druge at maximum tolerated dose.
6) If this combination fails,replace second-line drug with alternative second line drug.
7) If this combination fails,cosider alternative non-drug treatment (e.g epilepsy surgery,vagal nerve stimulation)
8) Do not use more than two drugs in combonation at any one time.

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