TALK first seizure

7/30/2019 TALK first seizure

1/39

Prepared by

Dr., Younous Anis

Bintaleb

Neurologist

1


2/39

2
http://www.123rf.com/photo_12357427_young-farmer-boy-working-on-the-farm-field-and-holding-a-fork-and-a-bucket.htmlhttp://www.epilepsiemuseum.de/alt/caesaren.htmlhttp://www.angelsghosts.com/photos_guardian_angel


3/39

An episode of abnormal neurological

functioning caused by abnormal discharge ofneurons!

3


4/39

1- Epilepsy2- Epileptic seizure

3- Epileptic disease

4- epileptic encephalopathy

5- Epileptic syndrome

4


5/39

Acute Symptomatic seizuresRemote Symptomatic seizuresIdiopathic

5


6/39

CNS infectionsMeningitis

Encephalitis

Abscess

Vascular diseaseCVA

Vasculitis

Trauma

Hypertensive

Eclampsia

NeoplasmsBenign

Malignant - Primary,Secondary

MetabolicElectrolyte disturbances

Hypoglycaemia

Hypoxia

Renal Failure

6


7/39

Tricyclic antidepressants

Antidepressants

Theophylline

Withdrawal - ETOH,benzos

Anticholinergics

Organophosphates

Cocaine

Amphetamines

Lignocaine

Anti -psychotics

Antihistamines

Isoniazid

7


8/39

Previous head injury

Previous CVA

Congenital CNS disorders

Previous hypoxic injury

Previous CNS infections

Degenerative diseases

8


9/39


10/39

6/12 to 5 years -Febrileconvulsions

Drug withdrawal 20% ,Trauma 26%-Young adults

Elderly - CVA 44%

10

Annegers et al 1995


11/39

Differentiated

Febrile convulsion

Idiopathic epilepsy

Acute symptomaticseizures

Remote Symptomaticseizures

Undifferentiated

Cardiac Arrhythmia's

Vasovagal Episode

Cardiac - StructuralBlood loss

Postural Hypotension

Sepsis

Psychogenicetc

11


12/39

Has the patient had a seizure?

What kind of seizure was it?

Was there a focal component?

Was this the first seizure?

Is there a family history of seizure

disorder?Why did the seizure occur?

12


13/39

Systemic illness

drug use/abuse

pregnancy

mental retardationhead injury

unexplained bruises/tongue biting

nocturnal enuresisprecipitants

13


14/39

Two schools of management:-

1- UK school

2- USA School

14


15/39

Documentation of the seizure

Physical examination

Investigations

Cessation of seizures

Observation

Advice

Seizure ProphylaxisFollow up

15


16/39

SEIZURE

glucoseNa,Mg,Ca

preg test

FIRSTSEIZURE

mental statusnormal

U&Es,Mg,Catoxicology

ECG, preg testCT

ALCOHOLISMABNORMAL

MENTAL STATUSPATTERN

Anitconvulsantlevels

KNOWN SEIZUREDISORDER

mental statusnormal

16


17/39

Always do a glucose

on any one who ishaving a seizure or

has had a seizure!17


18/39

17 year old girlPost first witnessed tonic clonic seizure

Been out to a party the night before

Uncle has epilepsy

Now well, GCS 15, Vital signs normal

Neurological exam normal

18


19/39

GlucoseSodium

Calcium

Consider urine and pregnancy test

CT [ MRI ] & EEG as outpatient

19


20/39

Management of a seizure at homeSafe activities

Driving

Who should know?

Have I got epilepsy?

Not life threatening

Exacerbating factors

Follow up20


21/39

Most common in the first 6 months

More than 50% of those who have

recurrence will occur within 6 months

Rate varies from 36 -77%

21


22/39

Symptomatic Seizure

History of epilepsy in a sibling

Todds paralysis

EEG abnormalities

2 seizures - 80-90%22


23/39

Seizure prophylaxisfor all first

symptomaticseizures

23


24/39

50 yr old womanPost tonic clonic seizure

Husband said twitching started in her R

arm, then progress to LOC.History of recent headaches.

Now well, GCS 15, appears

neurologically intactVital signs normal

24


25/39

ALWAYS LOOK IN THEFUNDI

25


26/39

First Focal Seizure

= CT scan!!!!!!

26


27/39

50 yr old womanPost generalised seizure

Previously well, no seizures in the past

Recent headache for 24 hours, unwell & feverNow GCS 13, Temp 39.8

Confused, unco-operative 30 minutes post

seizure

Moving all limbs.

27


28/39

Focal seizurestrauma

anticoagulants

alcoholicsimmunosuppressed

fever,stiff neck,persistent headache

focal neurology

28


29/39

Do not LP a patient who has a

decreased Glascow coma score!!

Treat first, CT & ask questions

later!!

29


30/39

A GCS < 13 is arelative

contraindication toLP even after a

normal CT!!30


31/39

A 75 yr old manPrevious hypertension

Post tonic clonic seizureNow GCS 15 but right arm

weakness

31


32/39

Focal neurology = CTscan

Focal neurology does= LPnot

32


33/39

18 yr old manRugby injury with LOC, scalp laceration

Initially in ED GCS 15, vomited twice and

complaining of a headacheHas tonic clonic seizure in ED. Self

resolved

Now GCS 12 - 2 minutes post seizure

33


34/39

Trauma &Seizure

= CT scan!!

34


35/39

Acute Symptomatic

Seizure requiring

ongoing treatment &

investigation

Febrile seizure where

underlying cause needs

treatment or fever

does not settle

Focal seizure

Status epilepticus or

prolonged seizure.

Recurrent seizures

Social Situation

35


36/39

A- Definitely:-1- With structural lesion:-

-Brain tumours

- AVMS- CNS infections

36

2 With t t t l l i


37/39

2- Without structural lesion:-

- History of epilepsy in sibiling

- EEG with definite epileptic pattern

- History of prior acute seizure

- History of brain insult

- Todd s post-ictal paresis

- Status epilpeticus at onset

37

B- Possibly:-


38/39

- Unprovoked seizure with none of the above risk

Factor

C- Probably not:-(Although short-term therapy maybe used).

- Alcohol withdrawal

- Drug abuse

- Seizure in context of acute illness, and Seizure

provoked by excessive sleep deprivation

- Post impact seizure

-A specific benign epilepsy syndromes

- 38


39/39

39

TALK first seizure

Documents

Transcript of TALK first seizure