Introduction to Seizures and Epilepsy
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Status Epilepticus Clinical Pathway
JOHNS HOPKINS ALL CHILDREN’S HOSPITAL Status Epilepticus Clinical Pathway 1 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Table of Contents 1. Rationale 2. Background 3. Diagnosis 4. Labs 5. Radiologic Studies 6. General Management 7. Status Epilepticus Pathway 8. Pharmacologic Management 9. Therapeutic Drug Monitoring 10. Inpatient Status Admission Criteria a. Admission Pathway 11. Outcome Measures 12. References Last updated: July 7, 2019 Owners: Danielle Hirsch, MD, Emergency Medicine; Jennifer Avallone, DO, Neurology This pathway is intended as a guide for physicians, physician assistants, nurse practitioners and other healthcare providers. It should be adapted to the care of specific patient based on the patient’s individualized circumstances and the practitioner’s professional judgment. 2 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Rationale This clinical pathway was developed by a consensus group of JHACH neurologists/epileptologists, emergency physicians, advanced practice providers, hospitalists, intensivists, nurses, and pharmacists to standardize the management of children treated for status epilepticus. The following clinical issues are addressed: ● When to evaluate for status epilepticus ● When to consider admission for further evaluation and treatment of status epilepticus ● When to consult Neurology, Hospitalists, or Critical Care Team for further management of status epilepticus ● When to obtain further neuroimaging for status epilepticus ● What ongoing therapy patients should receive for status epilepticus Background: Status epilepticus (SE) is the most common neurological emergency in children1 and has the potential to cause substantial morbidity and mortality. Incidence among children ranges from 17 to 23 per 100,000 annually.2 Prevalence is highest in pediatric patients from zero to four years of age.3 Ng3 acknowledges the most current definition of SE as a continuous seizure lasting more than five minutes or two or more distinct seizures without regaining awareness in between. -
Non-Epileptic Seizures a Short Guide for Patients and Families
Non-epileptic seizures a short guide for patients and families Department of Neurology Information for patients Royal Hallamshire Hospital What are non-epileptic seizures? In a seizure people lose control of their body, often causing shaking or other movements of arms and legs, blacking out, or both. Seizures can happen for different reasons. During epileptic seizures, the brain produces electrical impulses, which stop it from working normally. Non-epileptic seizures look a little like epileptic seizures, but are not caused by abnormal electrical activity in the brain. Non-epileptic seizures happen because of problems with handling thoughts, memories, emotions or sensations in the brain. Such problems are sometimes related to stress. However, they can also occur in people who seem calm and relaxed. Often people do not understand why they have developed non-epileptic seizures. Are non-epileptic seizures rare? For every 100,000 people, between 15 and 30 have non- epileptic seizures. Nearly half of all people brought in to hospital with suspected serious epilepsy turn out to have non- epileptic seizures instead. One of the reasons why you may not have heard of non- epileptic seizures is that there are several other names for the same problem. Non-epileptic seizures are also known as pseudoseizures, psychogenic, dissociative or functional seizures. Sometimes people who have non-epileptic seizures are told that they suffer from non-epileptic attack disorder (NEAD). How can I be sure that this is the right diagnosis? Non-epileptic seizures often look like epileptic seizures to friends, family members and even doctors. Like epilepsy, non- epileptic seizures can cause injuries and loss of control over bladder function. -
An Atypical Presentation of Epilepsy; What a Headache! J Neurol Transl Neurosci 5(1): 1078
Central Journal of Neurology & Translational Neuroscience Bringing Excellence in Open Access Case Report Corresponding author Sarah Seyffert, Trinity School of Medicine, 505 Tadmore court Schaumburg, Illinois 60194, USA, Tel: 847-217-4262; An Atypical Presentation of Email: Submitted: 13 April 2017 Epilepsy; What a Headache! Accepted: 07 June 2017 Published: 09 June 2017 Sarah Seyffert* and Wade Kvatum ISSN: 2333-7087 Trinity School of Medicine, USA Copyright © 2017 Seyffert et al. Abstract OPEN ACCESS The relationship between headache and seizure is a poorly understood and controversial topic; however, the literature has recently suggested that the two conditions may be related. Keywords The interplay between these conditions seems to be even more complex in a group of • Epilepsy patients with epilepsy related headaches. It has been proposed that the association could • Headache be classified into preictal, ictal, postictal, or interictal headaches. Here we present a case • Ictal epileptic headache report of a 62 year old male who presented with a chief complaint of new onset severe headache and subsequently underwent multiple diagnostic testing modalities before he was finally diagnosed and treated for epilepsy, which lead to the resolution of his headache. We conclude with a short discussion of how to subcategorize seizure related headaches based on their temporal relationship and why they can pose such a difficult diagnostic challenge. ABBREVIATIONS afebrile with a normal CBC and CMP. On arrival to the hospital he underwent a non-contrast head CT scan; however, no evidence of EEG: Electroencephalogram; CBC: Complete Blood Count; acute intracranial abnormality was seen. Additionally, a lumbar CMP: Complete Metabolic Panel; CT scan: Computerized puncture was performed which was negative for xanthochromia Tomography Scan; CTA: Computed Tomographic Angiography; and showed a protein count of 27, glucose 230, and 2 white MRI: Magnetic Resonance Imaging blood cells. -
Seizure Triggers
SEIZURE TRIGGERS M A R I A R AQUEL LOPEZ. M.D M I A M I V H A DEFINITION OF SEIZURE VS. EPILEPSY • Epileptic seizure: Is a transient symptom of abnormal excessive electric activity of the brain. EPILEPSY • More than one epileptic seizure. TYPE OF SEIZURES ETIOLOGY • Epilepsy is a heterogeneous condition with varying etiologies including: 1. Genetic 2. Infectious 3. Trauma 4. Vascular 5. Neoplasm 6. Toxic exposures TRIGGERS FOR EPILEPTIC SEIZURES • What is a seizure trigger? It is a factor that can cause a seizure in a person who either has epilepsy or does not. • Factors that lead into a seizure are complex and it is not possible to determine the trigger in each patient. TRIGGERS A. Most common ones Stress Missing taking the medication THE MOST OFTEN REPORTED BY PATIENTS • Sleep deprivation and tiredness • Fever OTHER COMMON CAUSES . Infection . Fasting leading into hypoglycemia. Caffeine: particularly if it interrupts normal sleep patterns. Other medications like hormonal replacement, pain killers or antibiotics. OTHER TRIGGERS External precipitants • Alcohol consumption or withdrawal. *Specific triggers that are related to Reflex epilepsy Bathing Eating Reading OTHER TRIGGERS • Flashing light: especially with patients with idiopathic generalized seizure disorder STRESS . Stress is the most common patient –perceived seizure precipitant, studies of life events suggest that stressful experiences trigger seizures in certain individuals. Animals epilepsy models provide more convincing evidence that exposure to exogenous and endogenous stress mediators has been found to increase epileptic activity in the brain, especially after repeating exposure. SOLUTION ABOUT STRESS • Intervention of copying with stress STRESS MANAGEMENT • Include trying to get in a place of peace utilizing multiple techniques: • Regular exercise • Yoga and medication • Therapy or psychological support with a provider. -
Seizure, New Onset
CLINICAL PATHWAY NEW ONSET SEIZURE Inclusion Criteria ALGORITHM 1. CONCERN FOR POSSIBLE SEIZURE • Age 6 months to 21 years • First-time seizure Exclusion Criteria • Status epilepticus (refer to status epilepticus pathway) Concern Unsure for possible Yes seizure? Obtain history and screening Obtain history and screening neurologic exam neurologic exam Consider differential diagnoses: Evaluate for possible provoking factors: • Breath holding • Fever/illness • Stereotypies/tics • Acute traumatic brain injury (TBI) ! • Vasovagal/syncope/vertigo • Central nervous system (CNS) infection Urgent call • Reflux • Tumor to ‘OneCall’ for: • Electrolyte imbalance • Ingestion • Suspected infantile spasm • Non epileptic seizure • Intoxication • Medically complex children • Electrolyte imbalance Off pathway: Consider outpatient referral to Neurology Off pathway: Provoked? Yes Address provoking factors No Continue to new onset unprovoked seizure algorithm on p.2 NEED REAL TIME HELP? CALL US! Call ‘OneCall’ at 720-777-3999 or 719-305-3999 (Colorado Springs) Page 1 of 17 CLINICAL PATHWAY ALGORITHM 2. NEW ONSET UNPROVOKED SEIZURE Inclusion Criteria • Age 6 months to 21 years New onset unprovoked • First-time unprovoked seizure seizure • Newly recognized seizure or epilepsy syndrome Exclusion Criteria • Provoked seizure: any seizure as a symptom of fever/illness, acute traumatic brain injury (TBI), Has central nervous system (CNS) infection, tumor, patient returned ingestion, intoxication, or electrolyte imbalance Consult inpatient • to baseline within No -
Myoclonic Atonic Epilepsy Another Generalized Epilepsy Syndrome That Is “Not So” Generalized
EDITORIAL Myoclonic atonic epilepsy Another generalized epilepsy syndrome that is “not so” generalized John M. Zempel, MD, Myoclonic atonic/astatic epilepsy (MAE), first described have shown predominant thalamic activation PhD well by Doose1 (pronounced dough sah: http://www. and default mode network deactivation.6–8 Even Tadaaki Mano, MD, PhD youtube.com/watch?v5hNNiWXV2wF0), is a general- Lennox-Gastaut syndrome, a devastating epileptic ized electroclinical syndrome with early onset charac- encephalopathy with EEG findings of runs of slow terized by myoclonic, atonic/astatic, generalized spike and wave and paroxysmal higher frequency Correspondence to tonic-clonic, and absence seizures (but not tonic activity, has fMRI correlates that are more focal than Dr. Zempel: [email protected] seizures) in association with generalized spike-wave expected in a syndrome with widespread EEG (GSW) discharges. Thought to have a genetic com- abnormalities.9,10 Neurology® 2014;82:1486–1487 ponent that has proven to be complicated,2 MAE EEG-fMRI is maturing as a research and clinical sometimes occurs in children who have otherwise technique. Recording scalp EEG in an electrically been developing normally and has variable outcome. hostile environment is not an easy task. Substantial MAE is typically treated with antiseizure medications technical artifacts, such as changing imaging gradients that are used for generalized epilepsy syndromes, with and ballistocardiogram (ECG-linked artifact observed perhaps a best response to valproate, felbamate, or the in the scalp electrodes), contaminate the EEG signal. ketogenic diet.3,4 However, the relatively distinctive EEG discharges in In this issue of Neurology®, Moeller et al.5 report patients with epilepsy have partially circumvented on the fMRI correlates of GSW discharges as mea- this problem. -
Epilepsy After Stroke
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Epilepsy after stroke In the first few weeks after a stroke some people have a seizure, and a small number go on to develop epilepsy – a tendency to have repeated seizures. These can usually be completely controlled with treatment. This factsheet explains what epilepsy is, the different types of seizures, and how epilepsy is diagnosed and treated. It also includes advice about coping with a seizure, and a glossary. Epilepsy is a tendency to have repeated What causes seizures? seizures – sometimes called ‘fits’ or ‘attacks’. It affects just under one per cent Cells in the brain communicate with one of people in the UK. Stroke is one of many another and with our muscles by passing conditions that can lead to epilepsy. electrical signals along nerve fibres. If you have epilepsy this electrical activity can Around five per cent of people who have a become disordered. A sudden abnormal stroke will have a seizure within the following burst of electrical activity in the brain can few weeks. These are known as acute or lead to a seizure. onset seizures and normally happen within 24 hours of the stroke. You are more likely There are over 40 different types of seizures to have one if you have had a severe stroke, ranging from tingling sensations or ‘going a stroke caused by bleeding in the brain (a blank’ for a few seconds, to shaking and haemorrhagic stroke), or a stroke involving losing consciousness. the part of the brain called the cerebral cortex. If you have an onset seizure, it This can mean that epilepsy is sometimes does not necessarily mean you have or will confused with other conditions, including develop epilepsy. -