Ver el código de «Seizure»

''This page covers seizures in general; refer to [[Status epilepticus]] for persistently seizing patients and [[seizure (peds)]] for pediatric patients.''

==Background==
*Caused by a pathologic pattern of brain cortex activity → involuntary movement or change in level of consciousness<ref name="Martindale">Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am. 2011 Feb;29(1):15-27.</ref>
**11% of people will have at least one seizure in their lifetime
**3% will have epilepsy (at least 2 unprovoked seizures)
*In pregnancy >20 WGA or <4wks postpartum, need to consider [[eclampsia]]
**Most seizures in pregnancy are not first-time seizures, but rather are due to medication noncompliance or pharmacokinetic drug changes as result of pregnancy

{{Seizure types}}

==Clinical Features==
{{Clinical features seizure}}

===Seizure vs. Syncope<ref>Sheldon R et al. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol. 2002 Jul 3;40(1):142-8.</ref>===
*Factors that strongly favor seizure from most specific to least:
**Waking with cut tongue
**Abnormal behavior noted by bystanders
**LOC with emotional stress
**Postictal confusion
**Head turning to one side during LOC
**Prodromal deja vu or jamais vu
*Factors that predict against seizure
**Presyncopal spells
**Prodromal vertigo
**LOC with prolonged standing, sitting
**Diaphoresis, vertigo, nausea, chest pain, feeling of warmth, palpitations, dyspnea before spell

==Differential Diagnosis==
[[File:Seizure Causes.png|thumb|Differential diagnosis of seizures]]
{{Seizure DDX}}

==Diagnosis==
===Physical===
*Check for:
**Head / C-spine injuries
**Tongue/mouth lacs
***Sides of tongue (true seizure) more often bitten than tip of tongue (Psychogenic nonepileptiform seizures, formerly "pseudoseizure.")
***Tongue biting has sensitivity of ~25% and approaches 100% specificity in lateral tongue biting<ref>Benbadis SR et al. Value of tongue biting in the diagnosis of seizures. Arch Intern Med. 1995 Nov 27;155(21):2346-9.</ref>
**Posterior shoulder dislocation
**Focal deficit (Todd paralysis vs CVA)

===Work-Up===
====Known Epileptic with NO Change in Baseline Seizures====
*Anticonvulsant drug concentration
*Fingerstick glucose
*Close out-patient follow-up
*Check for signs of trauma, cervical spine tenderness
*Consider head CT scan if suspicious of change in pattern, prolonged postictal period or trauma

====New Seizure or Change in Baseline Seizures====
*Consider: Pregnancy test, glucose, Electrolytes (Na, Ca, BUN, Crt), RPR, HIV, UA, EEG, lumbar puncture 
*Non-contrast CT in ED or advanced imaging arranged as outpatient
*Neurology follow up or consult

==Management==
[[File:Seizure Management.png|thumb|Management of seizures]]
{{Seizure actively seizing management}}

==Disposition==
===First Time Seizures===
*Those with single generalized seizure and otherwise normal history and physical can be discharged home with close follow-up
*Observation is not unreasonable for those that look ill or have a complicating history/physical
*24-hr recurrence of seizures in this group is about 9% when alcohol-related events are excluded<ref>Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007; 69(21):1996-2007.</ref>
*Instructions not to drive, swim, or participate in other potentially dangerous activities is important

==See Also==
*[[Anticonvulsants]]
*[[Anticonvulsant levels and reloading]]
*[[Seizure (peds)]]
*[[Febrile seizure]]
*[[Status epilepticus]]

==External Links==
*[http://ddxof.com/seizure-2/ DDxOf: Differential Diagnosis of Seizures]

==References==
<references/>

[[Category:Neurology]]