Seizures and Epilepsy

What is a seizure?

A sudden, uncontrolled electrical disturbance in the brain

1 of 22

When are seizures considered to be epilepsy?

Having 2 or more seizures at least 24 hours apart

2 of 22

What are the 2 types of seizures?

Generalised
Focal

3 of 22

What is the difference between generalised and focal seizures?

Generalised seizures affect both sides of the brain at the same time
Focal seizures happen in one area of the brain

4 of 22

What is the most common presentation of a seizure?

Tonic clonic
Muscle stiffness and jerking

5 of 22

What symptoms may occur during a focal seizure?

Staring blankly into space
Non-purposeful repetitive movement

6 of 22

What happens after a seizure?

There will be a post-ictal phase

7 of 22

How will a post-ictal phase present?

Gradual slowing down of seizure
Gradual recovery
Confusion
Headache
Drowsy
Nauseous
Hypertensive

8 of 22

Clinical signs of seizure

Reduced sats
Cyanosis
Tachycardia
Pupils unresponsive during tonic clonic
Jerking and stiffening
Loss of consciousness
Breathing problems

9 of 22

Red flags during seizure

Fever - consider infection
GCS persistently < 15
Focal neurological deficit
Raised ICP
Pregnancy
Prolonged seizure
Patient on anticoagulants
Sudden onset headache

10 of 22

Relevant questions to ask

What happened before
What happened during
What happened after

11 of 22

Relevant physical examination

ECG - arrhythmias can cause convulsive syncope
Neurological exam - stroke can cause seizures
Identify injuries - tongue biting etc
GCS, AVPU

12 of 22

Pharmacological interventions

Diazepam
Oxygen

13 of 22

DIAZEPAM
(action, dose, presentation, indications)

Action: anticonvulsant, sedative
Dose: 10mg
Max dose: 20mg
Presentation: 10mg/2ml
Indications: convulsion lasting >5mins, repeated convulsions (3+ in an hour), eclamptic convulsions lasting >2min

14 of 22

Benzodiazepine treatment for tonic clonic seizure

Give 1st benzo
Attempt IV or IO access
If still convulsing 10mins after first dose give 2nd benzo
If still convulsing 10mins after second dose, seek advice on 3rd dose

15 of 22

OXYGEN
(action, dose, presentation, indications)

Action: reversing hypoxia
Dose: 15L for seizure
Presentation: gas
Indication: low sats

16 of 22

Management plan for seizure

Airway - consider OPA
Breathing - O2
Circulation - BP, hr
Disability - AVPU, GCS, BM
Expose - temperature, injuries, rash, pregnancy
IV access

17 of 22

When should seizures be conveyed to hospital?

All patients with first seizure
Consider referral to epilepsy specialist team

18 of 22

What is a PNES

Psychogenic Non-epileptic Seizure
It is a seizure that may look epileptic but are instead caused by psychological factors

19 of 22

Potential causes of PNES

Mood or personality disorders
Mental health issues
Trauma or abuse
Substance use
Previous traumatic brain injury

20 of 22

Symptoms of PNES that differ to epileptic seizure

Wildly thrashing
Side to side head movements
Stuttering or shouting phrases
Lack of post ictal phase

21 of 22

Interventions for PNES

No pharmacological interventions required as these will not be effective and are potentially dangerous due to risk of side effects

22 of 22

Get Revising

Seizures and Epilepsy

Other cards in this set

Card 2

Front

Back

Card 3

Front

Back

Card 4

Front

Back

Card 5

Front

Back

Comments

Similar Medicine resources: