Hi. We’re gonna be talking about patients who present with seizures
and how to manage them in the Emergency Department.
So what is a seizure?
A seizure is when there is excessive abnormal neuron activity.
And seizures can be divided into two large groups.
You can have a partial seizure
which is also known as a focal seizure or a generalized seizure.
You know, just some definitions before we get started.
So the ictal period is the time when the actual seizure is occurring.
So this is the time that the patient is having or undergoing that seizure activity.
The post-ictal period is a period of altered mental status following a seizure.
A post-ictal period can range in time
anywhere from about 10 or 15 minutes up to hours or possibly even a day.
Status epilepticus is when a patient has seizure activity for more than 5 minutes,
or a patient has recurrent seizure activity.
So they have another seizure without a return to baseline mental status.
The reason that it’s important to mention status epilepticus
is because for those patients,
you wanna make sure that you treat the seizures aggressively
because as time goes on and as the patient has consistent or continuous seizure activity,
that can lead to an increased metabolic demand for the brain
and in turn, can eventually lead to brain damage.
So we wanna make sure that we’re paying attention
to how long a patient is seizing for
and whether or not they're having another seizure
before they turn back to their neurologic baseline,
because in those patients,
you wanna make sure that they’re treated more aggressively.
Epilepsy is an unprovoked seizure.
So that’s a seizure due to no provoking factor.
Sometimes it can be due to underlying structural issues in the brain.
The classification here like I said, seizures are divided into partial or focal seizures,
and then generalized seizures.
And within a partial seizure, there is simple partial seizures,
complex partial seizures, and then secondary generalized seizures.
What a simple partial seizure will look like
is it will look like seizure activity just in a single limb.
So it will just be you know, motor involvement of one portion of the patient’s body.
Complex partial is when that becomes a little bit more involved
and then secondarily generalized is when it starts out as a focal seizure
and then becomes a generalized seizure.
Generalized seizures can be divided into additional categories.
Absence is one of these and an absence seizure is a seizure
or a patient is not characterized by the patient having myoclonic jerking or seizure activity.
But more characterized by a patient who has a blank stare
and the issue is is that there is seizure activity in the brain.
Sometimes these can be a little bit more challenging to diagnose for patients.
And then myoclonic, tonic, clonic, tonic-clonic seizures are the big categories.
And this is what we think of as our classic seizure activity.
So these are the patients who have a lot of jerking of their muscles
and their tissues, and then an atonic seizure
is a seizure when you have seizure activity in your brain
but you're not necessarily having any of these movements.
Who primarily get seizures or presents to the hospital with seizures?
There's a by bimodal life distribution.
So infants and young kids primarily will have febrile seizures.
These are seizures that are related to generally higher temperatures.
For the most part, they’re benign in nature
and often times do not recur, although sometimes they do.
The other age of range are older people.
So patients who are greater than 75 years of age.
So you wanna think about the seizures
or you know who presents with them are the young and the old.
There’s definitely a lot of people in the middle as well
but those are kind of the biggest groups.
Recurring seizures occur in about half of patients with epilepsy.
So those patients may recurrently have these episodes.