Seizures

Seizures are defined as a “paroxysmal electrical discharge of the neurones in the brain resulting in a change of function or behaviour”. All of us involved in Emergency Care will encounter patients with seizures which can occur for a number of reasons, with Epilepsy affecting 1 in 100 people in the UK.

Being able to identify the cause, terminate ongoing seizures and provide ongoing investigation and care is complicated and of paramount importance, as some of these episodes carry with them a high morbidity and mortality rate.

In this episode of Roadside to Resus we run through the following;

  • The scale of the problem
  • Causes of seizures
  • Definition of status epilepticus
  • Different forms of seizures
  • Clinical assessment
  • Investigations
  • Antiepileptic’s
  • Management& guidelines; both Pre and In-hospital
  • RSI for status epilepticus
  • Follow up and guidance

As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions.

Enjoy!

SimonRob & James

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References

Distribution of seizure types in an epileptic population. Keränen T. Epilepsia. 1988

Seizures and Epilepsy: An Overview for Neuroscientists. Cold Spring Harb Perspect Med. 2015

Rapid Sequence Termination (RST) of status epilepticus; EMCrit

A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. Alldredge BK. N Engl J Med. 2001

Refractory status epilepticus: response to ketamine. Sheth RD. Neurology. 1998

Meta-analysis and cost-effectiveness of second-line antiepileptic drugs for status epilepticus. Sánchez Fernández I. Neurology. 2019

Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Brigo F. Epilepsy Behav. 2012

Value of tongue biting in the differential diagnosis between epileptic seizures and syncope. Brigo F. Seizure. 2012

A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. Treiman DM. N Engl J Med. 1998

Status epilepticus. Chapman MG. Anaesthesia. 2001

Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. McMullan J. Acad Emerg Med. 2010

Guidelines for the evaluation and management of status epilepticus. Brophy GM. Neurocrit Care. 2012

Meta-analysis and cost-effectiveness of second-line antiepileptic drugs for status epilepticus. Sánchez Fernández I. Neurology. 2019

Levetiracetam versus phenytoin in management of status epilepticus. Chakravarthi S. J Clin Neurosci. 2015

Cardiovascular adverse effects of phenytoin. B. Guldiken, Journal of Neurology 2016

Intravenous Levetiracetam versus Phenytoin in the Management of Status Epilepticus in Adults: A Systematic Review of Randomised-Controlled Trials.  Sanad Esmail. J Neurol Disord. 2019

Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus. J Clin Med. 2016

A randomized trial for the treatment of refractory status epilepticus. Rossetti AO. Neurocrit Care. 2011

Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Gaspard N. Epilepsia. 2013

The diagnostic value of urinary incontinence in the differential diagnosis of seizures.Brigo F. Seizure. 2013

Status Epilepticus; NICE guidelines 2004

Status Epilepticus;Life in the Fast Lane

Status Epilepticus;BMJ Best Practice

Pharmacotherapy for Status Epilepticus. Eugen Trinka. Drugs. 2015

Status Epilepticus; First 10 EM

Status Epilepticus; EMCrit

DVLA; Seizures and Driving

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