Dr.Amel

1. Amal Al Shibli SQUH ED Seizure Amal Al shibli

3. Pathophysiology

5. Seizure primary (epileptic) secondary (reactive) focal ( partial ) generalized convulsive nonconvulsive simple complex partial with 2 nd generalization

6. Classification of Seizures in a General Adult Population 9 Unclassified 12 Mixed partial 27 Secondarily generalized 11 Complex partial 3 Simple partial Partial 2–3 Others <1 Myoclonic 1 Absence 35 Tonic-clonic Generalized PERCENTAGE SEIZURE TYPE

7. Consciousness Vs Cognition

16. Seizure primary (epileptic) secondary (reactive) focal ( partial ) generalized convulsive nonconvulsive simple complex partial with 2 nd generalization

18. Metabolic Derangements

26. Infectious Diseases

29. Drugs & Toxins

34. Trauma

37. Stroke

40. Psychogenic Nonepileptic Seizures

44. Postictal States

48. Approach to Seizure in ED

58. Indications for Emergent Head CT for New-Onset Seizure Patients Persistently altered mental status Focal onset before generalization Age older than 40 years New focal neurologic examination History of anticoagulation Persistent headache Fever Immunocompromise History of malignancy History of acute head trauma Acute intracranial process is suspected

60. Differential Considerations for the Dx of Seizure

61. Posturing, deviation of eyes Extrapyramidal reactions Myotonic spasms Strychnine and camphor Myotonic spasms Tetanus Buccolingual spasms Phencyclidine Abnormal behavior Hypoglycemia Delirium tremens, blackout Alcohol abuse/withdrawal Toxic and metabolic disorders Loss of urinary continence Tonic-clonic movements More typical in children Prolonged breath-holding Posturing of extremities Mood disturbances Hyperventilation syndrome Preictal or postictal twitching “ Fit vs. faint” Vasodepressive vs dysrhythmogenic (including long QT syndrome) vs orthostatic Syncope ICTAL-LIKE MANIFESTATIONS CLASSIFICATION DISORDER

62. May closely resemble ictal activity; patients may have both true seizures and pseudoseizures Pseudoseizure Functional disorders Twitching, altered mental state Panic attacks Similar to postictal state, absence status Fugue state Psychiatric disorders Convulsions Hemiballismus, tics Movement disorders Drop attacks, “fit vs. faint” Narcolepsy Drop attacks, “fit vs. faint” Carotid sinus hypersensitivity Todd's paralysis Hemiparetic migraine Similar to postictal state, absence status Transient global amnesia Drop attacks, “fit vs. faint” Transient ischemic attacks Nonictal CNS events

64. Management

67. Intubation required; monitor hemodynamics 10–20 mg/kg IV load over 1–2 hours, then 0.5–1 mg/kg per hour infusion Numbutal Pentobarbital Intubation required; monitor hemodynamics 1–2 mg/kg IV bolus, then 5–10 mg/kg per hour infusion Diprivan Propofol Unlabeled use 20–40 mg/kg at ≤6 mg/kg per minute Depakote Valproate May be given as IM loading dose 20 mg/kg IV, then 5–10 mg/kg every 20 minutes, up to 2 g Luminal Phenobarbital Cardiac monitoring Less risk of infusion site reaction; may be given IM 20 PE/kg IV at 150 mg PE/minute Cerebyx Fosphenytoin Cardiac and blood pressure monitoring during infusion; large-bore intravenous line 20 mg/kg IV at <50 mg/minute Dilantin Phenytoin May be given intranasally (0.2 mg/kg) 0.2 mg/kg IV bolus, then 0.05–0.6 mg/kg per hour infusion Versed Midazolam Preferred benzodiazepine owing to its longer duration of action 0.1 mg/kg IV (usually 4 mg in adult); may repeat in 10 minutes, then 0.01–0.1 mg/kg per hour infusion Ativan Lorazepam May be given per rectum in pediatrics (0.3–0.5 mg/kg) 5–10 mg IV every 10 minutes, up to 30 mg per 8-hour period Valium Diazepam COMMENTS ADULT DOSE BRAND NAME GENERIC NAME

73. Long-Term Management

79. Thank U ??????