Management of seizures is a very Important topic, extremely High yield in Examinations and also a very common condition in the ER or wards :
suppose a patient presenting to the emergency room with a seizure or a history of seizure, your workup should include:
1- ABCDE , secure airway, breathing ,circulation,check for disabilities and adequate exposure for any signs of trauma or injuries
2- History taking
3- assess the type of seizure whether it's a status epilepticus or Generalized or a partial seizure
4- In status epilepticus you are targeting 2 things, first to stop the seizures, which you can achieve through the following and regular organized scheme of medications:
a- Diazepam or Lorazepam (Benzodiazepines)
b- Phenytoin or fosfophenytoin
c- try again Phenytoin!
d- Phenobarbital
e- if all above measures failed you would need an anesthesia consultation, usually Midazolam or Propofol would be used
the second thing is to detect the etiology of the seizures while all these events are taking place , blood samples should be collected to check for CBC, full chemistry and electrolytes profile, bleeding and clotting factors profile , glucose levels, CT scan and lumbar puncture, should be performed
although, EEG is the most important test in diagnosing seizures , though it's usually established after you exclude all other causes that cause the seizures , in other words after controlling the status epilepticus , make your priority to RAPIDLY detect the cause of the epilepsy and manage it as soon as possible and when applicable
5-in other types of seizures medications would differ though management would be essentially the same, with highlighting again the importance to identify possible cause of seizure and manage it when applicable before starting antiepileptic treatment
a- Generalized seizures:
Tonic-Conic : Valproic acid is the first line, Lamotrigine is the second line
Abscence: Ethosuximide is the first line, Valproic acid is the second line
Myclonic and Atonic: Valproic acid is the first line
Pregnancy : Carbamazepine is the drug of choice
b- Partial seizures:
Carbamazepine and Phenytoin are first line drugs
When to stop anti epileptic treatment ?
if seizures stopped developing for 2-3 years, + a Negative sleep deprivation EEG test.
due to the prolonged and chronic course of administration of the anti epileptic drugs, you should be aware of their expected side effects :
Phenytoin : rash , ataxia, diplopia, hirsutism,gum hyperplasia and lymphadenopathy
Phenobarbital : Rash and ataxia
Valproic Acid : Rash , GIT Irritation (vomiting and diarrhea), hepatotoxicity,
thrombocytopenia and hyponatremia
Ethosuximide : Stevens-johnson syndrome
suppose a patient presenting to the emergency room with a seizure or a history of seizure, your workup should include:
1- ABCDE , secure airway, breathing ,circulation,check for disabilities and adequate exposure for any signs of trauma or injuries
2- History taking
3- assess the type of seizure whether it's a status epilepticus or Generalized or a partial seizure
4- In status epilepticus you are targeting 2 things, first to stop the seizures, which you can achieve through the following and regular organized scheme of medications:
a- Diazepam or Lorazepam (Benzodiazepines)
b- Phenytoin or fosfophenytoin
c- try again Phenytoin!
d- Phenobarbital
e- if all above measures failed you would need an anesthesia consultation, usually Midazolam or Propofol would be used
the second thing is to detect the etiology of the seizures while all these events are taking place , blood samples should be collected to check for CBC, full chemistry and electrolytes profile, bleeding and clotting factors profile , glucose levels, CT scan and lumbar puncture, should be performed
although, EEG is the most important test in diagnosing seizures , though it's usually established after you exclude all other causes that cause the seizures , in other words after controlling the status epilepticus , make your priority to RAPIDLY detect the cause of the epilepsy and manage it as soon as possible and when applicable
5-in other types of seizures medications would differ though management would be essentially the same, with highlighting again the importance to identify possible cause of seizure and manage it when applicable before starting antiepileptic treatment
a- Generalized seizures:
Tonic-Conic : Valproic acid is the first line, Lamotrigine is the second line
Abscence: Ethosuximide is the first line, Valproic acid is the second line
Myclonic and Atonic: Valproic acid is the first line
Pregnancy : Carbamazepine is the drug of choice
b- Partial seizures:
Carbamazepine and Phenytoin are first line drugs
When to stop anti epileptic treatment ?
if seizures stopped developing for 2-3 years, + a Negative sleep deprivation EEG test.
due to the prolonged and chronic course of administration of the anti epileptic drugs, you should be aware of their expected side effects :
Phenytoin : rash , ataxia, diplopia, hirsutism,gum hyperplasia and lymphadenopathy
Phenobarbital : Rash and ataxia
Valproic Acid : Rash , GIT Irritation (vomiting and diarrhea), hepatotoxicity,
thrombocytopenia and hyponatremia
Ethosuximide : Stevens-johnson syndrome
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