Seizures and Status Epilepticus

Abstract

This chapter begins with a discussion that a seizure can have many causes such as metabolic derangements (severe hypoglycemia), infections (encephalitis or from high fever), drugs (amphetamines), drug-withdrawal (alcohol), genetic, or idiopathic. Next, the chapter describes the epidemiology of epilepsy, the pathophysiology of a seizure, and the value of an electroencephalogram in diagnosing seizures. The seizure classification system is then covered and its distinction from non-seizure events such as syncope, migraine, transient ischemic attack, psychogenic nonepileptic seizure, rage attacks, Meniere’s disease attack, and movement disorders. This chapter finishes with a complete description of focal seizures, generalized convulsive seizures (Grand Mal), absence seizures (Petit Mal), West’s syndrome, and status epilepticus. Attention is paid to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.

A 20-year-old woman was brought by an ambulance to the emergency room for a new onset seizure. Previously healthy, she was in the library studying for an exam when she suddenly had a seizure. The seizure was described by witnesses as two minutes of generalized tonic-clonic activity with urinary incontinence. She was lethargic afterward and confused. By the time she reaches the ER, she is awake and alert. She does not recall the event, but feels sore all over. Her neurologic exam, head CT, and laboratory work were all normal. She is cautioned not to drive for 6 months according to her state’s driving laws. She is scheduled for an outpatient EEG and MRI to evaluate for any focal reason for a seizure and follow-up with the neurologist.