Seizure and Epilepsy Overview

Patient Cases

• Stefan (7-year-old male):
  • Episodes of brief loss of consciousness several times a day.
  • Described as daydreaming by his teacher.
• Jacob (17-year-old male):
  • Sudden shaking and jerking with loss of consciousness for about 2 minutes.
  • Appears sluggish and tired post-episode.
• Megan (11-year-old female):
  • Episode of left foot twitching, unconscious with no memory.
• Joanna (19-year-old female):
  • Repeated jerking movements with loss of consciousness.
  • Episodes occur in the morning and are triggered by sleep deprivation.

Seizure and Epilepsy Definitions

• Seizure: Paroxysmal event due to abnormal excessive electrical discharges in the brain.
  • Lasts less than 5 minutes.
  • If longer, termed status epilepticus.
• Epilepsy: Chronic disorder characterized by recurrent unprovoked seizures.
  • Diagnosed with two or more unprovoked seizures 24 hours apart.

Classification of Seizures

1. Generalized Seizures:

   • Arise from both cerebral hemispheres.
   • Subtypes:
     • Motor Seizures:
       • Tonic-Clonic: Sudden stiffening and rhythmic twitching.
       • Myoclonic: Rapid muscle contractions, typically in the morning.
       • Atonic: Loss of muscle tone causing collapse.
     • Non-Motor Seizures (Absence):
       • Brief loss of consciousness without muscle tone change.
       • Common in children.

2. Focal Seizures:

   • Arise from a specific area in one hemisphere.
   • Types:
     • Affecting consciousness (with postictal phase).
     • Not affecting consciousness (no postictal phase).
     • Can include motor, sensory, or autonomic symptoms.
   • Auras: Subtle neurological symptoms preceding seizure.

Febrile Seizures

• Occur in children aged 6 months to 5 years.
• Types:
  • Simple Febrile Seizures: Generalized, last <15 minutes.
  • Complex Febrile Seizures: Focal, last >15 minutes, can recur within 24 hours.

Diagnostic Workup

• Initial tests: CBC, electrolytes, liver function, glucose.
• Possible brain imaging if structural lesion suspected.
• EEG to determine seizure type.
• Consideration of potential causes using "VITAMINS" mnemonic:
  • Vascular, Infection, Trauma, Toxins, Autoimmune, Metabolic, Idiopathic, Neoplasm, Syncope.

Treatment

• Abortive Therapy: Benzodiazepines for status epilepticus.
• Anti-Epileptic Drugs:
  • Various options including valproic acid, phenytoin.
  • Ethosuximide for absence seizures.
  • Magnesium sulfate for eclampsia.

Case Evaluations

• Stefan: Likely absence seizures.
• Jacob: Likely generalized tonic-clonic seizure.
• Megan: Likely focal seizure with impaired consciousness.
• Joanna: Likely myoclonic seizures.

Conclusion

• Seizures require thorough evaluation to identify triggers and underlying conditions.
• Treatment and management depend on type and cause of seizures.