what is acute seizure and its treatment

Medication

Review summary: A general overview regarding definition, epidemiology, and causes of acute symptomatic seizures is provided. Diagnosis, frequency, risk factors, pathophysiology, therapeutic management, and prognosis of acute symptomatic seizures related to each insult individually are discussed. The insults considered are: acute stroke, traumatic brain injury, …

Procedures

A typical protocol is shown in Fig 1: all involve initial treatment with benzodiazepines (in adults typically up to 2 doses of 4 mg of lorazepam or 10 mg midazolam, which may include pre-hospital treatment by carers or paramedics, 11 followed by AEDs for ongoing seizures. Phenytoin and phenobarbitone are the only AEDs currently licensed in this situation, with speed and adequate …

Therapy

Nov 12, 2021 · First-line treatment for seizures involves the use of benzodiazepines such as: Lorazepam (IV) is often used as first-line therapy (usually a 4 mg bolus in adults, repeated once after 10−20 minutes if the seizure continues).²; Dose reductions are …

Self-care

Mar 14, 2022 · Emergency treatment of acute seizures and status epilepticus. R. Tasker. ... Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973 Jan; 28 (1):10–17. [Google Scholar] ...

Nutrition

Treatment of acute seizures and status epilepticus. Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical.

What is the best treatment for seizures?

Refractory status epilepticus has been defined as a seizure that is unresponsive to an adequate dose of a first line parenteral anticonvulsant28; or a seizure that is unresponsive to at least two doses of diazepam intravenously or rectally in succession followed by phenytoin/phenobarbitone or both (20 mg/kg) given over 30 minutes as an infusion, or failure …

What are the medications used to treat seizures?

The NeuroPace responsive neurostimulation (RNS) device was approved by the FDA in 2014 as a treatment for adults with partial-onset seizures with one or two seizure onset-zones, whose seizures have not been controlled with two or more antiepileptic drugs. Surgery involves placing a neurostimulator in the skull and connecting to two electrodes that are placed either on the …

What is the first line treatment for seizures?

ity, obtundation secondary to seizures or treatment, or for treatment of the underlying neurologic dis-ease or injury. These patients are prone to seizure recurrence, which may be clinically overt or subtle. Approximately 10% to 15% of patients with chronic epilepsy will experience an episode of SE at some point of their clinical course.

When to treat seizures?

Epilepsy is a disorder of the brain. People are diagnosed with epilepsy when they have had two or more seizures. There are many types of seizures. A person with epilepsy can have more than one type of seizure. The signs of a seizure depend on the type of seizure. Sometimes it is hard to tell when a person is having a seizure.

What is the first line treatment for acute seizures?

What is acute seizure?

What is the immediate treatment for seizure disorders?

What is the best medication for seizures?

What are the first signs of a seizure?

Why do seizures happen?

How do hospitals treat seizures?

How do you stop a seizure?

Can seizures damage the brain?

What is the safest seizure medication?

Can seizures stop without medication?

Can seizures be cured permanently?

What is the first line of treatment for seizures?

First-line treatment for seizures involves the use of benzodiazepines such as: Lorazepam (IV) is often used as first-line therapy (usually a 4 mg bolus in adults, repeated once after 10−20 minutes if the seizure continues).². Dose reductions are often required for elderly patients.

What happens to a patient's consciousness level during a seizure?

In the context of a generalised seizure, a patient’s consciousness level will be reduced.

What is an acute scenario?

Acute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name , age , background and the reason the review has been requested.

How long does a seizure last in a child?

A child who is still convulsing on arrival in hospital can be assumed to have had a seizure lasting at least 10 minutes and therefore will require emergency treatment. Some children may have already received rectal diazepam. In this phase of management the issues are whether diazepam is the treatment of choice and, if it is, should it be used more than once. Although the precise serum diazepam concentration required for a therapeutic effect is not known, concentrations of 150–336 ng/ml are associated with arrest of seizure activity. 24 These are achieved with a single dose of rectal diazepam, 20 22 which questions the notion that further doses would be of benefit in those whose seizure has not come under control—unless of course administration of the first dose has been unreliable or if a second episode has occurred. Few studies in children have looked specifically at the effectiveness of serial doses of diazepam when the first dose has failed to control the seizure. However, some information on this question can be learnt indirectly from a recent prospective study reported by Appleton et al. 25 Of 53 patients presenting with acute seizures to an emergency department, 28 responded to a single dose of rectal or intravenous diazepam (0.3–0.4 mg/kg). In the 25 who required a second dose, 17 also needed additional anticonvulsant drugs. This may have been because of the local protocol, but it does suggest that in those who do not respond to an initial dose of diazepam, the second dose is also likely to be ineffective. Therefore, if giving diazepam twice is questionable, is there a better alternative?

What is the goal of anticonvulsant treatment?

The goal of anticonvulsant treatment is the rapid termination of clinical and electrical seizure activity by the prompt administration of appropriate drugs in adequate doses, with attention to the possibility of complicating apnoea, hypoventilation, and other metabolic abnormalities.

What is refractory status epilepticus?

Refractory status epilepticus has been defined as a seizure that is unresponsive to an adequate dose of a first line parenteral anticonvulsant 28; or a seizure that is unresponsive to at least two doses of diazepam intravenously or rectally in succession followed by phenytoin/phenobarbitone or both (20 mg/kg) given over 30 minutes as an infusion, or failure to respond to the latter alone or in combination 15 28-30; or a seizure that continues for 60 to 90 minutes after the initiation of treatment. 1 This lack of consistency in definition is important when one considers the treatment and its consequences. Traditionally, for the most severe cases of status epilepticus induction of general anaesthesia has been recommended using a short acting barbiturate such as thiopentone (4–8 mg/kg bolus followed by infusion of up to 10 mg/kg/h) along with supportive endotracheal intubation and mechanical ventilation. 15 29 An alternative, effective approach has been to use, if necessary, repeated bolus doses of intravenous phenobarbitone (10 mg/kg) every 30 minutes, without reference to a predetermined maximum level or dose, after one dose of intravenous diazepam has failed to control a seizure. 28 A number of questions arise—for example, at what point is induction of anaesthesia overexuberant? Is it really necessary to wait 60 to 90 minutes before deciding that standard anticonvulsants are ineffective? When is it inevitable that standard anticonvulsants are unlikely to work—after the second dose of diazepam, after the second drug, or after the third drug? Some of these issues have been addressed already. The main disadvantage of thiopentone relates to its high lipid solubility and slow metabolism, which results in a prolonged period of intensive care support before a child is completely awake and cooperative once treatment has been stopped. 29 Similarly, prolonged intensive care will be necessary when using the very high dose phenobarbitone strategy. 28

How effective is midazolam?

Intramuscular midazolam is also rapidly effective: in 36 of 38 patients undergoing seizures, seven of whom were children, seizures were controlled with a mean of 1 minute and 53 seconds. 34 The two patients whose seizures continued despite intramuscular midazolam responded to another benzodiazepine given intravenously.

Is diazepam safe for seizures?

The efficacy of intravenous diazepam for the treatment of status epilepticus is well recognised with termination of episodes in some 80% of cases. 17 However, safety is a significant concern as apnoea and respiratory depression are common complications. 18 Therefore, except in known cases of recurrent prolonged seizures, drug treatment in the UK has traditionally been reserved for administration after arriving in hospital. If, as already discussed, diazepam is not only effective treatment but also better when administered earlier, why not give it before arriving at hospital—providing it can be carried out safely? In support of this argument is a recent American retrospective, case-control, study by Alldredge et al. 7 Using a definition of status epilepticus as seizures lasting longer than 15 minutes, these authors found (in 45 convulsive episodes) that prehospital treatment with intravenous diazepam (0.2 mg/kg) or rectal diazepam (0.6 mg/kg) by paramedical staff significantly shortened the duration of status epilepticus (mean for prehospital 32 minutes v mean for emergency department 60 minutes; p = 0.007) and reduced the likelihood of recurrent seizures in the emergency department (58% v 85%; p = 0.045). This study found no difference between the effectiveness of rectal and intravenous diazepam. This experience seems to confirm the experimental data already described, 13 but is such an approach safe?

Is status epilepticus a low morbidity?

Status epilepticus in the 1990s has a relatively low morbidity and mortality directly attributable to the seizure itself, 8 9 and an overexuberant approach with anticonvulsants may expose patients to the unnecessary iatrogenic risks of respiratory depression and hypotension. One commentator has raised the important question “Does the morbidity ...

Is epilepticus a fever?

In many parts of the world status epilepticus in childhood is often associated with fever, although there is wide variation in the proportion of patients who have this symptom ...

What are the two types of seizures?

Typically, seizures belong in one of two basic categories: primary generalized seizures and partial seizures. The difference between these types is in how they begin.

What percentage of epilepsy patients have intractable seizures?

According to the National Institute of Neurological Disorders and Stroke, 20 percent of epilepsy patients have intractable seizures — seizures that do not respond to treatment. The reasons why epilepsy begins are different for people of different ages.

Why do people have seizures?

The reasons why epilepsy begins are different for people of different ages. But what is known is that the cause is undetermined for about half of all individuals with epilepsy, regardless of age. Children may be born with a defect in the structure of their brain or they may suffer a head injury or infection that causes their epilepsy. Severe head injury is the most common known cause in young adults. For middle-age individuals, strokes, tumors and injuries are more frequent catalysts. In people age 65 and older, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer's disease. Often, seizures do not begin immediately after a person has an injury to the brain. Instead, a seizure may occur many months later.

What is it called when seizures occur on both sides of the brain?

Epilepsy in which the seizures begin from both sides of the brain at the same time is called primary generalized epilepsy . Hereditary factors are important in partial generalized epilepsy, which is more likely to involve genetic factors than partial epilepsy — a condition in which the seizures arise from a limited area of the brain.

What is epilepsy disorder?

Check out the new videos at the bottom of the page. Epilepsy is a disorder of the brain characterized by repeated seizures. A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain.

How does epilepsy affect the brain?

In epilepsy the brain's electrical rhythms have a tendency to become imbalanced, resulting in recurrent seizures.

What is the diagnosis of epilepsy?

A doctor makes his or her epilepsy diagnosis based on symptoms, physical signs and the results of such tests as an electroencephalogram (EEG), computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI). It is essential that the type of epilepsy and the type of seizures both are diagnosed properly.

What is epilepsy seizures?

The proposed definition of an epileptic seizure is a “transient occur- rence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.” This definition underscores the dual clinical and electrographic nature of epileptic seizures. Following on from this, epilepsy is a “disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition.” The definition of epilepsy requires the occurrence of at least 1 epileptic seizure. Epileptic seizures are either partial (also termed “focal” or “localization-related”) or generalized. A generalized seizure may be generalized at onset (primary generalized) or may have evolved from an initial partial seizure (secondarily generalized). Partial seizures may (complexpartial seizures) or may not (simplepartial seizures) impair consciousness, depending on the extent of cortical involvement, although the distinction of intact from altered con- sciousness is often difficult. The clinical manifesta- tions exhibited by patients during focal seizures reflect both (1) loss of the normal function sub- served by the involved cortex, and (2) superadded manifestations inappropriately generated by the involved cortex, for example, unilateral involuntary motor activity during seizures arising from the motor cortex. Generalized seizures manifest clinically as tonic, atonic, clonic, tonic−clonic, myoclonic, or absence seizures. Secondarily generalized seizures usually are tonic−clonic in nature. It is often difficult to dif- ferentiate primary generalized SE from secondarily generalized SE in the absence of a good account of preceding focal seizures before the episode of SE. Overall, most cases of generalized convulsive SE in adults that require ICU care are ultimately due to focal cortical injury or irritation [1,9]. In general, epilepsy due to focal cortical injury (focal epilep- sies) is more difficult to control and manage than idiopathic generalized epilepsy syndromes and hence predominate in the ICU setting. More than 90% of generalized tonic−clonic seizures (either primary or secondarily general- ized) terminate within 2 minutes [10], probably due to the overriding inhibitory cerebral activity that accompanies the initial excitatory hypersynchro- nous cortical activity. This observation deserves some thought because it tells us something about the nature of SE, where the ictal activity endures. Approximately 7% of seizures will progress into SE [11]. The factors that allow or promote persistent ictal activity resulting in SE rather than self-limiting seizure activity are not well understood. What is evident is that the self-terminating nature of most seizures is lost or overridden in SE. Defining SE has proven more difficult than defining isolated seizures, and any definition of SE needs to high- light this self-perpetuating tendency. An intuitive approach to defining SE is to declare SE as any seizure activity sufficiently vigorous or prolonged enough to cause neuronal damage; how- ever, this definition is impractical because biomark- ers for brain injury are not easily available. Furthermore, similar electroclinical seizure activity will have variable deleterious effects in different patients, depending on confounding clinical and genetic factors such as age, fever, and medication effects. The threshold for induction of neuronal injury can thus vary significantly from patient to patient; for example, classic absence SE is unlikely to lead to significant morbidity, but nonconvulsive seizures in medically ill patients are frequently asso- ciated with very significant morbidity and mortality.

What is the spectrum of epileptic seizures?

The spectrum ranges from a self-limiting single seizure to highly refractory SE.

What is a convulsive seizure?

The original definition by Gastaut and colleagues in 1964 [12] described SE as “a seizure that persists for a sufficient length of time or is repeated fre- quently enough to produce a fixed or enduring epileptic condition.” This mechanistic definition has more recently been recast to read “generalized convulsive status epilepticus refers to a condition in which there is a failure of the ‘normal’ factors that serve to terminate a typical generalized tonic-clonic seizure” [13]. Again, the difficulty lies in providing a definition that is not just theoretically insightful and sound but is useful in an emergency department (ED) or ICU situation. These mechanistic definitions have largely been supplanted by more practical, operational, time- based definitions (particularly applied to convulsive SE) referring to SE as “at least 5 minutes of persis- tent generalized, convulsive seizure activity or two or more discrete seizures between which there is incomplete recovery of consciousness” [13]. Some experts find the 5-minute definition arbitrary and favor a working definition that SE is persistent seizure activity after sequential administration of appropriate doses of appropriate first- and second- line AEDs. We believe that the 5-minute and 2-drug definitions both convey an appropriate sense of urgency needed to proceed to the next stages of clinical management. Following on from the distinction between partial and generalized seizures, SE can be either partial or generalized in nature. Partial SE can manifest with preserved (simplepartial SE) or impaired (complex

What causes epilepsy status?

Status epilepticus can be caused by a variety of dif- ferent underlying processes, the unifying aspect of which is cortical irritation or injury. The clinical pre- sentation and semiology (clinical characteristics of the seizures) typically do not convey accurate infor- mation about the underlying cause, although the tempo of the seizure activity often reflects the aggressiveness of the etiology. Status epilepticus can be categorized as sympto- matic, idiopathic, or cryptogenic. The term “symp- tomatic” indicates that the seizure activity is a secondary phenomenon or a symptom of an under- lying disease process. “Idiopathic” denotes a con- stitutional or genetic predilection to seizure activity or SE, characteristic of idiopathic generalized epilepsy syndromes. “Cryptogenic” refers to seizure activity or SE for which a cause cannot be identi- fied. Most cases of cryptogenic SE are likely to be symptomatic, although the causative lesion cannot be identified with existing technology. Most cases of refractory SE in adults are symptomatic. The underlying brain injury or dysfunction may have occurred temporally distant from the present SE (remotesymptomatic) or may be recent (acute

What causes status epilepticus?

Status epilepticus can be caused by a variety of dif-ferent underlying processes, the unifying aspect ofwhich is cortical irritation or injury. The clinical pre-sentation and semiology (clinical characteristics ofthe seizures) typically do not convey accurate infor-mation about the underlying cause, although thetempo of the seizure activity often reflects theaggressiveness of the etiology.

What is the best treatment for RSE?

Current knowledge suggests that the optimal agent for treatment of RSE should have both GABA-ergic and NMDA antagonistic properties, be fast acting, cross the blood−brain barrier, have a short half-life, neuroprotective properties, and a favorable risk profile. In the future, the pharmacogenomic profile of the patient may be another factor in determining the choice of agent for use in SE. At present, no such agent exists. Three classes of medications are currently in use for treatment of RSE: barbiturates, propofol, and benzodiazepines (midazolam). Each has particular advantages and disadvantages. All patients in whom there is a possibility of refractory, ongoing seizure activity (manifesting clin- ically or confirmed electrographically) need to be cared for in an ICU by staff proficient in the man- agement of SE [23]. These patients need long-term EEG monitoring and typically need intubation. Although the management of early SE should be familiar to all frontline medical personnel, the care of patients in RSE should ideally be undertaken by those with experience in the ICU management of SE and with immediate access to expertise in EEG mon- itoring and interpretation. Hence, after recognition of SE and subsequent treatment with IV benzodi- azepine and phenytoin or fosphenytoin, the clinician in charge should seek transfer to an ICU, ideally where continuous EEG monitoring is available. Our overall approach to the management of difficult-to- terminate seizure activity is outlined in Table 4.

Is status epilepticus heterogeneous?

Status epilepticus (SE) is a heterogenous electro- clinical syndrome with diverse causes, inconsistent and dynamic clinical manifestations, and variable clinical course. Conventional teaching dictates that the outcome from SE is largely dependent on the underlying etiology; however, some evidence suggests that SE carries its own morbidity and mortality, independent of the cause. The pathophysiologic changes associated with ongoing seizure activity increasingly point to SE being a dynamic rather than a static process. The clinical course of SE parallels that of the underlying precipitating disease process but occasionally may prove intractable even when the underlying disease improves, suggesting that SE can “take on a life of its own” and come to domi- nate the clinical picture. Moreover, SE may arise in patients with chronic epilepsy in the absence of newfound brain injury. Although SE can be viewed and managed as an entity or disease in itself, somewhat separate from associated medical and surgical comorbidities, in most cases, particularly in the intensive care unit (ICU) set- ting, SE should be more accurately thought of as a stereotypical electroclinical response to a recent or remote cortical injury or irritation. One potential over- sight in the management of SE in the ICU is to equate SE with out-of-control epilepsy and give inadequate consideration to the underlying cause. Ironically, SE occurring in persons with established epilepsy may be easier to control than SE in persons without preexist- ing epilepsy, possibly owing to earlier recognition of SE and the presence of antiepileptic drugs (AEDs) in these individuals. Furthermore, new onset SE is often due to an acute, active epileptogenic disease process, termed “acute symptomatic” SE, whereas SE in per- sons with preexisting epilepsy often arises owing to a remote but less acutely active disease process, termed “remote symptomatic.” When SE is viewed as an elec- troclinical response to brain injury, it follows that a rigorous exploration for the underlying cause is always warranted. This review will outline our approach when confronting SE in adults, paying par- ticular attention to the ICU environment.

What are the words used to describe seizures?

These words are used to describe generalized seizures: Tonic: Muscles in the body become stiff. Atonic: Muscles in the body relax. Myoclonic: Short jerking in parts of the body. Clonic: Periods of shaking or jerking parts on the body.

What are the two types of seizures?

Seizures are classified into two groups. Generalized seizures affect both sides of the brain. Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space. Tonic-clonic seizures, also called grand mal seizures, can make a person. Cry out.

What is a tonic clonic seizure?

Tonic-clonic seizures, also called grand mal seizures, can make a person. Cry out. Lose consciousness. Fall to the ground. Have muscle jerks or spasms. The person may feel tired after a tonic-clonic seizure. Focal seizures are located in just one area of the brain. These seizures are also called partial seizures.

How do you know if you have a seizure?

A person having a seizure may seem confused or look like they are staring at something that isn’t there. Other seizures can cause a person to fall, shake, and become unaware of what’s going on around them.

What is the name of the disorder of the brain?

Epilepsy is a disorder of the brain. People are diagnosed with epilepsy when they have had two or more seizures.

Where do secondary seizures occur?

Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure.

Can epilepsy cause a strange taste?

These seizures can cause twitching or a change in sensation, such as a strange taste or smell. Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes.