Approach to an adult with an episode of seizure
Open Access
- 15 January 2022
- journal article
- Published by IP Innovative Publication Pvt Ltd in IP Indian Journal of Neurosciences
- Vol. 7 (4), 266-274
- https://doi.org/10.18231/j.ijn.2021.049
Abstract
A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.Keywords
This publication has 37 references indexed in Scilit:
- Clinical profile of patients with nascent alcohol related seizuresAnnals of Indian Academy of Neurology, 2013
- Status epilepticusAnnals of Indian Academy of Neurology, 2009
- Antiepileptic drugs in pediatric epilepsyJournal of Pediatric Neurosciences, 2008
- Reassessment: Neuroimaging in the emergency patient presenting with seizure (an evidence-based review)Neurology, 2007
- Practice Parameter: Neuroimaging in the Emergency Patient Presenting With Seizure (Summary Statement)Annals of Emergency Medicine, 1996
- Incidence of Epilepsy and Unprovoked Seizures in Rochester, Minnesota: 1935–1984Epilepsia, 1993
- National General Practice Study of Epilepsy: recurrence after a first seizureThe Lancet, 1990
- Complex partial seizures of frontal lobe originAnnals of Neurology, 1985
- Electroencephalographic spiking activity, drug levels, and seizure occurence in epileptic patientsAnnals of Neurology, 1985
- Convulsive syncope in blood donorsAnnals of Neurology, 1982