milixpert.blogg.se - Cataplexy vs syncope

From the Commission on Classification and Terminology of the International League Against Epilepsy.

↑ Proposal for revised clinical and electroencephalographic classification of epileptic seizures.

Emergency department seizure epidemiology.

↑ Martindale JL, Goldstein JN, Pallin DJ.

DDxOf: Differential Diagnosis of Seizures.

Instructions not to drive, swim, or participate in other potentially dangerous activities is important.

24-hr recurrence of seizures in this group is about 9% when alcohol-related events are excluded.

Observation is not unreasonable for those that look ill or have a complicating history/physical.

Those with single generalized seizure and otherwise normal history and physical can be discharged home with close follow-up.

Nonconvulsive seizures or status epilepticus - get EEG.

hyponatremia, hypoglycemia, INH toxicity, ecclampsia)

Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants).

Ketamine loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr.

Midazolam 0.2mg/kg, then infusion of 0.05-2mg/kg/hr OR.Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR.Phenobarbital IV 20mg/kg at 50-75mg/min (be prepared to intubate).Levetiracetam IV 60mg/kg, max 4500mg/dose.Valproic acid IV 20-40mg/kg at 5mg/kg/min.Contraindicated in pts w/ 2nd or 3rd degree AV block.Fosphenytoin IV 20-30mg/kg at 150mg/min (may also be given IM).Midazolam IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg - may also be given IN.Benzodiazepine (Initial treatment of choice).If possible, place patient in left lateral position to reduce risk of aspiration.Non-contrast CT in ED or advanced imaging arranged as outpatient.Always perform ECG as prolong QT and torsades can cause shaking after intermitent runs.Consider: Pregnancy test, glucose, Electrolytes (Na, Ca, BUN, Crt), RPR, HIV, UA, EEG, lumbar puncture.New Seizure or Change in Baseline Seizures Consider head CT scan if suspicious of change in pattern, prolonged postictal period or trauma.Check for signs of trauma, cervical spine tenderness.Work-Up Known Epileptic with NO Change in Baseline Seizures Tongue biting has sensitivity of ~25% and approaches 100% specificity in lateral tongue biting.Sides of tongue (true seizure) more often bitten than tip of tongue (Psychogenic nonepileptiform seizures, formerly "pseudoseizure.").Posterior reversible encephalopathy syndrome.Diaphoresis, vertigo, nausea, chest pain, feeling of warmth, palpitations, dyspnea before spellĭifferential diagnosis of seizures Seizure.Factors that strongly favor seizure from most specific to least:.Tonic–clonic seizures (Older term: grand mal).Absence seizures (Older term: petit mal).Simple partial seizures evolving to complex partial seizures evolving to generalized seizures.Complex partial seizures evolving to generalized seizures.Simple partial seizures evolving to generalized seizures.Focal seizures evolving to secondarily generalized seizures.With impairment of consciousness at onset.Simple partial onset, followed by impairment of consciousness.With impairment in consciousness - (AKA Complex Partial Seizures-Older terms: temporal lobe or psychomotor seizures).

Without impairment in consciousness– (AKA Simple partial seizures).Most seizures in pregnancy are not first-time seizures, but rather are due to medication noncompliance or pharmacokinetic drug changes as result of pregnancyĬlassification is based on the international classification from 1981 More recent terms suggested by the ILAE (International League Against Epilepsy) task Force.In pregnancy >20 WGA or 3% will have epilepsy (at least 2 unprovoked seizures).11% of people will have at least one seizure in their lifetime.Caused by a pathologic pattern of brain cortex activity → involuntary movement or change in level of consciousness.4.2.2 New Seizure or Change in Baseline Seizures.4.2.1 Known Epileptic with NO Change in Baseline Seizures.