Disease modifying treatment available:
Time critical diagnosis and management:
Lateralising:
| Subclassifications | Epidemiology | Clinical features |
|---|---|---|
| Absence seizure | None | |
| Focal seizure | None | Hallucination |
| Generalized seizure | None | Transient loss of consciousness |
| Disorder | Clinical features | Associated features | Investigations | Disease modifying treatment available | Time critical |
|---|---|---|---|---|---|
| Cerebral venous sinus thrombosis |
Headache Bilateral papilloedema Visual field defect Weakness |
Pregnancy Crohn's disease Antiphospholipid syndrome Polycythaemia rubra vera Nephrotic syndrome Essential thrombocythaemia Antithrombin deficiency Protein C deficiency Protein S deficiency Paroxysmal nocturnal haemoglobinuria Myelofibrosis Ulcerative colitis |
|||
| Eclampsia |
Headache |
Posterior reversible encephalopathy syndrome |
|||
| Herpes simplex encephalitis |
Cognitive impairment |
||||
| Bacterial meningitis |
Headache |
||||
| Acute intermittent porphyria |
Peripheral neuropathy Abdominal pain Anxiety |
||||
| Anti-NMDA-receptor encephalitis |
Dementia Psychosis |
Ovarian teratoma |
|||
| Lead toxicity |
Peripheral neuropathy Optic neuropathy |
||||
| Carbon monoxide toxicity |
Headache |
||||
| Juvenile myoclonic epilepsy | |||||
| Dentatorubral-pallidoluysian atrophy |
Cerebellar ataxia Myoclonus Dementia Chorea |
||||
| Cerebral cavernous malformation | |||||
| Posterior reversible encephalopathy syndrome |
Headache Visual loss Reduced conscious level |
Pre-eclampsia Eclampsia Hypertension |
|||
| Anti-CASPR2 encephalitis |
Myokymia Generalised pain Insomnia Weight loss Cerebellar ataxia Hyperhidrosis Psychosis Amnesia |
Thymoma Anti-LGI1 encephalitis |
|||
| Anti-DPPX encephalitis |
Weight loss Diarrhoea Myoclonus Tremor Hyperekplexia Amnesia Cognitive impairment Hallucination |
||||
| Anti-AMPA-receptor encephalitis |
Amnesia Psychosis |
||||
| Aortic dissection |
Abdominal pain Chest pain Ischaemic stroke Cardiogenic syncope |
||||
| Lennox-Gastaut syndrome |
Epilepsy |
||||
| Rett syndrome | |||||
| Angelman syndrome |
Intellectual disability Ataxia |
||||
| Ciguatera poisoning | |||||
| Tin poisoning | |||||
| Solvent neurotoxicity | |||||
| Alpers-Huttenlocher syndrome |
Bilateral ptosis |
Seizure may cause the following:
The management of a seizure is dependent on the individuals risk of having further seizures. A significant proportion of people who have a seizure will never have another. In such patients, significant changes to their lifestyle or medications to reduce the risk of further seizures are not necessary. The challenge is predicting the people who will go on to have further seizures! Around 1 in 3 people would be expected to have a further seizure within a five year period.
The risk of further seizures is assessed by a neurologist. Assessment should be rapid, but while awaiting assessment the following advice should be given.
- Avoid undertaking activities which could pose a danger to yourself or others if you had a further seizure and lost consciousness. Examples include working at heights, sports such as climbing or swimming, bathing, driving, looking after young children and operating heavy machinery. This list is not exhaustive and while awaiting assessment it is prudent to consider with every activity what the implications of a further seizure during the activity might be.
- Group 1 license holders cannot drive for 6 months and must inform the DVLA they have had a seizure. The patient has a legal responsibility to do this can be fined if they do not.
- Alcohol can reduce the threshold at which seizures occur.
People who might witness the patient having further seizures should be given the following advice:
- Try to ensure the area around the person seizing is safe by removing any dangerous objects or covering sharp or hard surfaces if possible
- Do not try to restrain the person
- Lay them on their side
- Time how long the episode lasts
- Take a video of the episode if possible
- Call 999 if the person is not known to have seizures, the seizure lasts more than 5 minutes, the person is not conscious after the episode or is taking longer than normal to regain consciousness
Factors that increase the risk of further seizures include:
- Epileptiform abnormalities on an EEG
- Abnormal neurological examination
- Intellectual disability
- First seizure occurring during sleep
- Remote symptomatic cause identified (e.g. brain tumour, previous CNS infection etc) - note that the 'remote' is important here as if seizures occur within a week of brain injury, infection or stroke there is a relatively low risk of recurrence
- How can we improve the prediction of individuals who will go on to have further seizures after an index event?
- How are seizure clusters optimally managed and do they confer and increased risk of epilepsy?