SEIZZURE

DISORDER
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Causes for seizzure

• Hypoxia
• Hypoglycemia
• SE imbalance except pottasium
• Meningitis
• Encephalitis
• Head trauma
• Intoxification
• Alcohol withdrowal
• Brain tumor
• Poor compliance
• Hepatic encephalopathy , Renal enceph , HTn enceph

Case 1
23 yr old female presented with generalizes tonic clonic movements
• Not stable
• Count TIME
• => 5mins
• Start with resussitation
• A - asess airway
Suck out secretions
Turn to left lat possition after exclude head neck truma by bystander
Position head tilt chin lift
Connect to monitor check SO 2 , RR , BP , PR = NL
• Breathing pattern assess
• C - insert 2 wide bore cannular
Take blood for CFC , CRP ( if pt has Fever = meningitis
BS ( low 20mg/dl)
SE ( only K doesnt cause fits)
LFT , RFT

Then give IV Loracepam 4mg slow bolus ( RR monitor )

= Pead 0.1mg/kg over 2-5min
20% Dextrose 75ml over 10mins (hypoglycemia )
Loracepam S/E = Ataxia , Respi distress , Bp drop
After give 1st dose
Ask for Pmed Hx
Druf Hx
Intoxification
Allergy
Fhx
Head truama
Infection
Immunization

Quick Ex
GCS , Pupils , fundus , focal neurological signs
( if prolong post ictal drownzy do SE , ECG )

After 5mins repeat Loracepam

Check BS of yet low repeat dose can give up to 250ml
Mean while Anaesthetist

( Will give Thilamine 250ml over 30min IV if Alcoholic

Or malnurished
If pt with Eclepsia give MgSO4 4mg stat then 2g/ 1hr slow IV)
 Transver
If ambulance delay is there

Give IV Phenytoin 15-20mg/kg ( rate 50mg/min) ( pead

15mg/kg)
Then 100mg/ 6-8hr slow IV infusion
1.monitor Bradycardia (ECG)
Hypotension
Can't give phenytoin in heart block 🤧🤧
S/E - Ataxia , Megaloblastic Aneamia , S-J Xn , gingival
hyperplasia

After transver pt will be paralysed by Anasthetic by propofol

What does status epileptic means?

• seizzure doesn't settle >5mins
• Repeated seizzures without gain fully conciousneds <30mins

How to Mx Neonatal convulsions?

What is seizzure disorder

Seizzure
23yr old male presented with general tonic clonic movements
Unstablr i will start with resussitation

Ask the TIME and start counting

A – assess air way patency
Exclude head trauma and keep him in LL possition
Suck out secretions
100% O2 via face mask
Connect to So2 , RR , PR , BP monitor for continous monitoring

Breathing assess 2 wide bore cannulars

If the time is more than 5mins
Circulation - i will drow blood for CFC CRP ( suspect infection )

Blood sugar – NL
SE , RFT , LFT
I will start IV Lorazepam 4mg slow bolus
Mean while i will take a breaf Hx
1.How long?
2.eye witness
3.general tonic clonic / Focal
4.Aura / typical seizzure features?
5.Hx o fever , AOM infection
 6.any intoxication / alcohol / malnutrition
7.PMx - known epileptic
8?Drug Hx - was on Na valproate with good compliance
remission for 1 yr.newly started on anti TB drugs for 2 mnths )
9.F Hx NL
10.Immnuniztion JE NL

Do a brief ex - general appearance

• Febrile
• Rashes
• Fundus & pupils
• Focl neurological signs
Take a ECG

If mor than another 5min of onset of seizzure give 2nd dose Loracepam IV
And call anasthesiologists

If doesnt settle after 5min better to contact tertiaryl emergency unit ovr the phone
and transver
• Rf for a neurologist to adjust valproate dose or further Ix
If there is a delay in transver give IV Phenytoin 15-20mg / kg ( 15mg / min ) rate
Then 100mg over 6-8hrs
• Dont give phenytoin to pt with Heart block
• Monitor pt BP , PR ( hypotension , bradycardia ) while giving phenytoin
Why this pt got a relapse
Pt Started on Rifampicine ( first 4 mnths of TB give all four drugs)
Rifampicin increase liver metabolism of drugs including Na Valproate
So need to increase the dose of Valproate which didn't
What will be your health education after pt come for your G followyp?
• If pt start on new drugs pt should inform those to GP
• Keep Diazapam gel ( PR) at home and educate family members how to do
first aid in seizzure and
• Avoid risk places
• Avoid put in medicine and etc in pt mouth while fitting

When will you start long term antiepileptics for a pt

• Strong FHx
• After first Fit pt should send to Neurologist to do EEG if abnormal
• Abnormal CT
• Fit that nees Benzodiazepine to stop ( status)
• Non corrective factor - brain tumor
• Focal neurological sign

Can tail off and stio drugs if seizzure free for 2 yrs

What are the first line Antiepileptics long term

• Na valproate
• Carbamezapine
• Phenytoin
• Lamotrigine ( Steven J but best for Preg
Efficacy equal in all above drugs.

What are the 2nd line long term antiepileptics

 • Phenobarbitol
• GABA pentine
What is drug of choice for absent seizzure?
• Ethosuximide

What drugs reduce actiion of antiepileptics ?

• Rifampicin
• OCP - Lamotigrine

Never forget eclepsia in seizzure with a Female

 Na valproate
• Action - facilitate GABA neuro transmittio

• Dose 15mg / kg / d PO ( pead , Adult)

• 125/250mg capsules available

• Bets for complex partial seizzure

Teratogenic - neural tube defects

A/E - waight gain

Hepatic impair
Alopesia / change texture of har
Erethema multiform

21yr old lady presented to you with fitting

Unstable
Time - count if > 5mins start IV Antiepileptics
A - assess air way patency
Exclude head injury and keep in LL position
Suck out secretions
Give 100% O2 via face mask
Connect to monitor and continous monitoring of SO2, RR , PR , BP - RR 8
GCS cant detect
Assess breathing

C - Take blood CFC

BS
SE LFT RFT
IV Lorazzepam 4mg sloe bolus
Catheterise - Urine Beta HCG
ECG
Take bring d Hx
• Is she sexually active
• Eye witness - typical seizzure features
First epi?
• PMed Hx – no
• Drug Hx – no
• Alcohol / intofications - she went for a party and had tablets
• FhX - no
• Immunization – nl

Ex
• Febrile
• GCS
• Rashes ( meningitis )
• Fundus pupils - pin point ( miosis )
• Focal neurological
• Sweaty runny nose
• Wet axillar
• Simphysio fundal height - if ecepsia
After 5min 2nd dose IV Lorazepam 4mg slow bolud
Call anesthetic
Pt took Opioid ( Tramadol at party thats why her RR low , seizzure ,
Give Naloxone 0.4mg/ml

Febrile convulsion

What is a simple FV
• Fever high
• Generalized tonic clonic
• Age - 6mnth to 5yr
• Less than 5mins
• No post ictal drowziness >30min
• Fhx possitive
What is a complex febrile convulsion ?
• Focal fit
• >1 fit in 24hrs
• Fit >5mins need antiepi to stop
Ix should do on FC?
• BS
• CFC , CRP
• Every child less than 18 mnths should do LP
• Ca
• To fins focus - CXR / UFR

Mx in FC
• Control fever - PCM 15mg/kg ( IV / PR / PO)
Tappied sponging

• Controll fit

• Rx course
 • Advice mother
Not to put anything include medicine in to child's mouth ehile fitting
• Keep pt 24hr for observation
• Rf to Neurologist to decide about EEG ( not recommend to do GP level
and also for a simple FC)

Intermittent CLOBA profile ( this is not adviced in oman

guideline )
• When ever child get fever advuce mother
• Give PO Clobazan 1mg/kg for 3 days to th child

Why use Lorezapam instead Diazapam

• Long duration of action
• MOA ( action ) and S/ E same
• MOA - GABA neurotransmitter activate and sedate brain
• S/ E - respiratory destress
Hypotension

Septic screen
• CFC CRP
• URine analysis
• LP culture
• Blood culture
• Urine culture
.Neonatal seizzure Mx?
• How to asess neonate?
seizzure
A female brought to clinic having seizzure.
Witness said she fell down
• Epilepsy vs head truama ?
• Exclude hypoglycemia
• Thorough discussion with medications for seizzure ,
• Exact dose
• Exact dosage
• Alternatives than Lorazepam / Diazeoam with doses