Emergency: seizure

  1. Seizure-Definition
    Aberrant cortical neural pathway activation

    Motor activity

    Sensory activity 

  2. Status epilepticus
    Long lasting 

    Life threatening
  3. other seizures, e.g grand mal (life threatening ???)

    but have to notice the time length that could indicate status epilepticus
  4. Seizure - Pathophysiology
    Focal source of excessive neuronal electrical discharge in the brain



    Head trauma

    Fever (quick change in body temp --> feverile seizure)

    ETOH withdrawal

    Hypoxia (birth, syncope) 


    Brain tumor  Meningitis

    Local anesthetic overdose  Hypoglycemia
  5. Seizure - possible cause

    Head trauma

    Fever (quick change in body temp --> feverile seizure)

    ETOH withdrawal

    Hypoxia (birth (inc chance of having epilepsy later on), syncope)


    Brain tumor


    Local anesthetic overdose *** (for dentist)

  6. Seizure-Pathophysiology: types
    --Generalized seizures spread to entire brain

    Absence (froze completely for a short time) or petit mal seizures

    Tonic/ clonic or grand mal seizures

    • --Partial seizures remain focal and
    • localized
  7. Treatment of Epilepsy

    Vagal nerve stimulation

    Ketogenic diet

  8. Medications




    Others (carbamazepine, felbemate, gabapenin, lamotrigine. levetiracetam, oxcarbazepine, valproic acid, zonisamide)
  9. Vagal Nerve Stimulation
    Spontaneous discharge (periodically)

    Patient-controlled discharge (aura prior to seizure) 

    when med fails
  10. Ketogenic Diet
    Used mostly in children

    • About one third who try it become
    • completely or near-completely seizure free

    • Another third still have seizures,
    • but with many less and with less medical therapy

    • The remainder do not respond, or
    • find it too hard to continue the diet.
  11. Seizure-Risk Factors
    Patients with a history of seizures
  12. Question to ask pt with history of seizure
    Frequency (1x or 2x a week --> high chance of having seizure)

    Last seizure?

    Precipitating factors (stress?)

    • Medications:
    •          last time serum drug levels were checked (could varied) 
    •          Changes in medications since last check (the more change, the high the chance of having seizure)
  13. Inc chance of having seizure with pt who has history of seizure
    • 1x or 2x per week 
    • no change in med 
    • normal drug serum level
  14. Seizure-Precipitating Factors
    Failure to comply with medications (no stopping abruptly, waning. if not, result in status epilepticus) 


    Other emergency conditions

    Flashing lights
  15. Failure to comply with med result in
    status epilepticus
  16. Seizure-Prevention
    Confirm that patient has taken anti-seizure medications on day of procedure

    Limit stress: Sedation, Benzodiazepines, Barbiturates
  17. Seizure-Recognition
    Prodromal phase with personality changes

    Aura, depends on the location of the initiating seizure focus (smell, visual

    Loss of consciousness

    Ictal phase (tonic-clonic phase)

    Post-ictal phase
  18. Seizure - recognition: post ictal phase
    need to control airway

  19. Seizure-Treatment
    Stop dental treatment

    all objects out of mouth

    • Remove dangerous items from around
    • patient

    Gently restrain and protect patient during ictal phase

    • Nothing placed in the patient’s
    • mouth

    Let the seizure run its course
  20. Seizure-Treatment
    • ---Supportive therapy during post-ictal phase
    • Maintain airway
    • Oxygen
    • Monitor vital signs

    ---Consider 911, especially if seizure continues or repeats

    ---Possible valium 5-10 mg IV or midazolam 2-4 mg IV / IM if seizure continues or repeats
  21. Call 911 is a must after the pt has seizure (true or false)
  22. Pt with seizure for the 1st time or haven't had one in a year or change blood serum. Call 911
    (true or false)
  23. When to phone 911: No need for assistance
    -----No need for assistance:

    If a known epileptic patient (medical I.D.)

    If seizure ends in less than 5 minutes

    If normal consciousness returns

    If there is no physical injury

    If not pregnant or diabetic
  24. When to phone 911: An ambulance should be called
    If the seizure happened in water

    If it’s a first time seizure

    • If the person is not known to have
    • epilepsy

    • vIf the person is pregnant, injured
    • or diabetic

    • vIf the seizure lasts more than 5
    • minutes

    • If a second seizure starts shortly
    • after the first

    • If consciousness does not start to
    • return shortly after the ictal
    • phase
Card Set
Emergency: seizure
Emergency: stroke and seizure