YouTube What to do if someone is having a seizure. Available at: https://www.youtube.com/watch?v=fvlzKoP10iQ&t=1s .

Definition

Seizure disorders refer to conditions characterised by transient episodes of abnormal electrical activity in the brain, leading to motor, sensory, autonomic, or cognitive disturbances. Epilepsy is diagnosed when there is a predisposition to recurrent unprovoked seizures.

Aetiology

Idiopathic: genetic predisposition with no identifiable structural cause.
Structural: stroke, traumatic brain injury, brain tumours.
Metabolic: hypoglycaemia, electrolyte imbalances, uraemia.
Infectious: meningitis, encephalitis, neurocysticercosis.
Toxic: alcohol withdrawal, drug intoxication (e.g., cocaine, amphetamines).

Pathophysiology

Excessive neuronal excitation or reduced inhibition leads to hyper synchronous electrical activity.
Generalised seizures arise from both hemispheres, while focal seizures originate in a specific cortical region.
Prolonged seizures can lead to neuronal damage and excitotoxicity.

Risk Factors

Family history of epilepsy.
History of traumatic brain injury.
Neurodevelopmental disorders (e.g., cerebral palsy).
Febrile seizures in childhood.
Previous stroke or brain infection.

Signs and Symptoms

Generalised tonic-clonic seizures: loss of consciousness, stiffening (tonic) followed by rhythmic jerking (clonic) movements.
Absence seizures: brief episodes of staring and unresponsiveness.
Focal seizures: may involve motor (jerking), sensory (tingling), or autonomic (sweating, flushing) symptoms.
Aura: premonitory symptoms such as visual disturbances, déjà vu, or abnormal sensations.
Postictal confusion: transient disorientation or drowsiness following a seizure.

Investigations

EEG (electroencephalogram): identifies abnormal electrical activity and seizure type.
Brain MRI: detects structural abnormalities (tumours, stroke, mesial temporal sclerosis).
Metabolic panel: evaluates for hypoglycaemia, electrolyte disturbances.
LP (lumbar puncture): if infection is suspected.
Toxicology screen: assesses for drug induced seizures.

Management

1. Acute Seizure Management:

First aid: place the patient in the recovery position, do not restrain movements.
Benzodiazepines: lorazepam or diazepam for prolonged seizures (>5 minutes).
ABC approach: assess airway, breathing, and circulation.

2. Long-Term Management:

Anti-epileptic drugs (AEDs): carbamazepine, valproate, levetiracetam based on seizure type.
Ketogenic diet: adjunct for refractory epilepsy.
Surgical options: resective surgery for drug resistant focal epilepsy.

3. Lifestyle and Safety Advice:

Avoid sleep deprivation and alcohol.
Driving restrictions according to DVLA guidelines.
Seizure precautions (e.g., showering instead of bathing).

4. Referral:

Neurology: all new onset seizures require specialist assessment.
Epilepsy nurse: for education and lifestyle counselling.
Neurosurgery: if surgical intervention is considered.