Group – I

Seizure type and frequency History Examination Laboratory findings EEG findings Imaging studies Consciousness

Partial ( focal, local) seizures

◦ Simple Partial Seizures (consciousness not impaired) motor sensory autonomic psychic symptoms

◦ Complex Partial Seizures (consciousness impaired)

◦ Partial seizures with secondary generalization

Generalized seizures

◦ Tonic – clonic seizures (Grand mal)

◦ Absence seizures (Petit mal)

◦ Tonic seizures◦ Atonic seizures◦ Myoclonic seizures

Unclassified seizures

Neonatal seizures Infantile spasms

HISTORY

History obtained◦ Patient◦ witnesses

Describe events ◦ Before◦ During the seizure◦ After

Family history

Personal history

◦ Birth trauma◦ Head injuries◦ h/o febrile seizures◦ CNS infections◦ Middle ear and sinus

infections◦ Alcohol◦ Drug use◦ Earlier auras or

seizures not recognized

Precipitating events

◦ Sleep deprivation◦ Systemic diseases◦ Electrolyte disturbances◦ Metabolic derangements◦ Acute infections◦ Drugs that lower seizure

threshold Β lactam antibiotics Quinolones INH Acyclovir Theophylline

Airway, breathing, circulation – vital signs Signs of infection or systemic illness Neurocutaneous markers

◦Neurofibromatosis◦Tuberous scleroses◦Liver and kidney disease◦Subcutaneous nodules

Organomegaly◦Storage disorders

Limb asymmetry ◦Brain injury early in development

Auscultation of heart and carotid arteries◦Predisposition to cerebrovascular disease

Signs of injury◦ Head injury◦ Tongue, Lip bite◦ Fractures and soft

tissue injury

The Differential Diagnosis of SeizuresSyncope Vasovagal syncope Cardiac arrhythmia Orthostatic hypotensionPsychological disorders Psychogenic seizure Hyperventilation Panic attackMetabolic disturbances Alcoholic blackouts Delirium tremens Hypoglycemia Hypoxia

Transient ischemic attack (TIA)

Sleep disorders

Migraine

Movement disordersSpecial considerations in children Breath-holding spells Apnea Night terrors Sleepwalking

 

Blood investigations◦Blood sugar◦Acidosis◦Electrolytes◦Serum creatine kinase activity◦Serum prolactin

Increased in Generalized and Complex partial seizures

Not increased in Absence and Myoclonic seizures

◦Rise in ACTH and cortisol Post ictal phase

Screen for toxins ◦Blood◦Urine

Lumbar puncture◦ Indicated

if there is suspicion of meningitis or encephalitis

All HIV infected persons even in the absence of signs and symptoms of infection

◦ In 15% patients after a seizure - WBCS – 10 – 50 /mm3 Slight increase in protein content

Diagnosis of epilepsy Classification of seizures / epilepsy Selection of AEDs Prognosis

PROLONGED RECORDINGS◦Ambulatory EEG recordings◦ Inpatient evaluation with continuous video

and EEG monitoring

INTRACRANIAL MONITORING

MAGNETO – ENCEPHALOGRAPHY

Indications – New onset seizures A fixed focal deficit Failure of seizure control with first

line AEDs Recurrence of seizures after a stable

control of seizures with continued AEDs

Change in seizure pattern Worsening of seizures

Computed Tomography Magnetic Resonance Imaging (FLAIR) Functional Magnetic Resonance

Imaging◦ Positron Emission Tomography◦ Single – Photon Emission Computed

Tomography

It means the state of the patient’s awareness of self and environment and his responsiveness to external stimulation and inner need.

ABCDE approach; Airway Breathing Circulation Disability Exposure

Assess level of consciousness: by GLASGOW COMA SCALESigns of meningeal irritation-• meningitis•SAHFundus•Raised ICP•SAH• Hypertensive encephalopathy

Pupil size and response to light Occular movements Posture and limb movement

Three components .score derived by adding the score for each component.Eye opening (4points) Verbal response (5 points)Best motor response(6 points)