See Status Epilepticus for emergent treatment of seizure
Overview
Seizure Definition:
- transient occurrence of signs &/or symptoms [semiology] due to abnormal excessive or synchronous neuronal activity in the brain
- Sterotypic for patient!
Seizure Imitators:
- Psychogenic Non-epileptic spells/seizures (PNES)/Functional Neurologic Disorder (FND)/Functional Seizures (FS)
- Convulsive syncope
- Migraine variants
- Some sleep disorders (cataplexy/narcolepsy)
- Movement disorders
- TIAs vs Todd’s Paralysis
- Cardiac arrhythmias
- Vertigo
| Provoked Seizure | Epilepsy |
|---|---|
| •Hypo-/hyper-glycemia •Hypoxia •Ischemia •Metabolic abnormalities •Withdrawal seizures | Unprovoked but can have triggers •Sleep deprivation •Illness (UTI) and certain meds •Medication non-adherence •Stress 60% Focal 40% General 90% temporal lobe foci (sensory aura!) |
| Seizure Types |
- Tonic = tight/stiffening
- Clonic = rhythmic shaking/jerking (usually high frequency, low to moderate amplitude)
- Myoclonic = brief jerking spasm of a muscle or group of muscles
- Nonmotor = staring/behavior arrest or sensory only with/without retained awareness
- Motor = has some movement associated with the semiology
- Bilateral tonic-clonic = both sides of body have stiffening then progresses to rapid rhythmic shaking/jerking
- Focal to bilateral tonic-clonic = starts with a focal seizure (motor on only 1 side or nonmotor coming from one side of cortex) and spread to encompass all of cortex with bilateral stiffening -> jerking
Driving after Seizure in NC
No driving until at least 6 months seizure free on a stable regimen.
- reduction or discontinuing seizure treatment requires the same driving restriction, as it is unknown whether a smaller dose will control seizures as effectively.
- Advise patients that after 6 months without seizures on a stable regimen, if the patient obtains a valid DMV medical reporting form, neurologist can sign this recommendation for return to driving.
- The law requires citizens of the state of NC are supposed to self-report all medical conditions that could affect the ability to drive.
- This form can be obtained at the DMV or on their website (https://www.ncdot.gov/download/dmv/DL78MedicalReportForm.pdf)
- The right to drive is conferred by the approval of the DMV Medical Board, not by any physician office.
- Annual review and resubmission of physician recommendation to the DMV is the obligation of the patient.