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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {| class="infobox" style="float:right;" |
| Image = |
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| Caption = |
| | | [[File:Siren.gif|30px|link=Seizure resident survival guide]]|| <br> || <br> |
| DiseasesDB = 19011 |
| | | [[Seizure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| ICD10 = {{ICD10|G|40||g|40}}, {{ICD10|I|64||i|64}}, {{ICD10|P|90||p|90}}, {{ICD10|R|56||r|56}}|
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| ICD9 = |
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| OMIM = |
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| MedlinePlus = |
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| MeshID = D012640 |
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| }}
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| {{Seizure}} | | {{Seizure}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} {{AE}} {{SHA}} |
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| ==Signs and symptoms==
| | {{SK}} Fits, convulsions |
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| | ==[[Seizure overview|Overview]]== |
| | ==[[Seizure historical perspective|Historical Perspective]]== |
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| | ==[[Seizure classification|Classification]]== |
| | ==[[Seizure pathophysiology|Pathophysiology]]== |
| | ==[[Seizure causes|Causes]]== |
| | ==[[Seizure differential diagnosis|Differentiating Seizure from other Diseases]]== |
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| Symptoms experienced by a person during a seizure depend on where in the brain the disturbance in electrical activity occurs. Recent studies show that seizures happen in sleep more often than was thought. A person having a tonic-clonic seizure may cry out, lose consciousness and fall to the ground, and convulse, often violently. A person having a [[complex partial seizure]] may appear confused or dazed and will not be able to respond to questions or direction. Some people have seizures that are not noticeable to others. Sometimes, the only clue that a person is having an [[absence seizure]] is rapid blinking or a few seconds of staring into space.
| | ==[[Seizure epidemiology and demographics|Epidemiology and Demographics]]== |
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| It is commonly thought among healthcare providers that many seizures, especially in children, are preceded by [[tachycardia]] that frequently persists throughout the seizure. This early increase in heart rate may supplement an aura as a physiological warning sign of an imminent seizure.
| | ==[[Seizure risk factors|Risk Factors]]== |
| | ==[[Seizure screening|Screening]]== |
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| | ==[[Seizure natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ==Diagnosis== | | ==Diagnosis== |
| | [[Seizure history and symptoms|History and Symptoms]] | [[Seizure physical examination|Physical Examination]] | [[Seizure laboratory findings|Laboratory Findings]] | [[Seizure electroencephalogram|Electroencephalogram]] | [[Seizure CT|CT]] | [[Seizure MRI|MRI]] | [[Seizure other imaging findings|Other Imaging Findings]] | [[Seizure other diagnostic studies|Other Diagnostic Studies]] |
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| It can be difficult to distinguish a seizure from other conditions causing a collapse, abnormal movements or other seizure manifestations. A 2007 [[Evidence based medicine|evidence-based]] review from the [[American Academy of Neurology]] and the American Epilepsy Society recommends an [[electroencephalogram]] (EEG, brain wave activity) and brain imaging with [[CT scan]] or [[MRI scan]] in the work-up of adults presenting with a first apparently unprovoked seizure. [[Blood tests]], [[lumbar puncture]] or toxicology screening can be helpful in specific circumstances suggestive of an underlying cause like [[meningitis]] or [[drug overdose]], but there is insufficient evidence to support their routine use in the work-up of an adult with an apparently unprovoked first seizure.<ref name="AAS2007">Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. ''Neurology'' 2007; '''69(21)''': 1996-2007. PMID 18025394</ref>
| | ==Treatment== |
| | [[Seizure medical therapy|Medical Therapy]] | [[Seizure surgery|Surgery]] | [[Seizure primary prevention|Primary Prevention]] | [[Seizure secondary prevention|Secondary Prevention]] | [[Seizure cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Seizure future or investigational therapies|Future or Investigational Therapies]] |
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| ===Determining whether a seizure occurred=== | | ==Case Studies== |
| | [[Seizure case study one|Case #1]] |
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| Differentiating a seizure from other conditions such as [[Fainting|syncope]] can be difficult. In addition, 5% of patients with a positive [[tilt table test]] may have seizure-like activity that seems to be due to [[cerebral hypoxia]].<ref name="pmid12963568">{{cite journal |author=Passman R, Horvath G, Thomas J, ''et al'' |title=Clinical spectrum and prevalence of neurologic events provoked by tilt table testing |journal=Arch. Intern. Med. |volume=163 |issue=16 |pages=1945-8 |year=2003 |pmid=12963568 |doi=10.1001/archinte.163.16.1945}}</ref>
| | ==Related Chapters== |
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| ====Physical examination====
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| A small study found that finding a bite to the side of the tongue was very helpful when present<ref name="pmid7487261">{{cite journal |author=Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F |title=Value of tongue biting in the diagnosis of seizures |journal=Arch. Intern. Med. |volume=155 |issue=21 |pages=2346-9 |year=1995 |pmid=7487261 |doi=}}</ref>"
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| * [[sensitivity (tests)|sensitivity]] of 24%
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| * [[specificity (tests)|specificity]] of 99%
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| ====Serum prolactin level====
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| Two [[meta-analysis|meta-analyses]] have quantified the role of an elevated serum prolactin.
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| The first meta-analysis found that<ref name="pmid14988379">{{cite journal |author=Ahmad S, Beckett MW |title=Value of serum prolactin in the management of syncope |journal=Emergency medicine journal : EMJ |volume=21 |issue=2 |pages=e3 |year=2004 |pmid=14988379 |doi=}}</ref>:
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| "If a serum prolactin concentration is greater than three times the baseline when taken within one hour of syncope, then in the absence of test "modifiers":
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| # the patient is nine times more likely to have suffered a GTCS as compared with a pseudoseizure positive LR = 8.92 (95% CI (1.31 to 60.91)), SN = 0.62 (95% CI (0.40 to 0.83)), SP = 0.89 (95% CI (0.60 to 0.98))
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| # five times more likely to have suffered a GTCS as compared with non-convulsive syncope positive LR 4.60 (95% CI (1.25 to 16.90)), SN = 0.71 (95% CI (0.49 to 0.87)), SP = 0.85 (95% CI (0.55 to 0.98)). "
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| The second meta-analysis found:<ref name="pmid16157897">{{cite journal |author=Chen DK, So YT, Fisher RS |title=Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=65 |issue=5 |pages=668-75 |year=2005 |pmid=16157897 |doi=10.1212/01.wnl.0000178391.96957.d0}}</ref>
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| #"Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic-clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B)."
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| #"Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B).
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| #"The use of serum PRL assay has not been established in the evaluation of status" epilepticus, repetitive seizures, and neonatal seizures (Level U)."
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| The serum prolactin level is less [[sensitivity (tests)|sensitive]] for detecting partial seizures.<ref name="pmid15256189">{{cite journal |author=Shukla G, Bhatia M, Vivekanandhan S, ''et al'' |title=Serum prolactin levels for differentiation of nonepileptic versus true seizures: limited utility |journal=Epilepsy & behavior : E&B |volume=5 |issue=4 |pages=517-21 |year=2004 |pmid=15256189 |doi=10.1016/j.yebeh.2004.03.004}}</ref>
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| ====EEG====
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| An isolated abnormal electrical activity recorded by an [[electroencephalography]] examination without a clinical presentation is called subclinical seizure. They may identify background epileptogenic activity, as well as help identify particular causes of seizures.
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| ===Investigation of underlying cause===
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| Additional diagnostic methods include [[CT Scan]]ning and [[MRI]] imaging or angiography. These may show structural lesions within the brain, but the majority of those with epilepsy show nothing unusual.
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| As seizures have a [[differential diagnosis]], it is common for patients to be simultaneously investigated for cardiac and endocrine causes. Checking [[glucose]] levels, for example, is a mandatory action in the management of seizures as [[hypoglycemia]] may cause seizures, and failure to administer glucose would be harmful to the patient. Other causes typically considered are [[Fainting|syncope]] and [[cardiac arrhythmia]]s, and occasionally [[panic attack]]s and [[cataplexy]]. For more information, see [[non-epileptic seizures]].
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| ==Management==
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| The first aid for a seizure depends on the type of seizure occurring. Generalized seizures will cause the person to fall, which may result in injury. A tonic-clonic seizure results in violent movements that cannot and should not be suppressed. The person should never be restrained, nor should there be any attempt to put something in the mouth. Potentially sharp or dangerous objects should also be moved from the vicinity, so that the individual is not hurt. After the seizure if the person is not fully conscious and alert, they should be placed in the [[recovery position]].
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| It is not necessary to call an ambulance if the person is known to have epilepsy, if the seizure is shorter than five minutes and is typical for them, if it is not immediately followed by another seizure, and if the person is uninjured. Otherwise, or if in any doubt, medical assistance should be sought.
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| A seizure longer than five minutes is a medical emergency. Relatives and other caregivers of those known to have epilepsy often carry medicine such as rectal [[diazepam]] or [[buccal mucosa|buccal]] [[midazolam]] in order to rapidly end the seizure.
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| ===Safety===
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| A sudden fall can lead to broken bones and other injuries. Children who are affected by frequent drop seizures may wear helmets to protect the head during a fall.
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| The unusual behavior resulting from the chaotic brain activity of a seizure can be misinterpreted as an aggressive act. This may invoke a hostile response or police involvement, where there was no intention to cause harm or trouble. During a prolonged seizure, the person is defenseless and may become a victim of theft.
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| A [[seizure response dog]] can be trained to summon help or ensure personal safety when a seizure occurs. These are not suitable for everybody. Rarely, a dog may develop the ability to sense a seizure before it occurs.<ref name=Dalziel_2003>{{cite journal |author=Dalziel D, Uthman B, Mcgorray S, Reep R |title=Seizure-alert dogs: a review and preliminary study |journal=Seizure |volume=12 |issue=2 |pages=115-20 |year=2003 |pmid=12566236}}</ref>
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| ==See also==
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| *[[Epilepsy]] | | *[[Epilepsy]] |
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| *[[EPUNA]] | | *[[EPUNA]] |
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| ==References==
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| {{Reflist|2}}
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| [[es:Convulsión]]
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| [[fr:Convulsion]]
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| [[it:Convulsione]]
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| [[nl:Epileptisch insult]]
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| [[scn:Cummursioni]]
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| [[tr:Havale (tıp)]]
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| {{WikiDoc Help Menu}}
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| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Epilepsy]] | | [[Category:Epilepsy]] |
| [[Category:Signs and symptoms]]
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Mature chapter]]
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| [[Category:Disease]] | | [[Category:Disease]] |
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| | [[es:Convulsión]] |
| | [[fr:Convulsion]] |
