62 SEIZURE General Discussion Seizures may be classified as localized (partial or focal) or generalized based upon clinical and electroencephalographic changes. A generalized seizure involves the cerebral hemispheres bilaterally and symmetrically at the time of onset. In contrast, a partial seizure originates in a specific region of the cerebral cortex. These seizures may be associated with signs or symptoms related to the cerebral region of origin, and they may occur with or without mental status changes or loss of consciousness. Seizures have a bimodal frequency, declining in frequency from childhood until the age of 60 years, then increasing again. In adults less than 60 years of age, anticonvulsant discontinuation/withdrawal and low antiepileptic drug levels are the most common cause of seizures. Alcohol-related seizures account for most seizures between the ages of 30 and 60 years and are the second most common cause of seizures overall in adults. Other common causes of seizures are drug overdose, metabolic disorders, CNS infections, and trauma. Hypoglycemia and hyponatremia are the most common metabolic disorders. The first step in the evaluation of a seizure is to determine if the event is truly a seizure. The physician should attempt to obtain a moment-by-moment description of the event from a witness. When unable to obtain a reliable history, the examining physician should assume that the seizure is a first-time event and proceed with a new-onset seizure work-up. Special consideration should be given to the possibility of toxic exposure or underlying complicating medical conditions such as alcoholism, diabetes, and renal failure. The second step is to identify possible acute precipitants for seizures. Seizures may be the manifestation of an underlying medical illness requiring specific treatment. Medications Associated with Seizure Amantadine Bupropion Carbamazepine Citalopram Cyclic antidepressants Diphenhydramine Disopyramide Fluoride Hydroxychloroquine Iron Isoniazid Lidocaine Lithium Meperidine Olanzapine Phenytoin Procainamide Propoxyphene Quinidine Quinine Salicylates Selective serotonin reuptake inhibitors Theophylline Thioridazine Tramadol Venlafaxine Causes of Seizure Boric acid ingestion Brain tumor • Brain metastases • CNS lymphoma • Malignant glioma • Meningiomas Caffeine Camphor Carbamates Carbon monoxide exposure Cerebrovascular accident or transient ischemic attack CNS infection • Abscess • AIDS dementia • Bacterial meningitis • Cryptococcal meningitis • Cysticercosis • Encephalitis, especially herpes • Tuberculous meningitis Cyanide Degenerative disorders • Alzheimer’s dementia • Amyloid angiopathy Dialysis disequilibrium Dialysis encephalopathy Drugs of abuse • Amphetamines • Cocaine • Gamma-hydroxybutyric acid • N-methyl-D-aspartate (NMDA) • Nicotine • Phencyclidine Elapid envenomation Encephalopathy Ephedra Granulomatous angiitis of the CNS Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: HAIR LOSS HYPOTHYROIDISM SYNCOPE THROMBOCYTOPENIA Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on SEIZURE Full access? Get Clinical Tree
62 SEIZURE General Discussion Seizures may be classified as localized (partial or focal) or generalized based upon clinical and electroencephalographic changes. A generalized seizure involves the cerebral hemispheres bilaterally and symmetrically at the time of onset. In contrast, a partial seizure originates in a specific region of the cerebral cortex. These seizures may be associated with signs or symptoms related to the cerebral region of origin, and they may occur with or without mental status changes or loss of consciousness. Seizures have a bimodal frequency, declining in frequency from childhood until the age of 60 years, then increasing again. In adults less than 60 years of age, anticonvulsant discontinuation/withdrawal and low antiepileptic drug levels are the most common cause of seizures. Alcohol-related seizures account for most seizures between the ages of 30 and 60 years and are the second most common cause of seizures overall in adults. Other common causes of seizures are drug overdose, metabolic disorders, CNS infections, and trauma. Hypoglycemia and hyponatremia are the most common metabolic disorders. The first step in the evaluation of a seizure is to determine if the event is truly a seizure. The physician should attempt to obtain a moment-by-moment description of the event from a witness. When unable to obtain a reliable history, the examining physician should assume that the seizure is a first-time event and proceed with a new-onset seizure work-up. Special consideration should be given to the possibility of toxic exposure or underlying complicating medical conditions such as alcoholism, diabetes, and renal failure. The second step is to identify possible acute precipitants for seizures. Seizures may be the manifestation of an underlying medical illness requiring specific treatment. Medications Associated with Seizure Amantadine Bupropion Carbamazepine Citalopram Cyclic antidepressants Diphenhydramine Disopyramide Fluoride Hydroxychloroquine Iron Isoniazid Lidocaine Lithium Meperidine Olanzapine Phenytoin Procainamide Propoxyphene Quinidine Quinine Salicylates Selective serotonin reuptake inhibitors Theophylline Thioridazine Tramadol Venlafaxine Causes of Seizure Boric acid ingestion Brain tumor • Brain metastases • CNS lymphoma • Malignant glioma • Meningiomas Caffeine Camphor Carbamates Carbon monoxide exposure Cerebrovascular accident or transient ischemic attack CNS infection • Abscess • AIDS dementia • Bacterial meningitis • Cryptococcal meningitis • Cysticercosis • Encephalitis, especially herpes • Tuberculous meningitis Cyanide Degenerative disorders • Alzheimer’s dementia • Amyloid angiopathy Dialysis disequilibrium Dialysis encephalopathy Drugs of abuse • Amphetamines • Cocaine • Gamma-hydroxybutyric acid • N-methyl-D-aspartate (NMDA) • Nicotine • Phencyclidine Elapid envenomation Encephalopathy Ephedra Granulomatous angiitis of the CNS Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: HAIR LOSS HYPOTHYROIDISM SYNCOPE THROMBOCYTOPENIA Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on SEIZURE Full access? Get Clinical Tree
