Acute Seizure Emergencies

Dr. William 0. Tatum, IV

Clinical Associate Professor

Department of neurology

University of South Florida

INTRODUCTION

A. Definitions

i. Acute seizures

ii. Prolonged seizures

iii. Acute repetitive seizures (seizure clusters/flurries)

iv. Status epilepticus

B. Epidemiology-the scope of the problem

C. Classifications of seizure type

i. Partial seizures

a. Simple partial seizures

b. Complex partial seizures

c. Partial-onset secondarily generalized seizures

ii Generalized seizures

a. Tonic-clonic

b. Absense (typical and atypical)

c. Myoclonic

d. Tonic

e. Atonic

D. Classification of Status Epilepticus

a. Convulsive

b. Non-convulsive

II. RISK FACTORS FOR PROLONGED SEIZURES

A. Demographics-who is at risk?

B. Precipitants-what are the causes

III. COMPLICATIONS

A. Mechanism of injury

i Direct injury as a result of seizures

a. contusion

b. laceration

c. burns

d. fracture

e. head injury

    1. death
  1. Indirect injury as a result of seizures
  1. Acute systemic problems
  1. fever
  2. acidosis
  3. arrhythmia
  4. respiratory arrest
    1. Acute neurologic problems
    1. rhabdomyolsis
    2. hyperthermia
    3. cerebral edema

B. Mortality

IV. Emerging Drug Treatments for Prolonged Seizures

A. Home Setting (Seizure Clusters)

i Rectal diazepam gel (diastat)

ii Oral Agents

iii. (?)Intranasas/buccal midazolam (Versed)

A. "The Field" — The Golden Opportunity

i First Line Treatment

a. Intravenous Agents (*The VA Cooperative Study)

i Benzodiazepines (*Lorazepam)

ii Fosphenytoin (Cerebyx)

iii. Phenobarbital (luminal)

iv. ? Valproate (Depacon)

b. Rectal

i Rectal diazepam gel (diastat)

c. Other (Intramuscular, Endotracheal)

B. Hospital Setting

i First Line Treatment Intravenous Agents

ii Agents for Refractory Status Epilepticus

a. Pentobarbital

b. Intravenous Benzodiazepine (Midazolam, Lorazepam)

c. Propofol

V. The Future

A. Neuroprotectants

i. NMDA Antagonists

ii. Non-NMDA Antagonists

B. Others

i Free-radical Scavengers

ii Nitric Oxide Agents

iii. Adenosine

C. Combined Therapies

i GABA agonist + NMDA Antagonist