Seizures: Pathophysiology and Treatment

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Table of Contents

Introduction
Incidence and Prevalence
Pathophysiology
Physical Assessment and Examination
Treatment Plan and Patient Education
Follow-up
References

Introduction

A seizure is defined as an asynchronous electrical activity in the central nervous system (Mayo Clinic, 2019). Thus, it causes changes in motor activity, emotions, and consciousness. When a person has two or more seizures, they are likely to have epilepsy. They are classified into two major groups which include focal and generalized seizures. This is dependent on the area of the brain they affect. The generalized type affects the whole brain while the focal type is limited to a section of the brain. Focal seizures can be further divided into simple and complex types. The difference between these two seizures is the loss of consciousness experienced in complex partial seizures.

Incidence and Prevalence

Epilepsy had a prevalence of 1.2 percent in the United States as of 2015. This included almost five hundred thousand children and three million adults. This prevalence was mainly for active epilepsy denoting individuals who were on medication or had experienced a seizure within the last year. The average incidence of epilepsy is estimated at 48 per 100,000 people (Shafer & Sirven, 2014). These statistics can be used to determine the prevalence of seizures as it is inextricably linked with epilepsy.

Pathophysiology

In the occurrence of a seizure, a number of neurons are activated in a repetitive fashion. It is also unrestricted as inhibition of transmission between the synapses fails. This is the cause of the spike and wave activity seen on electroencephalograms. A partial seizure is usually restricted to a defined part of the cortex of the brain. The electrical activity may be restricted to this region or spread to involve the entire brain, thus leading to a generalized seizure. This phenomenon is termed secondary generalization (Kumar & Clark, 2011). It may spread too quickly, and it may not be manifested symptomatically. In observable cases, it may start with the twitching of a limb.

The localized nature of partial seizures leads to the manifestation of auras before the attack (Kumar & Clark, 2011). It may be tingling in a leg/hand, smell, or strange feelings. The aura emanates from the initial electrical activity that results in the attack. Seizures can be due to various factors: genetic, developmental abnormalities, head injury, pyrexia, intracranial lesions, drug withdrawal, metabolic dysfunction, neurodegenerative disorders, and alcohol withdrawal (Kumar & Clark, 2011).

Physical Assessment and Examination

In most cases, individuals will present in the postictal phase. In case of a generalized convulsion, it will be important to assess the physical condition of the patient. The entire body will be inspected for bruises or other injuries. Seizures are usually sudden in onset and may cause even grievous injuries depending on the environment. This is important, as it eliminates injuries that may be more life-threatening compared to the seizure. In the case of a child, an inspection may help in identifying a developmental abnormality such as microcephaly.

Symptoms such as tremors may be useful, as they may indicate a syndrome when summed up with a seizure. The patient is also inspected for signs of drug use or withdrawal such as miosis. The patient should undergo a head-to-toe examination to check for any other abnormalities. Most individuals are confused in the post-ictal phase and limit the thoroughness of the history that can be obtained. The examination helps in identifying the cause of the seizure such as fever or trauma.

Treatment Plan and Patient Education

The plan involves minimizing further harm that may befall the individual. Some patients present in the hospital with unremitting seizures. Any seizure that lasts more than three minutes or occurs repeatedly is called a status epilepticus. This is a medical emergency that requires immediate intervention. During a seizure especially the prolonged ones, the airway needs to be kept open. Wooden gags, physical restraint, and tongue forceps will cause injury. Status epilepticus should be treated with 10 milligrams of rectal or intravenous diazepam. If it persists, intravenous phenytoin is used at 15 milligrams per kilogram. Phenobarbital is the next drug as 10 milligrams per kilogram is given intravenous in case it fails to resolve. If it persists beyond 90 minutes, coma is induced using propofol (Kumar & Clark, 2011).

The individual is given cardiorespiratory support as coma may be induced in intractable seizures unresponsive to medication. They should be assessed for hypoglycemia and metabolic derangements. They also undergo a drug screen and measurement of blood levels of anticonvulsants. A computed tomography scan may also be carried out to identify the cause. If the cause is identified, it is treated. Epilepsy is a diagnosis of exclusion. If no cause is identified and another unprovoked seizure occurs within six months, the individual is diagnosed as epileptic. They are put on anti-epileptic drugs and advised of a lifestyle change. These include drug abstinence or operating machinery. They are taught to identify their auras; thus, they can lie down in safe spaces limiting their injuries. Drug adherence is stressed as sudden withdrawal can precipitate a severe attack (Kumar & Clark, 2011).

Follow-up

These follow-up visits are made every three months to review the efficacy of the dosage. The serum levels of the drugs can be measured during these visits to ascertain therapeutic levels are attained. If the current dosage is inadequate, it may be raised, switched, or combined with another drug. Withdrawal from medication is considered after one is seizure-free for more than two years. Tapering of the dose is done over six months (Kumar & Clark, 2011).

References

Kumar, P., & Clark, M. (2011). Kumar & Clarks clinical medicine (7th ed.). Edinburgh, Scotland: Saunders Elsevier.

Mayo Clinic. (2019). Seizures.

Shafer, P., & Sirven, J. (2014). Epilepsy statistics.

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