Seizures: diagnosis and treatment updates

2021-06-18 05:03 PM

It is important to distinguish a seizure from a "false seizure" (eg, hysteria or quadriplegia) in which altered consciousness may be present but not lost.

Involuntary movements of cerebral origin (rigidity followed by asexual movements), accompanied by loss of consciousness, and frequent urinary incontinence (generalized tonic-clonic seizures). It is important to distinguish a seizure from a "false seizure" (eg, hysteria or quadriplegia) in which altered consciousness may be present but not lost.

Priority: stopping seizures and determining the cause.

In pregnant women, obstetric seizures require specific medical and obstetric care.

Initial treatment of seizures

Protect from injury, maintain airway, place patient in "recovery" position, loosen clothing.

Most seizures are rapidly self-limiting. The immediate use of anticonvulsants is not systematic.

If the generalized seizure lasts more than 3 minutes, use diazepam to stop it: diazepam:

Children: 0.5 mg/kg rectally, preferably no more than 10 mg orally. An intravenous route (0.3 mg/kg over 2 or 3 minutes) can be used, only if a means of ventilation is available (Ambu bag and mask).

Adults: 10 mg by slow intravenous injection (or rectally).

Initial treatment in all cases

Dilute 10 mg (2 ml) of diazepam in 8 ml of 5% glucose or 0.9% sodium chloride.

If convulsions continue, repeat the dose once after 5 minutes.

In neonates and elderly patients, monitor respiration and blood pressure.

If convulsions continue after the second dose, treat them as status epilepticus.

The patient no longer has seizures

Find the cause of the seizure and assess the risk of recurrence.

Keep diazepam and glucose on hand in case the patient starts convulsing again.