CuraRN

Seizures

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

EMS etiologies

Setting: ER

Seizures are caused by abnormal electrical activity in the brain, due to epilepsy, head injury, infection, or metabolic disturbances.

Seizures can be either provoked or unprovoked:

1. Provoked Seizures (acute symptomatic seizures) are triggered by identifiable factors such as:
   • Electrolyte disturbances (e.g., hypoglycemia, hyponatremia)
   • Toxins (e.g., antidepressants, sympathomimetics)
   • Withdrawal from substances (e.g., alcohol, benzodiazepines)
   • Traumatic brain injury
   • CNS infections (e.g., meningitis, encephalitis)
   • Stroke (ischemic or hemorrhagic)
   • Neoplasms
   • Hypoxia
2. Unprovoked Seizures occur without a clear trigger or more than seven days after an acute injury (e.g., stroke). Recurrent unprovoked seizures define epilepsy, which can be due to genetic predisposition or chronic brain pathology.

Epileptic seizures represent one form of paroxysmal event and are due to abnormal excessive neuronal activity in the brain. Seizures can be classified into two main categories: partial (focal) or generalized. Partial seizures originate in one part of the brain and may present with simple motor or sensory symptoms, while generalized seizures affect the entire brain from onset. Status epilepticus is a medical emergency characterized by prolonged seizures (lasting more than five minutes) or repeated seizures without a return to consciousness in between.

Treatment Modalities:

• Antiepileptic medications
• Treat underlying cause
• Surgery (for refractory epilepsy)

• Vagus nerve stimulation

• First-time seizures in adults often do not require immediate long-term treatment unless specific risk factors are present.
• For status epilepticus, immediate treatment with benzodiazepines (e.g., lorazepam, midazolam, diazepam) is essential, followed by second-line treatments like fosphenytoin, valproate, or levetiracetam if the seizures persist.
• Provoked seizures are treated by addressing the underlying cause, such as correcting electrolyte imbalances or discontinuing causative drugs.
• Epilepsy management involves antiepileptic medications based on seizure type and underlying conditions, with options including sodium channel blockers (e.g., carbamazepine), GABA agonists (e.g., benzodiazepines), and newer agents like levetiracetam.

Long-term management may require lifestyle adjustments, regular medication compliance, and monitoring to prevent further seizures.