Convulsive seizures are usually easily identified.Look for nuchal rigidity, rash, asterixis, or signs of trauma.As discussed previously, empiric thiamine should be given when treating hypoglycemia. Vital signs and blood sugar should be obtained immediately on all patients.Include tonic, clonic, tonic-clonic, atonic, myoclonic, and absence.May begin as a generalized seizure or a focal seizure with secondary generalization.Generalized seizures originate from the bilateral hemispheres and, by definition, consciousness is lost.Frontal seizures are often misdiagnosed as nonepileptic seizures (i.e., pseudoseizures) because of their often complex, sometimes bizarre, semiology and the frequent absence of electrographic seizure activity on standard EEG. The symptoms vary based on whether they involve the temporal (automatisms such as lip smacking or picking at clothes, staring, behavior arrest), frontal (hypermotor behaviors, bicycling, pelvic thrusting, and automatisms), or occipital lobes (unformed images, visual hallucinations). Focal seizure with impairment of consciousness or “dyscognitive” focal seizures (complex partial): Consciousness is impaired.The symptoms can be motor (hand jerking), sensory (focal tingling, visual, auditory), autonomic (sensation of epigastric rising), or psychic (déjà vu). Focal seizure without impairment of consciousness (simple partial): Consciousness is not impaired.Provided are both the current seizure nomenclature (International League against Epilepsy, 2010) and the more classic nomenclature. Focal seizures begin at a single locus in the brain.Distinguishing a prodrome from an aura can be clinically challenging. A prodrome is a sensation or feeling that a seizure will soon occur.An aura is a simple partial seizure manifesting as sensory, autonomic, or psychic symptoms.
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NCSE should be treated promptly to avoid irreversible cerebral injury. NCSE is defined by electrographic seizures with clinically absent or subtle motor activity and impairment or loss of consciousness.Generalized convulsive status epilepticus (GCSE) is a medical emergency. However, in practice, a seizure lasting >5 minutes in adults (>10 minutes in children) should be treated as status epilepticus.
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