Description

• Seizure: Sudden change in cortical electrical activity, manifested through motor, sensory, or behavioral changes, and/or an alteration in consciousness
• System(s) affected: Nervous
• Synonym(s): Epilepsy; Convulsion; Attacks; Spells

Geriatric Considerations
Fractures from falls are more common in the osteopenic age range.

Pediatric Considerations
Breastfeeding is not contraindicated. Sedation of the infant should be monitored.

• Monitor serum levels of antiepileptic drugs (AEDs).
• There is a 2-fold increase in congenital malformations in children born to mothers taking certain anticonvulsants. Some expectant mothers can stop taking anticonvulsants safely for the 1st trimester or initial 6-week period (organogenesis). Avoid valproate and lamotrigine. Epileptic patients should notify their neurologist before conception, if possible.
• Recommend against use of category C or D AEDs during pregnancy/nursing. Levetiracetam and topiramate are alternatives for women of childbearing potential (1).

Epidemiology

• 200,000 new cases of epilepsy are diagnosed in the US yearly, with 45,000 new cases in children <15 years of age.
• Pediatric (<2 years) and older adults (>65 years) more commonly present with new-onset seizures.
• Predominant sex: Male = Female

• 2.7 million with seizure disorder
• 4 million people have had ≥1 seizures.
• 326,000 children (≤14 years) and 600,000 adults (>65 years) have a seizure disorder.

Risk Factors

Children delivered breech have a prevalence rate of 3.8% compared with 2.2% in vertex deliveries.

Genetics
Family history increases risk 3-fold.

General Prevention

Take measures to prevent head injuries. Reduce exposure to lead-containing products. Avoid excessive alcohol use/abuse.

Pathophysiology

Synchronous and excessive firing of neurons, resulting in impairment of normal control of CNS

Etiology

True seizures may be triggered by the following metabolic/medical conditions, but seizures occurring due to these conditions do not necessarily define the presence of a seizure disorder (see also “Differential Diagnosis”):

• CNS infection
• Hyperthyroidism
• Hypoglycemia or hyperglycemia
• Hyponatremia
• Uremia
• Porphyria
• Hypoxia
• Confusional migraine
• Transient ischemic attack
• Narcolepsy/Sleep disorder
• Toxins (e.g., lead, picrotoxin, strychnine)
• Brain tumor
• Cerebral hypoxia
• Stroke/Cardiovascular accident (CVA)
• Drug/Alcohol overdose/withdrawal
• Eclampsia
• Head injury
• Heat stroke

Commonly Associated Conditions

Infections, tumors, drug abuse, alcohol and drug withdrawal, trauma, metabolic disorders