Epilepsy
https://cks.nice.org.uk/topics/epilepsy/ [NICE guideline ref]
Definition: A seizure is the transient occurrence of signs or symptoms due to abnormal
excessive or synchronous neuronal activity in the brain.
Epilepsy is a disease of the brain defined by any of the following:
At least two unprovoked seizures occurring more than 24 hours apart.
One unprovoked seizure and a probability of further seizures similar to the general
recurrence risk after two unprovoked seizures, occurring over the next 10 years.
Diagnosis of an epilepsy syndrome.
Diagnosis:
Assessment of a person presenting with a first seizure should be asked about:
Any risk factors
Clinical features suggesting other causes of seizures
Information about
o Symptoms at the start of the seizure
o Any possible triggers
o Specific features of the seizure
o Residual symptoms after the attack
Perform a physical exam
o Cardiac, neurological, and mental state
o Oral mucosa to identify lateral tongue bites
o Identify any injuries occurred during seizure
Baseline test
o Bloods, electrolyte
o ECG
Management: https://cks.nice.org.uk/topics/epilepsy/management/
Epileptic seizure
For people having a tonic-clonic seizure lasting more than 5 minutes, or who have
more than three seizures in an hour, in addition to the above measures:
o Treat with one of the following:
o Buccal midazolam as first-line treatment in the community.
o Rectal diazepam if preferred, or if buccal midazolam is not available.
o Intravenous lorazepam if intravenous access is already established and
resuscitation facilities are available.
o Note that midazolam oromucosal solution is not licensed for children under 3
months or adults over 18 years of age (for infants between 3–6 months of
age treatment should be in a hospital setting); and some preparations of
rectal diazepam are not licensed for children under 1 year of age.
For people taking antiepileptic drugs whose seizures are controlled, advise about the
increased risk of osteoporosis when taking long-term carbamazepine, phenytoin,
primidone, phenobarbital, or sodium valproate.
https://cks.nice.org.uk/topics/epilepsy/ [NICE guideline ref]
Definition: A seizure is the transient occurrence of signs or symptoms due to abnormal
excessive or synchronous neuronal activity in the brain.
Epilepsy is a disease of the brain defined by any of the following:
At least two unprovoked seizures occurring more than 24 hours apart.
One unprovoked seizure and a probability of further seizures similar to the general
recurrence risk after two unprovoked seizures, occurring over the next 10 years.
Diagnosis of an epilepsy syndrome.
Diagnosis:
Assessment of a person presenting with a first seizure should be asked about:
Any risk factors
Clinical features suggesting other causes of seizures
Information about
o Symptoms at the start of the seizure
o Any possible triggers
o Specific features of the seizure
o Residual symptoms after the attack
Perform a physical exam
o Cardiac, neurological, and mental state
o Oral mucosa to identify lateral tongue bites
o Identify any injuries occurred during seizure
Baseline test
o Bloods, electrolyte
o ECG
Management: https://cks.nice.org.uk/topics/epilepsy/management/
Epileptic seizure
For people having a tonic-clonic seizure lasting more than 5 minutes, or who have
more than three seizures in an hour, in addition to the above measures:
o Treat with one of the following:
o Buccal midazolam as first-line treatment in the community.
o Rectal diazepam if preferred, or if buccal midazolam is not available.
o Intravenous lorazepam if intravenous access is already established and
resuscitation facilities are available.
o Note that midazolam oromucosal solution is not licensed for children under 3
months or adults over 18 years of age (for infants between 3–6 months of
age treatment should be in a hospital setting); and some preparations of
rectal diazepam are not licensed for children under 1 year of age.
For people taking antiepileptic drugs whose seizures are controlled, advise about the
increased risk of osteoporosis when taking long-term carbamazepine, phenytoin,
primidone, phenobarbital, or sodium valproate.
