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CME PPW 13
HAFFIZ MOHD NOOR
• Sudden temporary change in…
PHYSICAL movement
SENSATION
BEHAVIOUR
… because of abnormal discharged of electrical impu...
PARTIAL
SEIZURE
/
FOCAL
SEIZURE
GENERALIS
ED SEIZURE
(AFFECT / BEGIN IN ONE PART OF THE BRAIN)
SIMPLE COMPLEX
(CONCIOUSNESS REMAIN INTACT)
1. MOTOR
 Jerking
 Muscle Rigidity...
Sudden onset
Duration 5-10 sec / happen 100x daily
Commonly cause by
STRESS
Fatigue
Hypoglycemia
Some known as ‘day...
• Movement Disorder
• Seen when awake / fall asleep
• Cause by touch / visual stimuli
• Symmetrical / Asymmetrical
• Sign ...
• Muscle are maintained in continuous contracted state.
(Rigidity)
• Sign & Symptoms :
Variable LOC
Pupils dilated
Eyes...
• Opposing muscle contract and relax alternately. (Jerking)
• May occur only one limb or more.
• Sign & Symptoms :
• Mucus...
• Violent total body seizure
• Sign & Symptoms :
Usually LOC / Collapse
Tonic phase (30-60 sec)
Clonic phase
Postictal...
• Drop or fall attack
• Loss of posture tone
• FEBRILE FIT
 Convulsion associated with a HIGH GRADE (38C) body
temperature. They most commonly occur in children betwe...
1. Cerebral Vascular Accident (CVA)
2. Central Nervous System (CNS) Infection
3. Head Injury / Trauma
4. Hypoxemia / Anoxi...
ETIOLOGY
Many neurons fire in
a synchronous
pattern, resulting in
a transient
physiologic
disturbance
Physiologic
disturba...
Aimed to determine:
1. Type of seizure
2. Frequency
3. Severity
Aura
LOC
Dyspnea
Fixed and dilated pupil
Incontinence...
• Provide privacy and protect the patient from curios on-
lookers,
• Ease the patient to the floor or the lowest position,...
• Do not attempt to pry open jaws that are clenched in a
spasm to insert anything. Broken teeth and injury to the
lips and...
Rx GOAL : Prevent neuronal injury to the brain ( 20 min – 1hour)
 FIRST LINE THERAPY (Benzodiazephines) : Diazepam (Valiu...
• Diet: Ketogenic (a diet high in fats and proteins, and low in
carbohydrates)
• I.V. therapy: Secure line. Give medicatio...
• BLOOD INVESTIGATION : RBS , ABG
• EEG: abnormal wave patterns, focus of seizure activity
• CT scan: a space occupying le...
• Keep the patient on one side to prevent aspiration. Make
sure the airway is patent
• There is usually a period of confus...
• Take medications at regular basis
• Avoid alcohol. This lowers seizure threshold
• Adequate rest
• Well-balanced diet
• ...
Xie Xie!
APPROACH TO SEIZURE CME
APPROACH TO SEIZURE CME
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APPROACH TO SEIZURE CME

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Sudden temporary change in PHYSICAL movement, SENSATION, BEHAVIOUR because of abnormal discharged of electrical impulses from nerve cells.

CLASSIFICATION
PARTIAL SEIZURE / FOCAL SEIZURE

>> Aimed to determine:
Type of seizure
Frequency
Severity
Aura
LOC
Dyspnea
Fixed and dilated pupil
Incontinence

Factors that precipitate them.
Developmental history taking (events of pregnancy and childbirth)
Questioned about illnesses or head injury

Published in: Health & Medicine
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APPROACH TO SEIZURE CME

  1. 1. CME PPW 13 HAFFIZ MOHD NOOR
  2. 2. • Sudden temporary change in… PHYSICAL movement SENSATION BEHAVIOUR … because of abnormal discharged of electrical impulses from nerve cells. DEFINITI ON
  3. 3. PARTIAL SEIZURE / FOCAL SEIZURE GENERALIS ED SEIZURE
  4. 4. (AFFECT / BEGIN IN ONE PART OF THE BRAIN) SIMPLE COMPLEX (CONCIOUSNESS REMAIN INTACT) 1. MOTOR  Jerking  Muscle Rigidity  Head Turning 2. SENSORY (Unusual sensation affect )  Visual  Hearing  Taste  Touch 3. PSCYCHOLOGY  Emotional  Memory disturbance (IMPAIRMENT OF CONCIOUSNESS)  Begin in one part of brain and spreading to another part of brain.  Postictal Symptoms (Seizure State)  Aura Phase  Motionless / Automatic movement but inappropiate  Excessive emotion – irritate / anger etc  Not remember when episode is over.  Leading to Generalised Seizure
  5. 5. Sudden onset Duration 5-10 sec / happen 100x daily Commonly cause by STRESS Fatigue Hypoglycemia Some known as ‘day dreaming’ Sign & Symptoms LOR but still maintain posture Twitching eyelids / Lips smacking Long starring (most common)
  6. 6. • Movement Disorder • Seen when awake / fall asleep • Cause by touch / visual stimuli • Symmetrical / Asymmetrical • Sign & Symptoms : No LOC Sudden and simple Shoclike involuntary Dropping things (most common) • 90% individuals who have syncope hx.
  7. 7. • Muscle are maintained in continuous contracted state. (Rigidity) • Sign & Symptoms : Variable LOC Pupils dilated Eyes roll up Possible incontinence May foam at mouth
  8. 8. • Opposing muscle contract and relax alternately. (Jerking) • May occur only one limb or more. • Sign & Symptoms : • Mucus production • Muscle Stiffness
  9. 9. • Violent total body seizure • Sign & Symptoms : Usually LOC / Collapse Tonic phase (30-60 sec) Clonic phase Postictal Symptoms - Apneic
  10. 10. • Drop or fall attack • Loss of posture tone
  11. 11. • FEBRILE FIT  Convulsion associated with a HIGH GRADE (38C) body temperature. They most commonly occur in children between the ages of 6 months and 5 years of age • STATUS EPILEPTICUS  Acute prolonged seizure activity. Ictus more than 15-20 min.  Series of generalized seizures that occur without full recovery of consciousness between attacks • EPILEPSY  Group of syndromes characterized by unprovoked, recurring seizures  Ictus more than 30 min.
  12. 12. 1. Cerebral Vascular Accident (CVA) 2. Central Nervous System (CNS) Infection 3. Head Injury / Trauma 4. Hypoxemia / Anoxia 5. Hypertension 6. Metabolic / Toxic Condition 7. Brain Tumour 8. Drugs and Alcohol Withdrawal 9. Fever in childhood ETIOLOG Y
  13. 13. ETIOLOGY Many neurons fire in a synchronous pattern, resulting in a transient physiologic disturbance Physiologic disturbances include abnormal movements, abnormal sensations and change in LOC SEIZURE STATE!
  14. 14. Aimed to determine: 1. Type of seizure 2. Frequency 3. Severity Aura LOC Dyspnea Fixed and dilated pupil Incontinence 4. Factors that precipitate them. 5. Developmental history taking (events of pregnancy and childbirth) 6. Questioned about illnesses or head injury
  15. 15. • Provide privacy and protect the patient from curios on- lookers, • Ease the patient to the floor or the lowest position, if possible. • Protect the head with a pad to prevent injury (from striking a hard surface) • Loosen constrictive clothing • Push aside any furniture that may injure the patient during the seizure.
  16. 16. • Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth and injury to the lips and tongue may result from such an action • No attempt should be made to restrain the patient during the seizure because muscular contractions are strong and restraint can produce injury • If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions
  17. 17. Rx GOAL : Prevent neuronal injury to the brain ( 20 min – 1hour)  FIRST LINE THERAPY (Benzodiazephines) : Diazepam (Valium) / Lorazepam • Function as Anti-convulsants : To prevent the prolonged time in seizure. • Diazepam (Valium) • IV : Adults – 5 – 10 mg/kg , Peads – 0.2 mg/kg • Per Rectal 10 mg (> 5 min) – IV access unsuccessful – 0.5 mg/kg/dose • Lorazepam - IV : 0.1 mg/kg  SECOND LINE THERAPY (Phenobarbital) : Phenytoin (Cerebyx) • Function as Anti-Epileptic • Patient still in aggressive seize after first line therapy. • IV : 20 mg/kg usually use doses 1 gram in ED • Need BP & cardiac monitoring – develop hypotension and cardiac arrythmias  THIRD LINE THERAPY (Sedative) : Propofol / Midazolam • Function more as sedation • Greater sedative effect and more effective in infusion. • Propofol IV 2-5 mg/kg – IVI : 20 – 100 mcg/kg/min • Midazolam IV 0.2 mg/kg – IVI : 0.05 – 2 mg/kg/h
  18. 18. • Diet: Ketogenic (a diet high in fats and proteins, and low in carbohydrates) • I.V. therapy: Secure line. Give medication. • Activity: bed rest • Monitoring: Vital signs, I/O chart • Laboratory studies: glucose, potassium, and anticonvulsant drug levels if applicable. • Special care: seizure precautions- ABC , temperature, blood glucose, spinal care • Anticonvulsants: phenytoin (Dilantin), Valium (Diazepam), Lorazepam (Ativan)
  19. 19. • BLOOD INVESTIGATION : RBS , ABG • EEG: abnormal wave patterns, focus of seizure activity • CT scan: a space occupying lesion • MRI: pathologic changes / tissue lession • Lumbar Puncture: need pt consideration  Persistent fever/AMS/headache
  20. 20. • Keep the patient on one side to prevent aspiration. Make sure the airway is patent • There is usually a period of confusion after a grand mal seizure • A short apneic (sleeping) period may occur during or immediately after a generalized seizure • The patient, on awakening, should be reoriented to the environment • If the patients becomes agitated after a seizure (postictal), use calm persuasion and gentle restraint
  21. 21. • Take medications at regular basis • Avoid alcohol. This lowers seizure threshold • Adequate rest • Well-balanced diet • Avoid driving, operating machines, swimming until seizures are well controlled • Lead an active life • Parents/relative education
  22. 22. Xie Xie!

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