diagosis , investigation and mangmant of epileptic seizure and complete protocol of future and long term therapy of seizure and little discription about type of seizure

1. EPILEPTIC SEIZURE

2. 2o years Med student . Girl,
married , Came in Aand E with
history of recurrent generalised
fits for the last 24 hours. What
you will do? Immediate steps.
How will you reach to the
diagnosis? Enumerate long term
treatment in five steps

3. • Management of fits
• ABC AND rt lateral position with diazepam rectaly or 5mg iv or
• Midazolam is given IM 5mg or
• Lorazepam 4mg IV in 2 min Stage 1

4. 2nd stage
• phenotin na , na valproate , levetiracetam
1. Fosphenitoin with cardiac monitor 20mg/kg loading dose then 50
mg /hour infusion
2. Na valproate 40mg/kg iv infusion
3. Levetriacetam 1g or 3g

5. 3rd stage
• Phenobaribitone if not improve
• Midazolam for sedation
• Full paralize on ventilator

6. history
• Previous episode
• Any recreational drug or alchol , tca , amphetamine , cocaine
• Family history of fit(
• Lmp ask for gestational age 20 week of gestation proteinuria htn.
Deliviry done
• Tongue bite , headache , post icteral confusion , aura ,
unconsciousness
• History of fever , headache , vomiting , confusion
Meningoencephalitis

7. INVESTIGATION
• Hypoglycemia or hyperglycemia
• Stroke or subarachnid hemorrhage (very severe headache ) stroke or
accident
• Space occupying lesion

8. Exam investigation
• Cns examination
• Retinal exam
• Sing of meningeal irritation
• Examination
1. ECG AND blood sugar
2. Eclampsia with urine for protein , serum uric acid
3. Cacium, sodium , magnesium , potassium , albumin , cbc , LFT , ABG
4. Ct scan brain without contrast or MRI brain if not epilepsy
5. Drug level if missed dose of drug in epilepsy

9. Now on history added=Pregnant and 22 week
of gestation
• Mgso4 4-6 gm iv stat then 1-2 gm iv infusion for recurrent fits
• As cause respiratory depression so monitor RR
• Also monitor urine output and reflex
• Serum magnesium level 6 hourly or 8 hourly
• Hydralazine IV, labetalol IV , nifedipine 10 mg oral
• Take out the baby

10. • Counselling break bad
• 2 year fit free period
• Sleep deprive eeg and then taper dose for 6 month
• Drive,height,don’t swim, fire place away , electric work away
• If there is fit don’t do anyting pace towel in mouth to prevent tongue
bite
• Long term levetiracetam(250-3gm) and lamotrigine 50 mg then
gradually increase 2 week then 100 mg (50-400) in female
• If not control then one is taper and switch to other
• If not then 2-3 medicine
• Maintain diary

11. diagnosis
• Status epilepticus convulsive/non convulsive
• Tonic clonic (generalize tonic clonic), absent seizure , akinetic ,clonic ,
myoclonic , tonic
• Epilepsia partialis continua is a rare type of brain disorder in which a
patient experiences recurrent motor epileptic seizures that are focal
(hands and face), and recur every few seconds or minutes for
extended periods (days to years). type
• Simple focal petit e mal
• Complex focal
• Partial with secondary generalization

12. Recurrent unprovoked sizure is epilepsy
• Hypoglycemia hyperglycemia uremia hypocalcemia hypomagnesemia
encephalitis , meningitis is provoked type

13. Meeting link
• https://web.microsoftstream.com/video/8c5fedf8-e0c9-4118-8b93-
2aa679db5d12