This is a brief presentation for interns and residents in the ED or on duties for the approach and 101 management of first time seizure in adults.

1. APPROACH TO FIRST TIME
SEIZURES IN ADULTS
FOR PHYSICIANS AND RESIDENTS, IT'S IMPORTANT
TO HAVE A COMPREHENSIVE UNDERSTANDING OF
FIRST-TIME SEIZURES AS IT'S A COMMON PART OF
NEUROLOGY PRACTICE. THIS LECTURE WILL
PROVIDE YOU WITH ALL THE ESSENTIAL
INFORMATION YOU NEED TO KNOW ABOUT FIRST
TIME SEIZURES.
ByF1 ‘Hiba antar

2. SEIZURE: DEFINITION &
PATHOPHYSIOLOGY
• A seizure is a sudden, uncontrolled electrical disturbance in the
brain that can cause changes in behavior, movements, feelings,
and levels of consciousness. Seizures can happen to anyone at
any age.
• The exact cause of this disruption is not always clear, but it
can be related to a variety of factors such as genetics, brain
injury, infection, or metabolic imbalances.
• Recurrent unprovocked seizures is defined as Epilepsy.

3. CALCIFICATION OF SEIZURE ACCORDING
TO:
ETIOLOGY 🧠
• Seizures can be classified as provoked or
unprovoked, depending on the underlying cause.
• A provoked seizure is one that is triggered by a
specific cause, such as:
• Head Trauma
• Infection/Inflammation
• Brain tumor
• Stroke
• Metabolic: Electrolyte disturbances,
Uncontrolled BS, Uremia, HE, Porphyria
• Meds, toxins, drugs…
• Unprovoked-seizure is one that has no identifiable
cause.
PATHOPHYSIOLOGY 📊
• During a seizure, a burst of electrical impulses disrupts
normal brain function, causing various symptoms
depending on where in the brain the seizure occurs.,
and are divided into focal & generalized.
• Focal onset seizures begin in a specific area of the
brain, while generalized onset seizures involve both
sides of the brain.
• Focal onset seizures can be further classified as simple
partial seizures or complex partial seizures.
• Simple partial seizures affect a small part of the
brain and do not cause a loss of consciousness.
Symptoms may include jerking movements of
one part of the body, a sensation or smell, or a
change in emotions or thinking.
• Complex partial seizures affect a larger part of
the brain and can cause a loss of consciousness.
Symptoms may include staring, repetitive

7. HISTORY TAKING IN SEIZURE PATIENTS
• When evaluating a patient with a suspected seizure, it's important to take a detailed history
because making an accurate and specific diagnosis is achievable by taking an excellent
history.
What Happened Before,
During, and After the
Episode?
•Any warning symptoms
before the episode (aura,
pre-syncope, fever…)
•Type of movements or
behaviors during the
episode
•Duration
•Presence or absence of
post-ictal confusion or
fatigue
•Any injuries sustained
during the episode
What Were the
Circumstances
Surrounding the Episode?
•Ask about any triggers
that may have
precipitated the episode,
such as:
•Emotional or physical
stress
•Changes in sleep
patterns
•Drug or alcohol use
•Menstruation or
hormonal changes
•Also ask about any
recent illnesses or
changes in medications.
Have There Been Any
Similar Episodes in the
Past?
•Ask if the patient or
witnesses have observed
similar episodes in the
past. If so, ask for details
about the onset,
duration, and
progression of those
episodes.
•Also ask about any prior
history of head injury,
stroke, or other
neurological conditions.
What Is the Patient's
Medical and Psychiatric
History?
•Ask about any medical
conditions the patient
may have, including:
•Heart disease or high
blood pressure
•Diabetes
•Kidney & liver disease
•Thyroid disease
•Neurological disease
history
•Allergies
•Also ask about any
history of psychiatric
illness, including
depression, anxiety, or
other mood disorders.
Are There Any Family
Members with Seizure
Disorders?
•Ask if there is any family
history of seizure
disorders or other
neurological conditions.

8. PHYSICAL EXAM IN PATIENTS
PRESENTING WITH SEIZURES
• When evaluating a patient with a suspected seizure, a thorough physical exam is
essential to help determine the underlying cause and appropriate treatment.
Here are some key elements of the exam:
• General Exam
• Start with a complete physical exam to assess the patient's overall health and identify any
potential underlying causes of the seizure, such as:
• Fever or signs of infection
• Signs of head trauma or skull fracture
• Abnormal vital signs, such as low blood pressure or high heart rate
• Abnormalities in skin or mucous membranes, such as rashes, jaundice, or cyanosis
• Abnormalities in the eyes, such as nystagmus or unequal pupils
• Neck stifness
• Neurological Exam
• A detailed neurological exam is critical in evaluating a patient with a suspected seizure.

9. NEUROLOGICAL EXAM
MENTAL STATUS
• Assess the patient's level of
consciousness and
cognitive function. This can
include:
• Orientation to person,
place, and time
• Attention span and ability
to follow commands
• Memory and recall
• Language and speech
CRANIAL NERVES
• Assess the function of the
cranial nerves, which can
reveal important information
about the location and
severity of the seizure. This
can include:
• Visual acuity and visual
fields
• Pupillary size and reactivity
• Eye movements and
coordination
• Hearing and balance
MOTOR FUNCTION
• Assess muscle strength
and tone, which can reveal
any focal or generalized
weakness or paralysis. This
can include:
• Strength and tone in the
upper and lower
extremities
• Coordination and balance
• Presence of abnormal
movements or posturing
• Reflexes and sensory

11. DIAGNOSTIC TESTS FOR FIRST TIME
SEIZURE
Done by order of priority
Laboratory Tests 🧠
•CBCD, chem9 & FBS
•LFTs & TFTs
•ABGs
•Tests for infectious diseases, such as: Covid, influenza, HSV, EBV, HIV, Malaria, Lyme disease, WNV, HBCV, HCV
Imaging Tests 📷
•Imaging tests, such as MRI and CT scans, can help identify structural abnormalities and brain lesions that may be causing seizures.
•Both tests are painless and usually take less than an hour to complete. However, they may require contrast dye to be injected into the bloodstream, which can cause
side effects in some people.
Some EEG findings in different causes of seizures include:
Electrophysiological Testing 🔌
•Generalized epilepsy: symmetric, high amplitude spike and wave discharges
•Focal epilepsy: unilateral temporal lobe spikes and sharp waves
•Benign rolandic epilepsy: centrotemporal spikes
Diagnostic Procedures 💉
•Lumbar puncture to test cerebrospinal fluid
•Evoked potential studies to measure brain signals
•Neuropsychological testing to evaluate cognitive function

13. IMMEDIATE TREATMENT
OF SEIZURES
• When a patient is actively seizing, the
immediate goal is to stop the seizure
and prevent any potential harm or
injury.
• The approach is based on the "ABCDE"
Here are some key steps in the acute
treatment of seizures:

15. INDICATIONS FOR STARTING LONG-TERM
ANTI-EPILEPTIC DRUG (AED) TREATMENT
• Long-term AED treatment is typically started after a patient has experienced more than one seizure, or if they
are at high risk for recurrent seizures based on factors such as:
• Abnormal EEG results: Abnormal EEG results can indicate that a person is at high risk for seizures.
• Brain imaging results showing structural abnormalities or scarring: Some examples of structural abnormalities that can
increase a person's risk for seizures include:
• Hippocampal sclerosis: This is a condition in which the hippocampus, a part of the brain that is important for memory and learning,
becomes scarred and damaged. This can increase a person's risk for temporal lobe epilepsy, which is a type of epilepsy that can cause
seizures characterized by unusual sensations, emotions, or behaviors.
• Cortical dysplasia: This is a condition in which the outer layer of the brain, called the cortex, does not develop properly. This can increase
a person's risk for focal seizures, can cause symptoms such as muscle twitching or numbness.
• Tuberous sclerosis: This is a genetic disorder that causes noncancerous tumors to grow in various parts of the body, including the brain.
These tumors can increase a person's risk for seizures and other neurological problems.
• Family history of epilepsy or seizures: If a person has a family history of epilepsy or seizures, they may be more likely to
experience seizures themselves.
• Presence of neurological deficits or other underlying medical conditions: Certain medical conditions, such as stroke or
brain tumors, can increase a person's risk for seizures and may require long-term AED treatment.
• It's important to work closely with a healthcare provider to determine the most appropriate timing for starting
long-term AED treatment based on the individual patient's needs and medical history. Factors such as the type
of seizures a person experiences, the frequency of their seizures, and their age and overall health can all play
a role in determining when to start treatment and which AED to use.

16. THE BENEFITS OF MEDITATION
Reduced Stress and Anxiety
Meditation can help reduce stress and anxiety by
promoting relaxation and reducing negative emotions.
Improved Focus &
Concentration
Regular meditation practice can improve cognitive
function, including memory, attention, and
concentration.
Better Sleep
Meditation can also help improve sleep quality and
duration by promoting relaxation and reducing stress.
Increased Self-Awareness
Meditation can help increase self-awareness by
promoting introspection and mindfulness.

19. PROGNOSIS OF FIRST TIME SEIZURE
Most people who experience a first time seizure have
a good prognosis and can return to their normal
activities with proper treatment and follow-up.
People who experience recurrent seizures or have
other neurological disorders may have a poorer
prognosis and require more extensive treatment.

20. CONCLUSION AND SUMMARY
Key Takeaways 💡
A first time seizure requires prompt medical attention and diagnosis to determine the underlying cause and appropriate
treatment.
A detailed history taking and an eyewitness account and diagnostic tests such as EEG, MRI, and blood tests are essen
for diagnosis.
Treatment options include anti-epileptic drugs, yet aren't generally prescribed after a single seizure, except for patients
a high risk of recurrence.
The medication choice varies according to the type of seizure and the patient’s coexisting conditions and childbearing
potential. and lifestyle modifications.
The prognosis is generally good with proper treatment and follow-up.