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Emergency: requires immediate attention
Seizure
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Emergency: requires immediate attention

Seizure

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Contributors: Andrea Wasilewski MD, Eric Ingerowski MD, FAAP, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

A seizure is a paroxysmal event due to disturbed electrical function of the cerebral cortex. It is characterized by uncontrolled neuromuscular movements, convulsions, and/or altered sensorium and typically lasts only seconds or minutes.

Epileptic seizures are recurring events due to an epilepsy syndrome or brain / central nervous system injury. Acute symptomatic seizures occur in close temporal relationship to a central nervous system insult and can be seen with head trauma, alcohol withdrawal, infection, stroke, and metabolic derangements. In some women, seizures may be triggered or exacerbated by the menstrual cycle (catamenial epilepsy).

Seizures may be classified as focal (in one cerebral hemisphere) or generalized (both cerebral hemispheres). Some seizures may begin as focal seizures but become generalized. Reflex seizures may be precipitated by sensory stimulus such as flashing or bright lights, music or patterns, or by stress, lack of sleep, fatigue, or fever. Other types of seizures include benign neonatal seizures and febrile seizures. A variety of epilepsy syndromes are linked to genetic mutations and may have onset in childhood, adolescence, or adulthood.

Drug-induced seizures can be caused by medications and recreational drugs. A broad range of pharmacological classes are known to induce seizures including alkylating agents, antimalarials, antimicrobials and antivirals, anesthetics and analgesics, dietary supplements, immunomodulatory drugs, psychotropics such as antidepressants and antipsychotics, and radiographic contrast agents. Drugs used recreationally, like amphetamines, cocaine, fentanyl or heroin, marijuana, methylphenidate, phencyclidine, and synthetic cannabinoids, can provoke seizures, while drug withdrawal is also implicated and is associated with alcohol, barbiturates, and benzodiazepines. (See Drug Reaction Data for more information.)

Psychogenic nonepileptic seizures are sudden episodic disturbances that resemble epileptic seizures but are induced by emotional and stress-related events. Also called pseudoseizures, psychogenic seizures, or nonepileptic events, they fall under the category of somatoform symptom disorders or conversion disorders.

Management of seizures depends on the cause, type, and severity of seizures. Status epilepticus is defined as any seizure lasting more than 5 minutes and is a medical emergency.

Additional related topics:

Codes

ICD10CM:
G40.89 – Other seizures

SNOMEDCT:
128613002 – Seizure disorder

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 10/10/2018
Last Updated: 07/26/2019
Copyright © 2019 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Seizure
Print 1 Images
Seizure : Altered mental state, Drooling, Urinary incontinence, Paresthesias, Myoclonus, Focal neurologic deficit
Copyright © 2019 VisualDx®. All rights reserved.