neurologic disorders
Seizure Disorders
Key Points
Common causes of seizures include birth injuries, hereditary or congenital neurologic disorders, and metabolic disorders in children < 2 years; idiopathic seizure disorders in children 2 to 14 years; head trauma, alcohol withdrawal, tumors, strokes, and unknown causes (in 50%) in adults; and tumors and strokes in the older people. Loss of consciousness is likely to be caused by seizures if patients have bitten their tongue, are incontinent (eg, urine or feces in clothing), or are confused for a long time after loss of consciousness. Evaluate patients with seizures for signs of possible causes (eg, fever, stiff neck, focal neurologic deficits, neuromuscular irritability and hyperreflexia, papilledema), and test accordingly. Evaluate all patients who have new or unexplained seizures with neuroimaging, EEG, and blood tests. Talk to patients about how to avoid or minimize seizure triggers and how to reduce risk of seizure complications (eg, by not driving and not swimming alone). Antiseizure medications may be required indefinitely, but many types of seizures (eg, most febrile seizures, seizures due to alcohol withdrawal, seizures that do not recur) do not require treatment with antiseizure medications. Consider surgery if therapeutic doses of ≥ 2 antiseizure medications do not control seizures. Consider vagal nerve stimulation or the responsive neurostimulation system if patients have medically intractable seizures and may not be candidates for neurosurgical procedures. 