Related Subjects:
|Status Epilepticus (Epilepsy)
|Coma management
|Lorazepam
|Phenytoin
|Levetiracetam
|Epilepsy - General Management
|Epilepsy in Pregnancy
|First Seizure
|Carotid Sinus Syncope
|Brain tumour s
|Astrocytoma
|Brain Metastases
βΉοΈ About
- β‘ A first seizure has an estimated 8β10% lifetime risk of occurrence.
- π Around 3% progress to epilepsy (defined as β₯2 unprovoked seizures >24h apart).
- π¨ Always consider reversible causes (metabolic, structural, toxic, infectious) before diagnosing epilepsy.
𧬠Aetiology
- π§ Prior ischaemic stroke
- π©Έ Intracranial haemorrhage
- π¦ CNS infections (e.g., meningitis, HSV encephalitis)
- π€ Traumatic brain injury
- 𧬠Progressive multifocal leukoencephalopathy (PML)
- ποΈ Brain tumours
- π§© Alzheimerβs disease
- π Autoimmune conditions (e.g., autoimmune encephalitis)
π Drugs That Can Cause Seizures
- Antibiotics: Quinolones, Penicillins, Isoniazid
- Anticholinesterases: Organophosphates, Physostigmine
- Antidepressants: Tricyclics, SSRIs, heterocyclics
- Antihistamines: First-gen and some second-gen agents
- Antipsychotics: Phenothiazines, Butyrophenones, Atypicals
- Chemotherapeutics: Etoposide, Ifosfamide, Cisplatin
- Immunosuppressants: Cyclosporine, Tacrolimus
- Hypoglycaemics: Insulin, sulphonylureas
- Electrolyte disturbance: Hypo-osmolar IV solutions
- Lithium: Toxic levels
- Local Anaesthetics: Bupivacaine, Lidocaine, Procaine
- Methylxanthines: Theophylline, Aminophylline
- Narcotics: Fentanyl, Meperidine, Pentazocine
- Psychoactive drugs: PCP, Cocaine, Amphetamines, Ecstasy (MDMA)
π§Ύ Clinical Considerations
- π Half of βfirst seizuresβ may represent undiagnosed epilepsy with prior minor events.
- πΆ Ask about childhood seizures, febrile convulsions, or developmental issues.
- π· Screen for alcohol or recreational drug use (withdrawal and intoxication common triggers).
- βοΈ Consider catamenial epilepsy (menstrual cycleβrelated seizures).
π Investigations
- π©Έ Bloods: FBC, U&E, LFTs, Glucose, Calcium, Phosphate, ALP, TFTs
- β€οΈ ECG (rule out arrhythmia mimics); consider CXR if aspiration suspected
- π₯οΈ Imaging: CT head (if acutely unwell/obtunded); outpatient MRI preferred
- β‘ EEG: outpatient test to detect epileptiform discharges
π Differential Diagnosis
- π« Syncope (with anoxic jerks mimicking seizure)
- π Psychogenic non-epileptic seizures (PNES)
- β¬οΈ Hypoglycaemia
- β¬οΈ Hypocalcaemia, hyponatraemia
- π« Arrhythmias
π Management
- β
If patient recovers fully in ED: discharge with safety-netting + seizure advice
- π« Advise not to drive until cleared by DVLA guidance and a neurologist
- π‘οΈ Avoid high-risk activities (ladders, swimming alone, operating heavy machinery)
- π¨βπ© Stay with a responsible adult for first 48β72h; call 999 if seizures recur
- π· Advise abstinence/reduction in alcohol
- π
Urgent neurology referral: specialist review within 2 weeks
- Low-risk patients: (normal neuro exam, MRI & EEG) β recurrence risk β 35% in 5 years β usually no treatment
- High-risk patients: (neurological deficits, abnormal MRI or EEG) β recurrence risk β 70% β usually start anti-seizure medication
π UK Practice Tip: DVLA guidance requires at least 6 months off driving after a first seizure (12 months if high recurrence risk), depending on neurologist assessment.
π References