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Semin Neurol 2019; 39(01): 073-081
DOI: 10.1055/s-0038-1677008
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Emergency Management of Epilepsy and Seizures

Anna M. Bank
1   Department of Neurology, Columbia University Medical Center, New York, New York
,
Carl W. Bazil
1   Department of Neurology, Columbia University Medical Center, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2019 (online)

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Abstract

Seizure- and epilepsy-related complications are a common cause of emergency medical evaluation, accounting for 5% of 911 calls and 1% of emergency department visits. Emergency physicians and neurologists must be able to recognize and treat seizure- and epilepsy-related emergencies. This review describes the emergency evaluation and management of new onset seizures, breakthrough seizures in patients with known epilepsy, status epilepticus, acute symptomatic seizures, and acute adverse effects of antiepileptic drugs.

Keywords

new onset seizures - breakthrough seizures - status epilepticus - antiepileptic drug toxicity
 

  • References

  • 1 Johnston C, King WD. Pediatric prehospital care in a southern regional emergency medical service system. South Med J 1988; 81 (12) 1473-1476
    CrossrefPubMedGoogle Scholar
  • 2 Pallin DJ, Goldstein JN, Moussally JS, Pelletier AJ, Green AR, Camargo Jr CA. Seizure visits in US emergency departments: epidemiology and potential disparities in care. Int J Emerg Med 2008; 1 (02) 97-105
    CrossrefPubMedGoogle Scholar
  • 3 Noble AJ, Goldstein LH, Seed P, Glucksman E, Ridsdale L. Characteristics of people with epilepsy who attend emergency departments: prospective study of metropolitan hospital attendees. Epilepsia 2012; 53 (10) 1820-1828
    CrossrefPubMedGoogle Scholar
  • 4 Jacoby A, Buck D, Baker G, McNamee P, Graham-Jones S, Chadwick D. Uptake and costs of care for epilepsy: findings from a U.K. regional study. Epilepsia 1998; 39 (07) 776-786
    CrossrefPubMedGoogle Scholar
  • 5 Michael GE, O'Connor RE. The diagnosis and management of seizures and status epilepticus in the prehospital setting. Emerg Med Clin North Am 2011; 29 (01) 29-39
    CrossrefPubMedGoogle Scholar
  • 6 Glauser T, Shinnar S, Gloss D. , et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr 2016; 16 (01) 48-61
    CrossrefPubMedGoogle Scholar
  • 7 Webb J, Long B, Koyfman A. An emergency-medicine focused review of seizure mimics. J Emerg Med 2017; 52 (05) 645-653
    CrossrefPubMedGoogle Scholar
  • 8 Izumi M, Okabe T, Komura M, Hayashi Y. Convulsive syncope on electroencephalogram. J Gen Fam Med 2018; 19 (03) 109-110
    CrossrefPubMedGoogle Scholar
  • 9 Hartl E, Gonzalez-Victores JA, Rémi J, Schankin CJ, Noachtar S. Visual auras in epilepsy and migraine – an analysis of clinical characteristics. Headache 2017; 57 (06) 908-916
    CrossrefPubMedGoogle Scholar
  • 10 Chen DK, Sharma E, LaFrance Jr WC. Psychogenic non-epileptic seizures. Curr Neurol Neurosci Rep 2017; 17 (09) 71
    CrossrefPubMedGoogle Scholar
  • 11 Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs 2003; 17 (14) 1013-1030
    CrossrefPubMedGoogle Scholar
  • 12 Imad H, Zelano J, Kumlien E. Hypoglycemia and risk of seizures: a retrospective cross-sectional study. Seizure 2015; 25: 147-149
    CrossrefPubMedGoogle Scholar
  • 13 Wang X, Yu H, Cai Z, Wang Z, Ma B, Zhang Y. Nonketotic hyperglycemia-related epileptic seizures. Epilepsy Behav Case Rep 2013; 1: 77-78
    PubMedGoogle Scholar
  • 14 Halawa I, Andersson T, Tomson T. Hyponatremia and risk of seizures: a retrospective cross-sectional study. Epilepsia 2011; 52 (02) 410-413
    PubMedGoogle Scholar
  • 15 Leach JP, Mohanraj R, Borland W. Alcohol and drugs in epilepsy: pathophysiology, presentation, possibilities, and prevention. Epilepsia 2012; 53 (Suppl. 04) 48-57
    CrossrefPubMedGoogle Scholar
  • 16 Hakami T, McIntosh A, Todaro M. , et al. MRI-identified pathology in adults with new-onset seizures. Neurology 2013; 81 (10) 920-927
    CrossrefPubMedGoogle Scholar
  • 17 Sofat P, Teter B, Kavak KS, Gupta R, Li P. Time interval providing highest yield for initial EEG in patients with new onset seizures. Epilepsy Res 2016; 127: 229-232
    CrossrefPubMedGoogle Scholar
  • 18 Fisher RS, Acevedo C, Arzimanoglou A. , et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55 (04) 475-482
    CrossrefPubMedGoogle Scholar
  • 19 Krumholz A, Shinnar S, French J, Gronseth G, Wiebe S. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015; 85 (17) 1526-1527
    CrossrefPubMedGoogle Scholar
  • 20 Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology 1990; 40 (08) 1163-1170
    CrossrefPubMedGoogle Scholar
  • 21 Chen T, Si Y, Chen D. , et al. The value of 24-hour video-EEG in evaluating recurrence risk following a first unprovoked seizure: a prospective study. Seizure 2016; 40: 46-51
    CrossrefPubMedGoogle Scholar
  • 22 Kho LK, Lawn ND, Dunne JW, Linto J. First seizure presentation: do multiple seizures within 24 hours predict recurrence?. Neurology 2006; 67 (06) 1047-1049
    CrossrefPubMedGoogle Scholar
  • 23 Bora I, Seçkin B, Zarifoglu M, Turan F, Sadikoglu S, Ogul E. Risk of recurrence after first unprovoked tonic-clonic seizure in adults. J Neurol 1995; 242 (03) 157-163
    CrossrefPubMedGoogle Scholar
  • 24 Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last?. Ann Neurol 2001; 49 (05) 659-664
    CrossrefPubMedGoogle Scholar
  • 25 Poukas VS, Pollard JR, Anderson CT. Rescue therapies for seizures. Curr Neurol Neurosci Rep 2011; 11 (04) 418-422
    CrossrefPubMedGoogle Scholar
  • 26 Gaínza-Lein M, Benjamin R, Stredny C, McGurl M, Kapur K, Loddenkemper T. Rescue medications in epilepsy patients: a family perspective. Seizure 2017; 52: 188-194
    CrossrefPubMedGoogle Scholar
  • 27 Dreifuss FE, Rosman NP, Cloyd JC. , et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Engl J Med 1998; 338 (26) 1869-1875
    CrossrefPubMedGoogle Scholar
  • 28 Diazepam: Drug information. Available at: Uptodate.com. Accessed July 17, 2018
    PubMed
  • 29 Brophy GM, Bell R, Claassen J. , et al; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23
    CrossrefPubMedGoogle Scholar
  • 30 Midazolam: Drug information. Available at: Uptodate.com . Accessed July 17, 2018
    PubMed
  • 31 Scheepers M, Scheepers B, Clarke M, Comish S, Ibitoye M. Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy?. Seizure 2000; 9 (06) 417-422
    CrossrefPubMedGoogle Scholar
  • 32 McIntyre J, Robertson S, Norris E. , et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366 (9481): 205-210
    CrossrefPubMedGoogle Scholar
  • 33 Allen L, Jones CT. Emergency department use of computed tomography in children with epilepsy and breakthrough seizure activity. J Child Neurol 2007; 22 (09) 1099-1101
    CrossrefPubMedGoogle Scholar
  • 34 Abend NS, Loddenkemper T. Pediatric status epilepticus management. Curr Opin Pediatr 2014; 26 (06) 668-674
    CrossrefPubMedGoogle Scholar
  • 35 Silbergleit R, Durkalski V, Lowenstein D. , et al; NETT Investigators. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366 (07) 591-600
    CrossrefPubMedGoogle Scholar
  • 36 Welch RD, Nicholas K, Durkalski-Mauldin VL. , et al; Neurological Emergencies Treatment Trials (NETT) Network Investigators. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 2015; 56 (02) 254-262
    CrossrefPubMedGoogle Scholar
  • 37 Alldredge BK, Gelb AM, Isaacs SM. , et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001; 345 (09) 631-637
    CrossrefPubMedGoogle Scholar
  • 38 Santamarina E, González-Cuevas M, Toledo M. , et al. Intravenous lacosamide (LCM) in status epilepticus (SE): Weight-adjusted dose and efficacy. Epilepsy Behav 2018; 84: 93-98
    CrossrefPubMedGoogle Scholar
  • 39 Husain AM. Treatment of recurrent electrographic nonconvulsive seizures (TRENdS) study. Epilepsia 2013; 54 (Suppl. 06) 84-88
    PubMedGoogle Scholar
  • 40 Beleza P. Acute symptomatic seizures: a clinically oriented review. Neurologist 2012; 18 (03) 109-119
    CrossrefPubMedGoogle Scholar
  • 41 Won S-Y, Konczalla J, Dubinski D. , et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure 2017; 45: 28-35
    CrossrefPubMedGoogle Scholar
  • 42 Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 1990; 323 (08) 497-502
    CrossrefPubMedGoogle Scholar
  • 43 Radic JAE, Chou SH-Y, Du R, Lee JW. Levetiracetam versus phenytoin: a comparison of efficacy of seizure prophylaxis and adverse event risk following acute or subacute subdural hematoma diagnosis. Neurocrit Care 2014; 21 (02) 228-237
    CrossrefPubMedGoogle Scholar
  • 44 Gilmore E, Choi HA, Hirsch LJ, Claassen J. Seizures and CNS hemorrhage: spontaneous intracerebral and aneurysmal subarachnoid hemorrhage. Neurologist 2010; 16 (03) 165-175
    CrossrefPubMedGoogle Scholar
  • 45 Panczykowski D, Pease M, Zhao Y. , et al. Prophylactic antiepileptics and seizure incidence following subarachnoid hemorrhage: a propensity score-matched analysis. Stroke 2016; 47 (07) 1754-1760
    CrossrefPubMedGoogle Scholar
  • 46 North JB, Penhall RK, Hanieh A, Frewin DB, Taylor WB. Phenytoin and postoperative epilepsy. A double-blind study. J Neurosurg 1983; 58 (05) 672-677
    CrossrefPubMedGoogle Scholar
  • 47 Foy PM, Chadwick DW, Rajgopalan N, Johnson AL, Shaw MDM. Do prophylactic anticonvulsant drugs alter the pattern of seizures after craniotomy?. J Neurol Neurosurg Psychiatry 1992; 55 (09) 753-757
    CrossrefPubMedGoogle Scholar
  • 48 Gilad R, Boaz M, Dabby R, Sadeh M, Lampl Y. Are post intracerebral hemorrhage seizures prevented by anti-epileptic treatment?. Epilepsy Res 2011; 95 (03) 227-231
    CrossrefPubMedGoogle Scholar
  • 49 Lynam LM, Lyons MK, Drazkowski JF. , et al. Frequency of seizures in patients with newly diagnosed brain tumors: a retrospective review. Clin Neurol Neurosurg 2007; 109 (07) 634-638
    CrossrefPubMedGoogle Scholar
  • 50 Englot DJ, Chang EF, Vecht CJ. Epilepsy and brain tumors. Handb Clin Neurol 2016; 134: 267-285
    CrossrefPubMedGoogle Scholar
  • 51 Villanueva V, Saiz-Diaz R, Toledo M. , et al. NEOPLASM study: real-life use of lacosamide in patients with brain tumor-related epilepsy. Epilepsy Behav 2016; 65: 25-32
    CrossrefPubMedGoogle Scholar
  • 52 Iuchi T, Kuwabara K, Matsumoto M, Kawasaki K, Hasegawa Y, Sakaida T. Levetiracetam versus phenytoin for seizure prophylaxis during and early after craniotomy for brain tumours: a phase II prospective, randomised study. J Neurol Neurosurg Psychiatry 2015; 86 (10) 1158-1162
    CrossrefPubMedGoogle Scholar
  • 53 Rossetti AO, Jeckelmann S, Novy J, Roth P, Weller M, Stupp R. Levetiracetam and pregabalin for antiepileptic monotherapy in patients with primary brain tumors. A phase II randomized study. Neuro-oncol 2014; 16 (04) 584-588
    PubMedGoogle Scholar
  • 54 Glantz MJ, Cole BF, Forsyth PA. , et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54 (10) 1886-1893
    CrossrefPubMedGoogle Scholar
  • 55 Abend NS, Beslow LA, Smith SE. , et al. Seizures as a presenting symptom of acute arterial ischemic stroke in childhood. J Pediatr 2011; 159 (03) 479-483
    CrossrefPubMedGoogle Scholar
  • 56 Jauch EC, Saver JL, Adams Jr HP. , et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
    CrossrefPubMedGoogle Scholar
  • 57 Chernyshev OY, Martin-Schild S, Albright KC. , et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology 2010; 74 (17) 1340-1345
    CrossrefPubMedGoogle Scholar
  • 58 De Los Rios F, Kleindorfer DO, Guzik A. , et al; SPOTRIAS Investigators. Intravenous fibrinolysis eligibility: a survey of stroke clinicians' practice patterns and review of the literature. J Stroke Cerebrovasc Dis 2014; 23 (08) 2130-2138
    CrossrefPubMedGoogle Scholar
  • 59 Beghi E, D'Alessandro R, Beretta S. , et al; Epistroke Group. Incidence and predictors of acute symptomatic seizures after stroke. Neurology 2011; 77 (20) 1785-1793
    CrossrefPubMedGoogle Scholar
  • 60 Lamy C, Domigo V, Semah F. , et al; Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 2003; 60 (03) 400-404
    CrossrefPubMedGoogle Scholar
  • 61 Stefanidou M, Das RR, Beiser AS. , et al. Incidence of seizures following initial ischemic stroke in a community-based cohort: The Framingham Heart Study. Seizure 2017; 47: 105-110
    CrossrefPubMedGoogle Scholar
  • 62 Leung T, Leung H, Soo YO, Mok VC, Wong KS. The prognosis of acute symptomatic seizures after ischaemic stroke. J Neurol Neurosurg Psychiatry 2017; 88 (01) 86-94
    CrossrefPubMedGoogle Scholar
  • 63 Sung C-Y, Chu N-S. Epileptic seizures in thrombotic stroke. J Neurol 1990; 237 (03) 166-170
    CrossrefPubMedGoogle Scholar
  • 64 Belcastro V, Costa C, Galletti F. , et al. Levetiracetam in newly diagnosed late-onset post-stroke seizures: a prospective observational study. Epilepsy Res 2008; 82 (2-3): 223-226
    CrossrefPubMedGoogle Scholar
  • 65 Kutlu G, Gomceli YB, Unal Y, Inan LE. Levetiracetam monotherapy for late poststroke seizures in the elderly. Epilepsy Behav 2008; 13 (03) 542-544
    CrossrefPubMedGoogle Scholar
  • 66 Silverman IE, Restrepo L, Mathews GC. Poststroke seizures. Arch Neurol 2002; 59 (02) 195-201
    CrossrefPubMedGoogle Scholar
  • 67 Arboix A, García-Eroles L, Massons JB, Oliveres M, Comes E. Predictive factors of early seizures after acute cerebrovascular disease. Stroke 1997; 28 (08) 1590-1594
    CrossrefPubMedGoogle Scholar
  • 68 Toledano R, Gil-Nagel A. Adverse effects of antiepileptic drugs. Semin Neurol 2008; 28 (03) 317-327
    Article in Thieme ConnectPubMedGoogle Scholar
  • 69 Lamb EJ, Stevens PE, Nashef L. Topiramate increases biochemical risk of nephrolithiasis. Ann Clin Biochem 2004; 41 (Pt 2): 166-169
    CrossrefPubMedGoogle Scholar
  • 70 Shen AL, Lin HL, Tseng YF, Lin HC, Hsu CY, Chou CY. Topiramate may not increase risk of urolithiasis: a nationwide population-based cohort study. Seizure 2015; 29: 86-89
    CrossrefPubMedGoogle Scholar
  • 71 Kubota M, Nishi-Nagase M, Sakakihara Y. , et al. Zonisamide - induced urinary lithiasis in patients with intractable epilepsy. Brain Dev 2000; 22 (04) 230-233
    CrossrefPubMedGoogle Scholar
  • 72 Richards KC, Smith MC, Verma A. Continued use of zonisamide following development of renal calculi. Neurology 2005; 64 (04) 763-764
    CrossrefPubMedGoogle Scholar
  • 73 Garcia-Doval I, LeCleach L, Bocquet H, Otero X-L, Roujeau J-C. Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death?. Arch Dermatol 2000; 136 (03) 323-327
    PubMedGoogle Scholar
  • 74 Frey N, Bodmer M, Bircher A. , et al. The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptic drugs. Epilepsia 2017; 58 (12) 2178-2185
    CrossrefPubMedGoogle Scholar
  • 75 Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology 2005; 64 (07) 1134-1138
    CrossrefPubMedGoogle Scholar
  • 76 Berghuis B, van der Palen J, de Haan G-J, Lindhout D, Koeleman BPC, Sander JW. ; EpiPGX Consortium. Carbamazepine- and oxcarbazepine-induced hyponatremia in people with epilepsy. Epilepsia 2017; 58 (07) 1227-1233
    CrossrefPubMedGoogle Scholar
  • 77 Baddour E, Tewksbury A, Stauner N. Valproic acid-induced hyperammonemia: Incidence, clinical significance, and treatment management. Ment Health Clin 2018; 8 (02) 73-77
    CrossrefPubMedGoogle Scholar
  • 78 Mock CM, Schwetschenau KH. Levocarnitine for valproic-acid-induced hyperammonemic encephalopathy. Am J Health Syst Pharm 2012; 69 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 79 Murphy JV, Marquardt K. Asymptomatic hyperammonemia in patients receiving valproic acid. Arch Neurol 1982; 39 (09) 591-592
    CrossrefPubMedGoogle Scholar
  • 80 Chicharro AV, de Marinis AJ, Kanner AM. The measurement of ammonia blood levels in patients taking valproic acid: looking for problems where they do not exist?. Epilepsy Behav 2007; 11 (03) 361-366
    CrossrefPubMedGoogle Scholar