Presentation
The main outcome measures included cessation of the presenting tonic-clonic convulsion/episode of convulsive status epilepticus; the number of additional drugs required to stop the convulsion; people demonstrating respiratory depression and people requiring [ncbi.nlm.nih.gov]
Approximately 22 other posters about research on perampanel's safety profile and effectiveness were also presented at the meeting. [eisai.mediaroom.com]
This four step guideline is presented in this paper. [adc.bmj.com]
Witnesses present during the episodes often report them as "seizures." The spared consciousness and variability may be evidence against an epileptogenic mechanism. [jamanetwork.com]
They are characterized by non-motor symptoms, although brief twitches may be present. A common symptom of this type of seizure is blank staring that is often mistaken for daydreaming. [dravetsyndromenews.com]
Entire Body System
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Epilepsy
Stakeholder ( Chief Editor Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine Selim R Benbadis, MD is a [medscape.com]
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic uncontrolled epilepsy (Tomson et al., 2008 ). [onlinelibrary.wiley.com]
For some people living with epilepsy, the risk of Sudden Unexpected Death in Epilepsy (SUDEP) is an important concern. [cdc.gov]
What is epilepsy How is epilepsy diagnosed? Types of seizures Seizure Triggers Epilepsy is a disorder of brain function that takes the form of recurring convulsive or non-convulsive seizures. [epilepsyaustralia.net]
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Falling
The muscles will stiffen ( tonic phase), causing him/her to fall to the floor. Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). [epilepsyontario.org]
Generally, seizures fall into the two categories: focal and generalized seizures. The difference between these types is how they begin. [epilepsyqueensland.com.au]
If they are standing they often fall, usually backwards, and may injure the back of their head. Tonic seizures tend to be very brief and happen without warning. [epilepsysociety.org.uk]
TONIC-CLONIC – ( grand mal) convulsive (Most often recognized, but only 10% of those with epilepsy have this type of seizure) Stiffens, may utter cry, loss of consciousness, falls, body jerking 1 – 3 minutes loss of bladder or bowel control or vomiting [epilepsysandiego.org]
They may however vomit or bite their tongue and can sometimes injure themselves if they hit nearby objects as they fall or convulse. [epilepsyaustralia.net]
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Crying
The person will usually emit a short, loud cry as the muscles in the chest contract and the air rushes between the vocal cods, making a sound. This cry does not indicate pain. [epilepsyontario.org]
TONIC-CLONIC – ( grand mal) convulsive (Most often recognized, but only 10% of those with epilepsy have this type of seizure) Stiffens, may utter cry, loss of consciousness, falls, body jerking 1 – 3 minutes loss of bladder or bowel control or vomiting [epilepsysandiego.org]
At the start of the seizure: the person becomes unconscious their body goes stiff and if they are standing up they usually fall backwards. they may cry out they may bite their tongue or cheek. [epilepsysociety.org.uk]
Tonic Clonic seizures (previously called grand mal seizures) During a tonic clonic seizure a person’s body stiffens, air being forced past the vocal cords causes a cry or groan and they fall to the ground (the tonic phase). [epilepsyqueensland.com.au]
He also noted forced laughter-crying episodes associated with this motor phenomenon when the contralateral thalamus was involved. Dana and other authors believed that the abnormal movements observed in pontine lesions were not convulsive in nature. [jamanetwork.com]
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Pain
This cry does not indicate pain. The muscles will stiffen ( tonic phase), causing him/her to fall to the floor. Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). [epilepsyontario.org]
ADVERSE REACTIONS The most common adverse reactions in patients receiving FYCOMPA ( 5% and 1% higher than placebo) include dizziness, somnolence, fatigue, irritability, falls, nausea, weight gain, vertigo, ataxia, headache, vomiting, contusion, abdominal pain [eisai.mediaroom.com]
Intramuscular paraldehyde should be avoided because the injection is painful, and there are risks of damaging the sciatic nerve and causing sterile abscesses. 6 The working party considered whether a second dose of rectal diazepam should be given in preference [adc.bmj.com]
Because of its high pH, extravasation of phenytoin can result in severe subcutaneous irritation (‘purple glove syndrome’) characterized by edema, discolouration and pain distal to the site of administration. [cps.ca]
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Fatigue
After a seizure, the person may feel fatigue, confusion and disorientation, which may last from five minutes to several hours or even days. Rarely, this disorientation may last up to two weeks. [epilepsyontario.org]
SOMNOLENCE AND FATIGUE FYCOMPA caused dose-dependent increases in somnolence and fatigue-related events. [eisai.mediaroom.com]
[Journal Article] Clin Neurol Neurosurg 2019; 183:105392 Eguchi K, Tsuzaka K, … Sasaki H CN A 33-year-old man developed a generalized tonic-clonic seizure after a week of fever and fatigue. [unboundmedicine.com]
The child should return to his or her normal self except for fatigue within around 15 minutes. Often the child may have incontinence (lose urine or stool), and it is normal for the child not to remember the seizure. [emedicinehealth.com]
Respiratoric
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Hypoventilation
To the contrary, hypoventilation can be easily lethal. [onlinelibrary.wiley.com]
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Tachypnea
Clinical correlates of PGES Autonomic dysfunction, manifested by postictal tachycardia and tachypnea, was commonly observed in our patients with GCS. [onlinelibrary.wiley.com]
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Hyperpnea
Respiratory distress, manifested as hyperpnea with coarse breathing sounds, was common and appeared more prominent in patients with PGES. However, postictal central apnea was not observed in any patient. [onlinelibrary.wiley.com]
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Respiratory Distress
Moreover, Seyal et al. ( 2012b ) recently demonstrated that early periictal nursing intervention was associated with reduced duration of respiratory distress and reduced duration of PGES. [onlinelibrary.wiley.com]
Gastrointestinal
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Fecal Incontinence
Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). The child may bite the tongue, which may cause bleeding. The extremities will then jerk and twitch rhythmically ( clonic phase). [epilepsyontario.org]
Cardiovascular
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Tachycardia
Clinical correlates of PGES Autonomic dysfunction, manifested by postictal tachycardia and tachypnea, was commonly observed in our patients with GCS. [onlinelibrary.wiley.com]
Jaw & Teeth
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Mouth Breathing
Saliva that has not bene swallowed during the seizure may froth at the mouth. Breathing may be irregular as the respiratory muscles may be affected. The person will regain consciousness slowly. [epilepsyontario.org]
Urogenital
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Incontinence
Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). The child may bite the tongue, which may cause bleeding. The extremities will then jerk and twitch rhythmically ( clonic phase). [epilepsyontario.org]
Her family observed 3 "severe shaking episodes" with urinary incontinence. Angiography showed proximal basilar artery stenosis. Silverstein 21 analyzed 83 autopsies of patients with pontine infarcts. Eleven (13%) had basilar artery occlusions. [jamanetwork.com]
Often the child may have incontinence (lose urine or stool), and it is normal for the child not to remember the seizure. Sometimes the jerking can cause injury, which may range from a small bite on the tongue to a broken bone. [emedicinehealth.com]
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Urinary Incontinence
Increased pressure on the bladder and bowel may cause wetting (urinary incontinence) or soiling (fecal incontinence). The child may bite the tongue, which may cause bleeding. The extremities will then jerk and twitch rhythmically ( clonic phase). [epilepsyontario.org]
Her family observed 3 "severe shaking episodes" with urinary incontinence. Angiography showed proximal basilar artery stenosis. Silverstein 21 analyzed 83 autopsies of patients with pontine infarcts. Eleven (13%) had basilar artery occlusions. [jamanetwork.com]
Neurologic
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Seizure
Roll the child on his/her side after the seizure subsides. If a seizure lasts longer than five minutes or repeats without full recovery, seek medical assistance immediately. Talk gently to the person after the seizure. [epilepsyontario.org]
Abrupt seizure termination was defined as a sudden, bilateral, and synchronized electroclinical seizure termination, whereas a gradual seizure termination was defined as seizures that terminated slowly with nonconvulsive ictal discharges or seizures that [onlinelibrary.wiley.com]
Seizures also may be classified based on their cause such as, for example, febrile seizures, or seizures caused by high temperature, as well as symptoms they cause, myoclonic seizures, clonic seizures, tonic seizures, tonic-clonic seizures, absence seizures [dravetsyndromenews.com]
These seizures are known as focal aware seizures or focal impaired awareness seizures. [epilepsysociety.org.uk]
This types of seizure can be mistaken for drug/alcohol affected behavior or psychiatric disturbance. Focal dyscognitive seizures were previously known as complex partial seizures. At times focal seizures can evolve to become generalized seizures. [epilepsyqueensland.com.au]
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Confusion
After a seizure, the person may feel fatigue, confusion and disorientation, which may last from five minutes to several hours or even days. Rarely, this disorientation may last up to two weeks. [epilepsyontario.org]
3 minutes loss of bladder or bowel control or vomiting possible breathing – during tonic phase, breathing may decrease or cease – causing cyanosis (bluing) of lips, face, nail beds – returns during clonic phase though may be irregular after seizure confusion [epilepsysandiego.org]
After the seizure, the person may be confused for a while, sometimes called ‘post-ictal’ (after-seizure) confusion. It may be hard to tell when the seizure has ended. The person might be tired, and want to rest. [epilepsysociety.org.uk]
Unfortunately, a great deal of misunderstanding and confusion about seizures still exists, so it is important that your child's friends and teachers become educated about her condition. [healthychildren.org]
The person may often appear confused and dazed and may do strange and repetitive actions like fiddling with their clothes, making chewing movements or uttering unusual sounds. [epilepsyqueensland.com.au]
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Generalized Tonic-Clonic Seizure
Of the 151 GTCS, 2 (1.3%) were generalized tonic seizures, 28 (18.5%) were generalized clonic seizures, and 121 (80.1%) were generalized tonic clonic seizures (GTCS). [onlinelibrary.wiley.com]
[Journal Article] Clin Neurol Neurosurg 2019; 183:105392 Eguchi K, Tsuzaka K, … Sasaki H CN A 33-year-old man developed a generalized tonic-clonic seizure after a week of fever and fatigue. [unboundmedicine.com]
CONVULSIVE SEIZURE Generalized tonic-clonic seizures are typically bilateral and symmetric although variants with asymmetry including head and eye deviation can be seen. [epilepsydiagnosis.org]
• Specific provocation and rapid reorientation helps to distinguish syncope from generalized tonic clonic seizures. [medlink.com]
Generalized seizures account for approximately 40 percent of all epilepsy, with primary generalized tonic-clonic seizures being one of the most common and severe forms of generalized seizures. [eisai.mediaroom.com]
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Headache
S/he may have a headache once s/he regains consciousness. There is no evidence that tonic-clonic seizures cause brain damage. First Aid Expand First Aid Section Keep calm. Protect the child from further injury. Do not restrain the person. [epilepsyontario.org]
They may have a headache and want to sleep. This drowsiness can last for a numbers of hours. Although this type of seizure can be frightening to watch, the seizure itself is unlikely to seriously harm the person having the seizure. [epilepsyqueensland.com.au]
They may feel tired or confused after the event and have a headache. Tonic seizures are very rare in Dravet syndrome. Tonic-clonic seizures Tonic-clonic seizures usually are generalized onset, but also can be focal onset. [dravetsyndromenews.com]
In all perampanel-treated subgroups, the most common TEAE was dizziness, and there were no notable differences in the types of TEAEs across subgroups, including somnolence and headache. [eisai.mediaroom.com]
[…] affected and become difficult or sound noisy their skin may change colour and become very pale or bluish they may wet themselves After the seizure (once the jerking stops): their breathing and colour return to normal they may feel tired, confused, have a headache [epilepsysociety.org.uk]
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Focal Seizure
Focal seizures where the person retains full awareness of the event were previously called simple partial seizures. Focal seizures can also affect a person’s level of consciousness. In some focal seizures the person is in a dyscognitive state. [epilepsyqueensland.com.au]
Focal seizures can start in one area of the brain, and spread to involve both sides of the brain. In some instances a focal seizure can progress to a convulsive seizure. [healthychildren.org]
Some focal seizures involve movements, called motor symptoms and some involve unusual feelings or sensations called, non-motor symptoms. [epilepsysociety.org.uk]
Workup
Children experiencing this type of seizure may not require an extensive workup. The same may apply to children with a known seizure disorder who are already on anticonvulsant therapy. [cps.ca]
EEG
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EEG Slowing
PGES in a patient after a secondarily GCS (calibration bar: 1.0 s, 50 μV). ( A ) Abrupt seizure termination (as indicated by arrow) and followed by PGES. ( B ) Continued PGES subsequently evolved to postictal EEG slowing (as indicated by arrow). [onlinelibrary.wiley.com]
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EEG Suppression
Poh et al. recently demonstrated that autonomic changes with seizures also appear to correlate with postictal EEG suppression. [onlinelibrary.wiley.com]
Serum
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Hypercapnia
Comparing to clonic phase, tonic phase may cause more pronounced ictal apnea, leading to more pronounced postictal hypoxemia and hypercapnia. [onlinelibrary.wiley.com]
Treatment
First-line treatment First-line treatment usually begins outside the hospital. It has been shown that prehospital treatment of children reduces seizure length but often is not utilized [11]. [cps.ca]
Treatment for non-convulsive status epilepticus is less urgent than for convulsive status epilepticus. [nice.org.uk]
"Experiencing freedom from seizures, especially convulsive seizures, is a key objective in the treatment of epilepsy, and there is growing interest among doctors in the safety and efficacy of monotherapy AED treatment options like perampanel," said Lynn [eisai.mediaroom.com]
Emergency medical services (paramedics) also carry medicine so they can start treatment as soon as they arrive. [epilepsy.org.uk]
There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. [healthychildren.org]
Prognosis
What Is the Prognosis for Seizures in Children? The prognosis for children with seizures depends on the type of seizures. Most children do well, are able to attend regular school, and have no limitations. [emedicinehealth.com]
Etiology
An investigator must consider whether to include patients with a narrow spectrum of seizure etiologies (e.g. febrile seizures) as opposed to including ‘all-comers’. Additionally, efficacy and adverse event outcomes are not well standardized. [academiccommons.columbia.edu]
(17.8) Temporal 73 (67) 42 (65.6) 31 (68.9) Frontal 9 (8.3) 5 (7.8) 4 (8.9) Parietal 3 (2.8) 2 (3.1) 1 (2.2) Occipital 1 (0.9) 0 1 (2.2) Idiopathic: patients with generalized epilepsy; cryptogenic: patients with partial‐onset epilepsy and uncertain etiologies [onlinelibrary.wiley.com]
Common etiologies are listed in Table 1 [3]. Mortality has been reported to be between 2.7% and 8%, with an overall morbidity (mainly newly diagnosed neurological disorders) of between 10% and 20% [2]. [cps.ca]
If signs or symptoms are present, immediately evaluate the patient and discontinue FYCOMPA if an alternative etiology for signs or symptoms cannot be established. [eisai.mediaroom.com]
Epidemiology
Descriptive epidemiology of epilepsy: Contributions of population-based studies from Rochester, Minnesota. Mayo Clinic Proceedings, 71(6). 576-586. [epilepsyaustralia.net]
Data from epidemiological studies suggest that four to eight children per 1000 may be expected to experience an episode of CSE before the age of 15 years, 8 and in children with first seizures, 12% present with CSE as their first unprovoked seizure. 9 [adc.bmj.com]
Key Words: Convulsions; Emergency management; Paediatrics; Seizures; Status epilepticus Background and epidemiology The conventional definition of convulsive status epilepticus (CSE) is continuous generalized tonic-clonic seizure activity with loss of [cps.ca]
Pathophysiology
The pathophysiological mechanisms remain uncertain. Further functional studies are necessary to clarify the nature of this phenomenon. Accepted for publication July 5, 2000. We thank Jose A. Bueri, MD, for his kind collaboration. [jamanetwork.com]
Prevention
Hospital for Sick Children Health A-Z Search a complete list of child health articles expand_more View All Drug A-Z Search a list of articles about medications expand_more View All Learning Hubs Browse a complete list of content groups Healthy Living & Prevention [aboutkidshealth.ca]
How to Prevent Seizures in Children Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control, such as head trauma and infections during pregnancy. [emedicinehealth.com]
Accordingly, simple measures, such as stimulating the patient or placing the patient in a ventilatory recovery position after a convulsive seizure, or advising against the prone sleep position, may prevent SUDEP. [onlinelibrary.wiley.com]
Termination of the seizure and prevention of recurrence Principles of treatment and monitoring The major goal of treatment is to stop the seizure and, in doing so, prevent brain injury. [cps.ca]
Simple preventative measures can be taken to decrease seizures triggered this way such as wearing wrap-around sunglasses to reduce glare and covering one eye to reduce the effects of flickering or flashing light. [epilepsyaustralia.net]