Michael A. Nigro
Neuroimaqinq in lpilepsy
Newer.Äntiepil.eRtic.Druqs, (AEDs) Gabapentin
Additional .Advancesin Epilepsy ..Treatment that ..Warrant.. Consideration The... First Seizure Febrile Seizure lyaluation
Neonatal. Seizures Evaluation
Infantile. Spasms Treatment
Head. .Trauma ..and..S.e.izures Breakthrouqh..Seizures.. in ..Known.. Epileptics Lowered..Anticonyulsant. .Bloo.d.Leyels
Complicatinq Factors .of. Epilepsy. .Management
StatMs..Ipilepticus Effects.. ofStatus ..Grand. .Mal
Differential Diagnosis of Seizures Problems of Anticonvulsant Use
Errors in EmerqencyMana.qe.me.nt. ofSeizures Chapter References
Approximately 2 percent of the United States population have some form of epilepsy. Many more experience seizures in association with febrile illnesses or other acute problems. In children aged 0 to 9 years, the prevalence is 4.4 cases per 1000, and in those 10 to 19 years, the prevalence is 6.6 cases per 1000. Simple febrile convulsions constitute a separate category, with an incidence of 3 to 4 percent in children.
These numbers alone do not reveal the most important features of the seizure phenomenon—the increased morbidity and mortality rates that are a direct result of seizures, their cause, or their treatment. Epidemiologic studies indicate an overall mortality rate two to three times higher in epileptic patients than in nonepileptics. The earlier the onset of seizures and the more deprived the social environment, the higher the morbidity and mortality rates.
Typically, a patient with seizures arrives at the emergency department with one of the following:
1. The initial or a recurrent seizure
2. Status epilepticus
3. Complications of medication
4. A history of seizures with an acute, underlying disease—e.g., sickle cell anemia, metabolic disease, or febrile illness—that needs treatment
Emergency care should include (1) safely stopping the seizure, (2) identifying and correcting immediately treatable or reversible causes, and (3) initiating appropriate diagnostic studies and arranging follow-up. If management is difficult, the patient should be admitted. There are significant enough differences in the treatment of children that unless the physician is experienced in pediatric management or able to readily obtain pediatric consultation, the child should be transferred to a pediatric facility. Treatment and diagnostic studies may be complex, and time is important in reducing morbidity.
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