Seizures and Spells: Seizure Management in the Inpatient Setting-Slides

Slides

Pdf Summary

This document by Dr. T. Scott Diesing offers a comprehensive guide to differentiating epileptic seizures from non-epileptic events, with an emphasis on adult patients and practical hospital-based evaluation. Seizures result from pathological hypersynchrony of neuronal activity and can be classified broadly into convulsive (e.g., generalized tonic-clonic seizures or “grand-mal”) and non-convulsive types. The typical generalized tonic-clonic seizure progresses through four phases: onset/aura, tonic contraction, clonic jerking, and a post-ictal state characterized by confusion and lethargy.<br /><br />Differential diagnoses include psychogenic non-epileptic seizures (PNES), convulsive syncope, transient ischemic attacks (TIAs), transient global amnesia (TGA), and toxic-metabolic encephalopathies. PNES may mimic seizures but are characterized by inconsistent movements, responsiveness to external stimuli, and a lack of EEG seizure activity. Convulsive syncope often presents with brief jerks and is tied to cardiovascular triggers, while TIAs typically cause negative neurological deficits without consciousness loss.<br /><br />Effective initial evaluation includes obtaining eyewitness accounts, immediate patient assessment, and relevant labs (glucose, electrolytes, lactate, CPK) along with imaging as indicated. EEG utility depends on clinical suspicion; routine EEG may be helpful for unprovoked seizures, while urgent EEG is indicated if ongoing seizure or non-convulsive status epilepticus is suspected. MRI is reserved for unprovoked or unclear cases or when structural lesions are suspected.<br /><br />Management involves careful use of abortive (e.g., benzodiazepines) and maintenance antiseizure medications only when seizures are confirmed or recurrent and provoking factors persist. Prolactin measurement is discouraged due to poor specificity. The guide emphasizes detailed history, recognition of seizure phases and mimickers, and targeted diagnostics to distinguish seizures from other spells, enabling appropriate early management while awaiting specialist input.

Keywords

epileptic seizures

non-epileptic events

adult patients

hospital evaluation

generalized tonic-clonic seizures

psychogenic non-epileptic seizures

convulsive syncope

transient ischemic attacks

EEG

antiseizure medications