A common well-accepted clinical axiom in neurology is "seizures beget seizures." Therefore, seizure prevention, vigorous follow-up, and early therapy are key to success. More important, early treatment is not only more effective, but it also stops progression to status epilepticus. Every time seizures occur, it causes neurological dysfunction despite adequate oxygenation. Thus, it is vital to establish seizure precautions daily.
One factor when considering seizure precautions is knowledge of triggers and precipitating factors. Even though non-compliance with medications is one of the most common causes of breakthrough seizures, all caregivers and healthcare workers should examine these individuals for any underlying metabolic or infectious triggers. In patients with therapeutic drug levels, one should consider fever or any abnormal laboratory parameter as a cause. Substance abuse screening is important in the youth. Imaging studies and electroencephalogram (EEG) are important to establish the risk of seizure recurrence. In almost all cases, the prehospital care of seizure patients is supportive. Most seizures only last a few seconds or minutes, especially the simple febrile seizures in children.
Initial considerations for patients with an ongoing seizure:
- If the individual continues to have seizures in the emergency room, the one should follow the ABCs (airway, breathing, circulation)
- Administer oxygen if the individual is in status epilepticus, is cyanotic or is in respiratory distress. Some individuals may require rapid sequence intubation, but one should only use a short-acting neuromuscular blocker to avoid masking of the seizure activity
- Check finger stick blood glucose and replace if <50 mg/dl
- Obtain a toxicology screen and anti-convulsant drug levels (if appropriate).
- If the patient is intubated and paralyzed, consider EEG monitoring to determine if there is still ongoing seizure activity
- All patients with an active seizure should have two large-bore intravenous lines. Administer intravenous glucose and thiamine promptly. If the patient has signs of an infection, get cultures and consider the use of antibiotics
The key aim of treatment is to control the seizure before any significant neuronal damage occurs, which usually occurs between 20 to 60 minutes. Anoxia and central nervous system (CNS) infections correlate with a high mortality rate in status epilepticus.