Neurology
Seizures
Neurology

Seizures

Focal aware, absence, GTC, status epilepticus.

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◆Classification

  • •Focal aware (simple partial): consciousness preserved + stereotyped + anatomic spread (Jacksonian march)
  • •Focal impaired awareness: consciousness affected
  • •Generalized tonic-clonic: bilateral + AMS + postictal
  • •Absence (childhood): brief staring + no postictal + 3-Hz spike-and-wave EEG → ethosuximide
  • •Avoid carbamazepine + phenytoin in absence (can worsen)

◆Status epilepticus

  • •Seizure ≥5 min OR repeated without recovery
  • •Step 1: ABCs, glucose, IV access
  • •Step 2: lorazepam IV (or midazolam IM)
  • •Step 3: levetiracetam, fosphenytoin, or valproate IV
  • •Step 4: intubate + propofol/midazolam infusion

◆Brain death

  • •Irreversible cessation of all brain/brainstem function
  • •Clinical: GCS 3, absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough)
  • •Exclude confounders (hypothermia, drugs, metabolic)
  • •Apnea test: PaCO₂ rises ≥20 mm Hg without respiratory effort
  • •Brain death = legal death
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