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Generalized seizures in adults

Última revisão: 11 Sep 2025
Última atualização: 14 Mar 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • focal neurologic deficits
  • focal neurologic symptoms (before or after seizure)
  • premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu)
  • temporary hemiparesis
  • temporary aphasia
  • fever, nuchal rigidity, altered mental status
Detalhes completos

Outros fatores diagnósticos

  • neurocutaneous findings of neurologic disease
Detalhes completos

Fatores de risco

  • family history (extended or immediate) of generalized-onset epilepsy
  • previous central nervous system (CNS) infection
  • head trauma
  • CNS lesion
  • stroke
  • prenatal or perinatal brain insult
  • intellectual disability
  • HIV
  • prior seizure events or suspected seizure events
  • history of substance use
  • preterm birth
  • multiple or complicated febrile seizures
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • electroencephalogram (EEG)
  • blood glucose
  • CBC
  • electrolyte panel
  • toxicology screen
  • head CT
Detalhes completos

Investigações a serem consideradas

  • MRI brain
  • lumbar puncture
  • serum creatine kinase (CK)
Detalhes completos

Algoritmo de tratamento

AGUDA

acute repetitive seizures: in the community

acute repetitive seizures: in the hospital

CONTÍNUA

≥2 unprovoked generalized tonic-clonic seizures (GTCSs) without syndromic diagnosis

≥2 unprovoked GTCSs with focal-onset epilepsy

≥2 unprovoked GTCSs with generalized-onset epilepsy

Colaboradores

Autores

Abdulrahman Alwaki, MD

Assistant Professor of Neurology

Emory University School of Medicine

Atlanta

GA

Declarações

AA declares that he has no competing interests.

Daniel Winkel, MD

Assistant Professor of Neurology

Emory University School of Medicine

Atlanta

GA

Declarações

DW receives consulting fees from NextSense, Inc.

Agradecimentos

Dr Abdulrahman Alwaki and Dr Daniel Winkel would like to gratefully acknowledge Dr Vikram R. Rao, Dr John D. Hixson, and Dr Daniel H. Lowenstein, previous contributors to this topic.

Declarações

VRR has served as a paid consultant for NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System. VRR is also an author of several references cited in this topic. JDH has received research funding and consultancy funds from UCB Inc. DHL declares that he has no competing interests.

Revisores

Mauricio F. Villamar, MD, FACNS

Assistant Professor of Neurology and Clinician Educator

The Warren Alpert Medical School of Brown University

Providence

RI

Declarações

MFV declares that he has no competing interests.

Ranmal Samarasinghe, MD, PhD

Assistant Professor

Department of Neurology

David Geffen School of Medicine

UCLA

Los Angeles

CA

Declarações

RS declares that he has no competing interests.

Edward Barry Bromfield, MD

Chief

Division of Epilepsy and Sleep

Department of Neurology

Brigham and Women's Hospital

Associate Professor of Neurology

Harvard Medical School

Boston

MA

Declarações

EBB has received speaking fees from ICR Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He has received consulting fees from ICR Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately we have since been made aware that EBB is deceased.

Roderick Duncan, MD, PhD, FRCP

Honorary Clinical Senior Lecturer

University of Glasgow

Institute of Neurological Sciences

Glasgow

UK

Declarações

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30.Texto completo  Resumo

Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512-21.Texto completo  Resumo

Bernasconi A, Cendes F, Theodore WH, et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: a consensus report from the International League Against Epilepsy Neuroimaging Task Force. Epilepsia. 2019 Jun;60(6):1054-68. Resumo

Guery D, Rheims S. Clinical management of drug resistant epilepsy: a review on current strategies. Neuropsychiatr Dis Treat. 2021;17:2229-42.Texto completo  Resumo

Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Neurology. 2015 Apr 21;84(16):1705-13.Texto completo  Resumo

Campos MSA, Ayres LR, Morelo MRS, et al. Comparative efficacy of antiepileptic drugs for patients with generalized epileptic seizures: systematic review and network meta-analyses. Int J Clin Pharm. 2018 Jun;40(3):589-98. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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  • Folhetos informativos para os pacientes

    Epilepsy: what is it?

    Epilepsy: what are the treatment options?

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    Diagnostic lumbar puncture in adults: animated demonstration

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