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
Outros fatores diagnósticos
- neurocutaneous findings of neurologic disease
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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- electroencephalogram (EEG)
- blood glucose
- CBC
- electrolyte panel
- toxicology screen
- head CT
Investigações a serem consideradas
- MRI brain
- lumbar puncture
- serum creatine kinase (CK)
Algoritmo de tratamento
acute repetitive seizures: in the community
acute repetitive seizures: in the hospital
≥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
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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