Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- deficits neurológicos focais
- sintomas neurológicos focais (antes ou depois da convulsão)
- sensação ou experiência premonitória (medo, sensação epigástrica, déjà vu, jamais vu)
- hemiparesia temporária
- afasia temporária
- febre, rigidez da nuca, estado mental alterado
Other diagnostic factors
- achados neurocutâneos de doença neurológica
Risk factors
- história familiar (estendida ou imediata) de epilepsia de início generalizado
- Infecção prévia do sistema nervoso central (SNC)
- trauma cranioencefálico
- Lesões no SNC
- acidente vascular cerebral (AVC)
- insulto cerebral pré-natal ou perinatal
- deficiência intelectual
- vírus da imunodeficiência humana (HIV)
- eventos convulsivos prévios ou suspeita de eventos convulsivos
- História de abuso de substâncias
- nascimento pré-termo
- convulsões febris múltiplas ou complicadas
Diagnostic investigations
1st investigations to order
- eletroencefalograma (EEG)
- glicose sanguínea
- Hemograma completo
- painel de eletrólitos
- análise toxicológica
- tomografia computadorizada (TC) de crânio
Investigations to consider
- ressonância nuclear magnética (RNM) cranioencefálica
- punção lombar
- creatina quinase (CK) sérica
Treatment algorithm
convulsões agudas repetitivas: na comunidade
convulsões agudas repetitivas: no hospital
≥2 crises tônico-clônicas generalizadas (CTCGs) não provocadas sem diagnóstico de síndrome
≥2 crises tônico-clônicas generalizadas (CTCGs) não provocadas com epilepsia de início focal
≥2 CTCGs não provocadas com epilepsia de início generalizado
Contributors
Authors
Abdulrahman Alwaki, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
Disclosures
AA declares that he has no competing interests.
Daniel Winkel, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
Disclosures
DW receives consulting fees from NextSense, Inc.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Mauricio F. Villamar, MD, FACNS
Assistant Professor of Neurology and Clinician Educator
The Warren Alpert Medical School of Brown University
Providence
RI
Disclosures
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
Disclosures
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
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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. Abstract
Guery D, Rheims S. Clinical management of drug resistant epilepsy: a review on current strategies. Neuropsychiatr Dis Treat. 2021;17:2229-42.Full text Abstract
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.Full text Abstract
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. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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