Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Seizure Disorder

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In one line

·First figure out whether the seizure starts in one spot (focal) or everywhere at once (generalized), because that split steers every choice you make next.

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Normal physiology

·The brain is a network of billions of nerve cells (neurons) that send tiny electrical pulses to each other in a balanced, organized rhythm—excitatory signals tell the next cell to fire, and inhibitory signals tell it to stay quiet, so the whole system hums along in tune.

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What goes wrong

·A seizure happens when the balance between 'go' and 'stop' signals tips too far toward 'go,' so a group of nerve cells fires wildly all at once instead of in an organized rhythm—like a spark jumping across dry grass instead of staying in a campfire ring.

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Hallmark signs

·Sudden jerking movements that the person cannot control
·Staring spell with no response when you talk to them
·Confusion or sleepiness right after the event
·Loss of bladder or bowel control during the event
·Tongue biting on the side during the event
·Feeling a strange smell, taste, or rising feeling in the belly right before
·Seizure lasts longer than 5 minutes or a second one starts before the person wakes up
·First seizure ever in an adult, especially over age 25

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Red flags · escalate now

·Seizure lasts longer than 5 minutes or repeats without the person waking up in between (status epilepticus—a medical emergency that can kill brain cells)
·New seizure in an adult, especially over age 25 (raises worry for tumor, stroke, or infection)
·Fever, stiff neck, or severe headache with the seizure (may be meningitis or encephalitis—brain infection)
·Sudden weakness or numbness on one side after the seizure clears (could be a stroke instead of or along with the seizure)
·Person is pregnant (seizures can harm the baby, and eclampsia—dangerously high blood pressure in pregnancy—can cause seizures and needs immediate treatment)

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Workup

·Electroencephalogram (EEG), routine and ideally sleep-deprived or prolonged
·MRI brain with and without contrast (or CT head if MRI not available)
·Serum glucose
·Serum sodium and calcium
·Urine drug screen or serum toxicology
·Serum prolactin, drawn within 10–20 minutes of the event

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Treatment

·Identify seizure type (focal vs. generalized) by witness description, patient memory, and EEG findings
·Start a first-line anti-seizure medicine matched to seizure type: levetiracetam or lamotrigine for focal-onset; valproate (avoid in women of childbearing age) or lamotrigine for generalized-onset
·Obtain brain MRI to find structural causes (stroke, tumor, malformation, hippocampal sclerosis)
·Titrate medicine dose slowly (especially lamotrigine) and recheck at 2–4 weeks; monitor for rash and measure drug levels if seizures continue
·Counsel on safety: no driving until seizure-free per state law (usually 3–12 months), avoid swimming alone, avoid heights and heavy machinery, and shower instead of bath
·Prescribe folate (at least 0.4–1 mg daily) for all women of childbearing age on anti-seizure medicines; discuss teratogenicity (especially valproate) and interaction with hormonal birth control
·If seizures continue despite trying two appropriate medicines at therapeutic doses, refer to an epilepsy center for drug-resistant epilepsy evaluation (surgery, vagus nerve stimulation, responsive neurostimulation, or ketogenic diet)

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NCLEX trap

·After a first seizure, always get a CT or MRI of the brain and check blood tests (sugar, sodium, calcium) to look for a fixable cause like low blood sugar or a tumor. Then start a daily anti-seizure medicine (called an AED, or anti-epileptic drug) that matches the seizure type. Lorazepam (a benzodiazepine that calms the brain fast) stops the seizure right now, but it does not prevent the next one. Seizure disorder means the brain will likely misfire again, so the person needs protection every day.
·Staring spells can be three different things: focal seizures where the person loses awareness (the misfire starts in one spot and spreads to the networks that keep you alert), absence seizures (a brief pause caused by a burst of abnormal electricity across both sides of the brain at once), or psychogenic non-epileptic seizures (PNES, which are real events caused by stress, not brain electricity). You must watch the EEG (a test that records brain waves) and ask what the person remembers afterward. Focal seizures need lamotrigine or levetiracetam. Absence seizures need ethosuximide or valproate. PNES needs therapy, not seizure medicine. Giving the wrong medicine wastes time and can hurt the person.
·Women with seizure disorder can absolutely get pregnant and have healthy babies. The key is to plan ahead with the doctor. Switch from valproate (which causes spina bifida and developmental delays in the baby) to lamotrigine or levetiracetam (much safer). Start folic acid (a B vitamin that protects the baby's spine and brain) at 1 to 4 mg per day before getting pregnant. Seizure disorder is not a reason to ban pregnancy — it is a reason to prepare carefully.
·After 2 to 5 years with no seizures (depending on the seizure type and EEG), the patient, doctor, and family can talk together about slowly stopping the medicine. One year is too soon — the brain needs more time to prove it is stable. Stopping suddenly or too early can trigger status epilepticus (a seizure that will not stop) (a seizure that does not stop on its own), which kills 1 in 5 people. Always taper the dose down over weeks to months under a doctor's watch.
·Pick the seizure medicine based on the seizure type. For focal seizures (start in one spot), use lamotrigine, levetiracetam, or lacosamide. For generalized seizures (start in both sides of the brain at once), use lamotrigine, levetiracetam, or valproate (but not valproate in women who can get pregnant). Phenytoin and carbamazepine are older medicines with more side effects (gum overgrowth, bone thinning, rash, drug interactions with birth control and blood thinners) and are now second-line. Levetiracetam and lamotrigine are safer and easier to dose.
·Driving laws vary by state, but most say no driving for 3 to 6 months after a seizure. The person must be seizure-free on medicine during that time. If they seize while driving, they can crash and kill themselves or others. SUDEP (Sudden Unexpected Death in Epilepsy, where the heart stops after a seizure during sleep) and car accidents are the top two causes of death in people with uncontrolled seizure disorder. Safety rules exist to protect everyone.

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