Day #267 - Seizure

Today we heard a very complicated case of a man with an extensive cardiac and vascular history who presented with decreased level of consciouness and paresis which was felt to be due to a seizure (Todd's paresis)

The underlying cause for the seizure was presumed to be multiple old and subacute infarcts, the etiology of which was unclear -- but suspicious for embolism given his recent large territory myocardial infarction.

There is a good NEJM review of the initial treatment of epilepsy here. Another good review on the use of anti-seizure medication in adults and the elderly is available here. Choice of therapy depends on a number of issues:

1. Efficacy of medication for clinical scenario (i.e. partial complex vs. generalized)
2. Side effect profile and patient history
3. Drug-Drug Interactions
4. Cost or availability
5. Familiarity of prescriber

Most patients I see have been started on phenytoin, which is an old drug with poor pharmacokinetics and many drug-drug interactions. This drug is chosen because of low cost, familiarity, availability of IV formula. It can be effective. The article cited above would suggest that we have alternative options.

Though not discussed today, I have previously blogged about status epilepticus here.

One astute participant mentioned driving. The CMA has guidelines on medical fitness to drive which you can access for free here. The medical condition report form is available here.