Impaired consciousness with convulsions
Disorder of consciousness with convulsions is an acute condition that can arise from a variety of pathophysiological mechanisms such as epileptic paroxysm, metabolic or cardiovascular disorders. Early and correct diagnosis is essential in seizure disorder of consciousness to select adequate therapy and prevent complications. Special attention should be paid to the potentially life-threatening condition of status epilepticus. The algorithm guides you through key decisions, from first aid to differential diagnosis to therapeutic strategies that reflect the latest recommendations in neurology and emergency medicine.
Review
The chapter dedicated to seizure-related issues thoroughly analyzes acute symptomatic epileptic seizures and emphasizes the importance of understanding both basic lay and professional care for individuals at increased risk of health and life-threatening conditions.
The algorithm of anamnesis and examination is correctly described for the pre-hospital phase, as well as for the hospitalization and subsequent long-term follow-up care.
A basic differential diagnostic assessment and the indication for initiating or not initiating long-term anticonvulsant therapy are correctly presented.
A specific situation is status epilepticus. Knowledge of acute medication is crucial to reduce the risk of irreversible brain damage, including the death of the patient.
Seizure disorders usually have a significantly negative impact on the social and professional life of the patient, and it is a major responsibility of the witnesses of the event, who provide information to medical personnel, and of the healthcare staff themselves to educate the patient about the nature of the condition, current and future recommendations, and restrictions. The goal of cooperation with the patient is to reduce the risk of recurrence of seizure episodes.
Sources
BRÁZDIL, Milan. Epileptologie. Maxdorf. 2024., ISBN 978-80-7345-806-5
HLOCH, Ondřej. Užitečné tabulky pro praxi nejen v interních oborech. Praha: Grada Publishing, 2018. ISBN 978-80-271-0311-9.
POLÁK, Martin. Urgentní příjem: nejčastější znaky, příznaky a nemoci na oddělení urgentního příjmu. 3rd revised and updated edition. Praha: Grada Publishing, 2023. ISBN 978-80-271-3506-6.
RŮŽIČKA, Evžen. Neurologie. 3rd edition. Praha: Triton, 2024. ISBN 978-80-7684-312-7.
ŠÍN, Robin, Petr ŠTOURAČ a Jana KRUBA VIDUNOVÁ. Lékařská první pomoc. Praha: Galén, [2019]. ISBN 978-80-7492-433-0.
ŠTĚTKÁŘOVÁ, Ivana. Moderní farmakoterapie v neurologii. 3rd revised and updated edition. Praha: Maxdorf, [2021]. Jessenius. ISBN 978-80-7345-706-8.
Neurologie pro praxi. 2024. ISSN 1213-1814.
Vyhláška č. 277/2004 Sb. o zdravotní způsobilosti k řízení motorových vozidel - Version effective from January 1, 2025. In: ASPI [online]. Wolters Kluwer, cited January 8, 2025. Available from: ASPI.
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Learning targets
2. The student learns the acute management of status epilepticus
3. The student learns the definition of epilepsy
Key points
2. Not every disorder of consciousness with convulsions is an epileptic seizure
3. Not every epileptic seizure means a diagnosis of epilepsy for the patient
