EMS Neurological Emergencies - Seizure Disorder Treatments

The treatment for seizures depends on several factors, including the type of seizure, underlying cause, and individual patient characteristics. 

Here are some common treatments for seizures:

Antiepileptic Medications (AEDs): Antiepileptic drugs (AEDs) are the mainstay of treatment for epilepsy and other seizure disorders. These medications work by stabilizing electrical activity in the brain and reducing the likelihood of seizures. 

There are many different types of AEDs available, and the choice of medication depends on factors such as the type of seizure, patient age, comorbidities, and potential side effects. Examples of AEDs include carbamazepine, valproate, levetiracetam, lamotrigine, and phenytoin.

Lifestyle Modifications: Certain lifestyle modifications can help reduce the frequency and severity of seizures in some individuals. These may include:

Getting an adequate amount of sleep and maintaining a regular sleep schedule.

Avoiding triggers that may provoke seizures, such as stress, flashing lights, or certain medications.

Following a healthy diet, such as the ketogenic diet, which is high in fat and low in carbohydrates and has been shown to be beneficial for some people with epilepsy.

Limiting alcohol consumption and avoiding recreational drugs.

Surgery: For some individuals with epilepsy that is not well-controlled with medications, surgery may be an option. Surgical procedures such as resective surgery (removing the part of the brain responsible for seizures), laser ablation, or implantation of devices like vagus nerve stimulators or responsive neurostimulation systems can significantly reduce or eliminate seizures in certain cases.

Vagus Nerve Stimulation (VNS): Vagus nerve stimulation (VNS) is a surgical procedure in which a device is implanted under the skin of the chest and connected to the vagus nerve in the neck. 

The device delivers electrical impulses to the vagus nerve at regular intervals, which can help reduce seizure frequency and severity in some individuals with epilepsy.

Responsive Neurostimulation (RNS): Responsive neurostimulation (RNS) is a newer treatment option for epilepsy that involves the implantation of a device in the brain that detects abnormal electrical activity and delivers electrical stimulation to prevent seizures from occurring.

Ketogenic Diet: The ketogenic diet is a high-fat, low-carbohydrate diet that has been shown to be effective in reducing seizures in some individuals with epilepsy, particularly children with certain types of epilepsy syndromes.

Biofeedback & Relaxation Techniques: Some individuals with seizures may benefit from biofeedback training or relaxation techniques, which can help reduce stress and improve overall well-being.

Medication Adjustments: For individuals already taking antiepileptic medications, adjusting the dosage or switching to a different medication may be necessary if seizures are not adequately controlled or if side effects are problematic.

It's important for individuals with seizures to work closely with their healthcare providers to develop a comprehensive treatment plan tailored to their specific needs and circumstances. 

Regular monitoring and adjustments to treatment may be necessary to achieve optimal seizure control and improve quality of life.

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Huff, J.S. & Murr, N (2023) Seizure. Treasure Island, Florida: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK430765/ Accessed April 24, 2024

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Neurological Emergencies - Seizure Disorder Pathophysiology

The pathophysiology of seizures involves complex changes in the electrical activity of the brain, leading to abnormal synchronization of neuronal firing and the generation of seizure activity. 

While the precise mechanisms underlying seizures can vary depending on the type of seizure and the underlying cause, there are several key components involved in the pathophysiology of seizures:

Neuronal Hyperexcitability: Seizures are characterized by abnormal, excessive, and synchronous neuronal activity in the brain. 

This hyperexcitability can arise from various factors, including changes in ion channel function, neurotransmitter imbalance, or alterations in neuronal connectivity.

Ion Channel Dysfunction: Ion channels play a crucial role in regulating the flow of ions (such as sodium, potassium, calcium, and chloride) across neuronal cell membranes, which is essential for maintaining normal neuronal excitability and function. 

Dysfunction of ion channels, either through genetic mutations or acquired alterations, can lead to abnormalities in neuronal excitability and contribute to seizure generation.

Imbalance of Excitatory & Inhibitory Neurotransmission: Normal brain function relies on a delicate balance between excitatory and inhibitory neurotransmission. 

Excitatory neurotransmitters, such as glutamate, promote neuronal activation, while inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA), dampen neuronal activity. 

Imbalances in the relative levels or function of these neurotransmitters can disrupt the normal inhibitory control of neuronal firing and contribute to seizure generation.

Aberrant Synchronization of Neuronal Firing: Seizures result from the abnormal synchronization of neuronal firing, leading to hypersynchronous activity within neuronal networks. This synchronized firing can spread rapidly throughout the brain, resulting in the characteristic clinical manifestations of seizures.

Network Dysfunction: Seizure activity often involves multiple brain regions and networks. 

Abnormalities in the connectivity and communication between different brain regions can facilitate the propagation of seizure activity and contribute to the generation of seizures.

Excitotoxicity & Neuroinflammation: Prolonged or recurrent seizure activity can lead to excitotoxicity, a process in which excessive release of excitatory neurotransmitters, such as glutamate, results in neuronal damage and cell death. 

Additionally, seizures can trigger neuroinflammatory processes, further exacerbating neuronal dysfunction and contributing to seizure generation.

Structural & Metabolic Factors: Structural abnormalities in the brain, such as tumors, vascular malformations, or cortical dysplasia, can disrupt normal neuronal circuitry and increase the likelihood of seizure activity. 

Metabolic disturbances, such as hypoglycemia, electrolyte imbalances, or mitochondrial disorders, can also trigger seizures by affecting neuronal function.

Overall, the pathophysiology of seizures involves a complex interplay of genetic, molecular, cellular, and network-level processes that lead to abnormal neuronal excitability and synchronization. 

Understanding these mechanisms is essential for developing targeted therapies aimed at preventing or controlling seizure activity.

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Huff, J.S. & Murr, N (2023) Seizure. Treasure Island, Florida: StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK430765/ Accessed April 24, 2024

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Neurological Emergencies - Seizure Disorder Causes

The causes of seizures can vary widely and may depend on factors such as age, medical history, genetics, and environmental influences. 

Here are some common causes and risk factors associated with seizures:

Epilepsy: Epilepsy is a neurological disorder characterized by recurrent seizures. It can have various causes, including genetic factors, brain injury, infections, developmental disorders, and structural abnormalities in the brain.

Traumatic Brain Injury: Head injuries, such as those sustained in motor vehicle accidents, falls, or sports-related injuries, can lead to seizures. Traumatic brain injury (TBI) can disrupt normal brain function and increase the risk of seizures.

Brain Tumors: Tumors in the brain can cause seizures by interfering with normal brain activity or increasing intracranial pressure. Seizures may be a presenting symptom of a brain tumor.

Strokes: A stroke, which occurs when blood flow to the brain is disrupted, can lead to seizures, especially if the stroke affects certain areas of the brain responsible for regulating electrical activity.

Infections: Infections of the central nervous system, such as meningitis, encephalitis, or brain abscesses, can trigger seizures. These infections can cause inflammation and damage to brain tissue, leading to abnormal electrical activity.

Genetic Factors: Some seizure disorders have a genetic component, meaning they run in families. Mutations in certain genes can predispose individuals to develop epilepsy or other seizure disorders.

Metabolic Disorders: Metabolic imbalances, such as low blood sugar (hypoglycemia), electrolyte abnormalities, or kidney or liver failure, can provoke seizures by disrupting normal brain function.

Drug or Alcohol Withdrawal: Abrupt discontinuation of certain medications, especially anti-epileptic drugs or benzodiazepines, can trigger seizures. Similarly, alcohol withdrawal syndrome can lead to seizures in chronic alcoholics.

Toxic Exposure: Exposure to certain toxins, such as lead, carbon monoxide, or certain chemicals, can impair brain function and induce seizures.

Developmental Disorders: Some developmental disorders, such as autism spectrum disorder or cerebral palsy, are associated with an increased risk of seizures.

It's important to note that not all seizures have a clear identifiable cause, and in some cases, the cause may remain unknown (idiopathic). 

Proper evaluation and diagnosis by a healthcare professional are necessary to determine the underlying cause of seizures and guide appropriate treatment and management strategies.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 2 (6th Ed) Pearson.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Online Resources:

EpilepsyU