Chapter 7: Seizure Disorders

Seizures are defined as sudden episodes of abnormal electrical activity in the brain causing transient behavioral changes, and they may be provoked by identifiable triggers such as metabolic imbalances, trauma, or infection, or occur without an obvious precipitant. Epilepsy represents a chronic condition characterized by a predisposition to recurrent unprovoked seizures, whereas status epilepticus constitutes a medical emergency requiring immediate intervention when seizure activity persists beyond thirty minutes or when multiple seizures occur without return to baseline consciousness. The classification schema distinguishes between focal onset seizures, which originate in one hemisphere and represent the most prevalent adult presentation, and generalized onset seizures affecting bilateral brain regions with loss of consciousness and motor manifestations. Pathophysiologically, seizures emerge from neuronal hyperexcitability involving imbalances between excitatory glutamatergic and inhibitory GABAergic neurotransmission, with chronic seizure activity inducing kindling phenomena that progressively lower seizure thresholds. Clinical diagnosis relies heavily on detailed patient and eyewitness histories documenting auras, ictal features, and postictal phenomena such as Todd's paralysis, supplemented by electroencephalography to detect epileptiform discharges and neuroimaging to identify structural lesions. Differential diagnosis requires distinguishing true seizures from psychogenic nonepileptic seizures, syncope, transient ischemic attacks, and sleep disorders. Management prioritizes seizure prevention through individualized antiepileptic pharmacotherapy selected according to seizure type and patient-specific factors, with options including lamotrigine, levetiracetam, and ethosuximide for specific seizure presentations. Refractory cases may warrant nonpharmacologic interventions including ketogenic diet therapy, vagal nerve stimulation, or surgical resection of seizure foci. Patient education emphasizes comprehensive safety strategies addressing water activities, cooking hazards, and driving restrictions alongside caregiver instruction regarding seizure first aid protocols and recognition of status epilepticus requiring emergency intervention.