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Seizure mimics and misconceptions

Janet Taylor shares assessment and management tips for mastering seizure thresholds, classification and treatment approaches

Seizures are abnormal, unregulated electrical discharges in the brain. They are often misunderstood, and their presentation can vary significantly from the dramatic convulsions typically portrayed in media.

In a recent EMS1 webinar, Janet Taylor, an experienced nurse and medic with expertise in emergency nursing and critical care transport, shared her insights on seizures, offering valuable information for EMS professionals.

Watch for more: On-demand webinar: Short circuit – seizures

Memorable quotes

Following are some of Taylor’s memorable quotes:

  • “What most people think of as seizures is stuff they see on movies and in TV. That’s not what most seizures are.”
  • “Grand mal and petit mal are old terms. We don’t use those terms anymore to classify seizures.”
  • “A seizure threshold is the amount of tolerance a person’s brain has to stimulation and triggers.”
  • “The number one reason why somebody with an epilepsy diagnosis has a breakthrough seizure is they haven’t been taking their meds like they’re supposed to.”

Top takeaways

Here are the key takeaways from Taylor’s presentation:

1. Seizure classification. The International League Against Epilepsy (ILAE) has updated the classification of seizures. Terms like “grand mal” and “petit mal” are outdated. Seizures are now classified based on where they start in the brain, the level of awareness during the seizure, and whether they involve motor or non-motor symptoms. According to Taylor, there is a need for wider dissemination of updated seizure classification and treatment guidelines among healthcare professionals.

2. Seizure thresholds and triggers. Factors like age, sleep cycle, brain injuries, genetics, medications and certain triggers can influence seizure thresholds. Understanding these can help in managing and anticipating seizures.

3. Treatment approaches. While emergency intervention is crucial for status epilepticus (prolonged seizures), many seizures are self-limiting and may not require aggressive treatment. Post-seizure, rest is often the best recovery approach.

4. Status epilepticus. A seizure lasting more than five minutes or multiple seizures without full recovery in between is a medical emergency known as status epilepticus. Immediate medical intervention is required.

5. Seizure mimics. Conditions like migraines, catatonic states, and eclampsia can present symptoms similar to seizures. For instance, severe migraines might cause neurological disturbances that resemble seizure activity. “Migraines can be so severe that they actually cause you to have what looks like a seizure or a stroke,” Taylor reported. Understanding these mimics is crucial to avoid misdiagnosis and ensure appropriate treatment.

6. Psychogenic Non-Epileptic Seizures (PNES). PNES are episodes that resemble epileptic seizures but are psychological in origin. They do not involve abnormal electrical brain activity. “PNES is psychogenic, non-epileptic, meaning it’s not a seizure activity at all. It is a psychological response,” Taylor explained. Differentiating these from epileptic seizures is important for appropriate treatment. PNES are diagnosed primarily through patient history and normal EEG readings despite reported seizures. It’s a diagnosis of exclusion, typically made by a neurologist. Treatment focuses on addressing underlying psychological issues through therapies like cognitive behavioral therapy. Medications for epilepsy are ineffective for PNES.

Common misconceptions about seizures

Taylor shared the following common misconceptions about seizure diagnosis and management:

  • Presentation. Not all seizures involve dramatic convulsions. Some can be subtle, involving minor muscle twitching or brief lapses in awareness.
  • Awareness. Patients may remain conscious during some types of focal seizures, contrary to the common belief that seizures always involve a loss of consciousness.
  • Duration and severity. Many seizures are self-limiting and don’t always necessitate emergency medical intervention. However, prolonged seizures (status epilepticus) require immediate attention.
  • Triggers and thresholds. Seizures are not always spontaneous and unpredictable. Factors like missed medication, sleep deprivation and stress can lower the seizure threshold and act as triggers.
  • Epilepsy vs. seizures. Not everyone who experiences a seizure has epilepsy. Seizures can be isolated events caused by various triggers, including metabolic imbalances or acute neurological conditions.

A comprehensive understanding of seizures, their mimics and related conditions is essential for EMS professionals. Watch the on-demand webinar to learn more to improve your seizure assessment and management, and to avoid common pitfalls in seizure care.

EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.