Clinical meaning
Seizures result from abnormal, excessive, hypersynchronous neuronal electrical activity in the cerebral cortex. Under normal conditions, excitatory (glutamate) and inhibitory (GABA) neurotransmission are balanced. Seizures occur when this balance shifts toward excitation. Epilepsy is defined as ≥2 unprovoked seizures >24 hours apart, or one unprovoked seizure with high recurrence risk (>60%), or an epilepsy syndrome diagnosis. The 2017 ILAE classification divides seizures into: focal onset (aware or impaired awareness), generalized onset (tonic-clonic, absence, myoclonic, atonic), and unknown onset. Status epilepticus is continuous seizure ≥5 minutes or ≥2 seizures without return to baseline — a medical emergency causing excitotoxic neuronal death. First-line treatment is IV benzodiazepine (lorazepam 0.1 mg/kg or midazolam 10 mg IM), followed by second-line ASM (fosphenytoin, levetiracetam, or valproate) if seizures persist.
Diagnosis & workup
Diagnostics & workup: - EEG: gold standard for seizure classification - MRI brain with epilepsy protocol: identifies structural causes - Prolactin level: elevated >2× baseline within 20 minutes supports true seizure vs. psychogenic event - BMP: glucose, sodium, calcium, magnesium (rule out metabolic causes) - Antiseizure medication levels for narrow-therapeutic-index drugs - CT head: initial imaging in emergency for new seizure - Lumbar puncture if CNS infection suspected - Video-EEG monitoring for seizure classification and presurgical evaluation