1B. Accidental (provoked) seizures

Provoked seizures

Definition and epidemiology

A provoked seizure is one caused by well-defined provoking factors and not by an underlying disorder.

Etiology

  • Febrile seizures in childhood
  • Sleep deprivation
  • Photic stimulation with a stroboscope
  • Alcohol withdrawal
  • Drug withdrawal

Clinical features

Provoked seizures are almost always generalised tonic-clonic.

Treatment

Antiepileptics may be required acutely, but it’s not necessary to use antiepileptics for prevention long-term. It’s enough to avoid the provoking factor.

Symptomatic or accidental seizures

Definition and epidemiology

A symptomatic seizure is one caused by a serious acute illness affecting the CNS.

Etiology

  • HSV encephalitis
  • Autoimmune encephalitis
  • Intracranial tumour (esp. meningioma)
  • Head trauma
  • Sinus thrombosis
  • Stroke
  • Metabolic disturbances (hypoglycaemia, hyponatraemia, hypernatraemia, …)
  • Drug intoxication
  • Sepsis

Clinical features

Symptomatic seizures are usually focal, although they can progress to generalised tonic-clonic seizures.

Treatment

Patients with symptomatic seizures often require lifelong antiepileptics to prevent seizure recurrence, even if the underlying condition is treated.


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2A. Benign positional paroxysmal vertigo

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