⚡ Seizures · Focal vs Generalized · Epilepsy Syndromes · Status Epilepticus · Febrile Seizures

Schwartz Clinical Handbook — Chapter 68 · Absence (petit mal) · Tonic‑clonic (grand mal) · Myoclonic · Febrile seizure · Status epilepticus · EEG · MRI · AEDs

Select seizure type (generalized, focal, absence, myoclonic), duration (>5 min), fever, postictal state, age, EEG findings, and family history → differentiate febrile seizure, generalized epilepsy (absence, GTC), focal epilepsy, infantile spasms, Lennox‑Gastaut, and status epilepticus.
⚠️ Red flags: status epilepticus (seizure >5 min), focal deficit, first seizure with fever in <18m → CSF for meningitis.

📋 Step 1 — Seizure semiology & fever
📌 Diagnostic impressions
📖 Schwartz Ch 68

Select seizure type (generalized tonic‑clonic, focal, absence, myoclonic), duration, fever, postictal state, age (infant, child, adolescent), EEG findings, and family history → differentiate febrile seizure (simple vs complex), absence epilepsy, focal epilepsy, infantile spasms (West syndrome), Lennox‑Gastaut, myoclonic epilepsy, and status epilepticus (emergency).

✔️ Febrile seizure: 6m‑5y, fever, generalized <15 min, no focal features.
✔️ Absence: brief staring, 3Hz spike‑wave, responds to ethosuximide.
✔️ Focal: aura, automatisms, postictal confusion, focal EEG.
✔️ Infantile spasms: clusters of flexor/extensor spasms, hypsarrhythmia.
✔️ Status epilepticus: >5 min continuous seizure → benzodiazepine.
📘 Schwartz pearls (Chapter 68)
• Status epilepticus: lorazepam 0.1 mg/kg IV, then fosphenytoin/ levetiracetam.
• Febrile seizure: lumbar puncture if <12‑18m or meningeal signs.
• EEG for first unprovoked seizure, MRI for focal or refractory.
• Ketogenic diet for refractory epilepsy.
• First seizure: no AED unless recurrent or high risk.