Seizures / epilepsy

Rationale

Seizures are common and present in a variety of settings. They have many underlying causes and can be both disabling and life-threatening.

Causal Conditions

(list not exhaustive)

1. Primary neurological disorders (e.g., idiopathic epilepsy, head trauma, encephalitis)
2. Systemic disorders (e.g., hypoglycemia, electrolyte disorders)
3. Other (e.g., febrile seizures, withdrawal)

Key Objectives

Given a patient presenting with (a) seizure(s), the candidate will diagnose the cause, severity, and complications, and will initiate appropriate management. The candidate will differentiate a seizure from other transient but non-seizure conditions (e.g., syncope, conversion disorder). As well, the candidate will consider the presence of seizures in patients presenting with episodic neurological symptoms (e.g., inattention, psychosis). The candidate will outline a plan for the emergent treatment of a patient presenting with a seizure.

Enabling Objectives

Given a patient presenting with (a) seizure(s), the candidate will

1. list and interpret critical clinical symptoms and findings, including those uncovered during an appropriate history and physical examination conducted in order to
   1. differentiate between a true seizure and non-seizure conditions;
   2. categorize the type(s) of seizure(s);
   3. determine if seizures are secondary to co-existing medical conditions;
   4. identify pre-morbid conditions, triggers, and circumstances leading to the seizure (e.g., medication non-adherence);
   5. monitor for complications resulting from seizure prophylaxis medications (e.g., weight gain);
2. list and interpret critical investigations, including those conducted in order to
   1. exclude underlying medical conditions (e.g., serum glucose);
   2. investigate for possible intracranial pathology (e.g., computed tomography scan, magnetic resonance imaging);
   3. investigate seizure type (e.g., electroencephalography);
   4. monitor for complications related to seizure prophylaxis medications (e.g., lipid profile);
3. construct an effective initial management plan, including
   1. providing emergent management of an ongoing seizure;
   2. ensuring appropriate management if the patient presents with a history of seizures, including counselling (e.g., personal safety, psychosocial impact), pharmacotherapy and appropriate follow-up;
   3. referring the patient for specialized care, if necessary;
   4. notifying the patient and/or the appropriate authorities in case of inability to drive.