Seizures: Medical Causes and Management

369 Pages·2002·8.977 MB·English

by  Norman Delanty MB, FRCPI (auth.), Norman Delanty MB, FRCPI (eds.)

SEIZURES
CURRENT CLINICAL NEUROLOGY
Daniel Tarsy, MD, Series Editor
Seizures: Medical Causes and Management, edited by
Norman Delanty, MB, FRCPI, 2001
Clinical Evaluation and Management of Spasticity, edited by David A. Gelber, MD,
and Douglas R. Jejfery, MD, PhD, 2001
Early Diagnosis of Alzheimer's Disease, edited by Leonard F. M. Scinto, PhD
and Kirk R. Daffner, MD, 2000
Sexual and Reproductive Neurorehabilitation, edited by Mindy Aisen, MD, 1997
SEIZURES
Medical Causes and Management
Edited by
NORMAN DELANTY, MB, FRCPI
Department of Clinical Neurological Sciences
Royal College ofS urgeons in Ireldnd
Beaumont Hospital Dublin, Ireldnd
Foreword by
Marc Dichter,
MD, PhD
Professor ofN eurology, Director, Penn Epilepsy Center,
Hospital oft he University ofP ennsylvania, Philadelphia, PA
*-
SPRINGER-SCIENCE+BUSINESS
MEDIA, LLC
© 2002 Springer Science+Business Media New York
Originally published by Humana Press Inc in 2002
Softcover reprint of the hardcover 1 st edition 2002
999 Riverview Drive, Suite 208
Totowa, New Jersey 07512
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written
permission from the Publisher.
The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted
due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for
errors or omissions or for any consequences arising from the information or opinions presented in this book and
make no warranty, express or implied, with respect to its contents.
Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the
information published and to describe generally accepted practices. The contributors herein have carefully checked
to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards
accepted at the time of publication. Notwithstanding, since new research, changes in government regulations, and
knowledge from clinical experience relating to drug therapy and drug reactions constantly occur, the reader is
advised to check the product information provided by the manufacturer of each drug for any change in dosages or
for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is
a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment
strategies for individual patients. Further, it is the responsibility of the health care provider to ascertain the Food
and Drug Administration status of each drug or device used in their clinical practice. The publishers, editors, and
authors are not responsible for errors or omissions or for any consequences from the application of the information
presented in this book and make no warranty, express or implied, with respect to the contents in this pUblication.
This publication is printed on acid-free paper. g
ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials.
Cover design by Patricia F. Cleary.
For additional copies, pricing for bulk purchases, andlor information about other Humana titles,
contact Humana at the above address or at any of the following numbers: Tel: [phone];
Fax: [phone]; E-mail: [email protected] or visit our website at http://humanapress.com
Photocopy Authorization Policy:
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is
granted by Humana Press Inc., provided that the base fee of US $10.00 per copy, plus US $00.25 per page, is paid
directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations
that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is
acceptable to Humana Press Inc.
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Seizures: medical causes and management I edited by Norman Delanty ; foreword by Marc Dichter.
p. ; cm. --(Current clinical neurology)
Includes bibliographical references and index.
ISBN 978-1~1737-207-0 ISBN 978-1-59259-094-0 (eBook)
DOI 10.1007/978-1-59259-094-0
1. Convulsions. I. Delanty, Norman. 11. Series
[DNLM: 1. Seizures--diagnosis. 2. Seizures--therapy. WL 340 S462 2002]
RC394.C77 S45 2002
616.8'45--dc21
2001039367
Foreword
Seizures are frightening events. They frighten the patients who experience them;
they frighten those who witness them; they also frighten many physicians who have
to deal with them. Most individuals with seizures present to family physicians or to
emergency room physicians. However, despite the fact that seizures are among the
most common neurological conditions, most general practitioners, family practice
specialists, and intemists do not see large numbers of patients with seizures. Given the
apoplectic appearance of generalized tonic clonic convulsions, it is not difficult to
understand why they arouse such emotional responses in those that experience them,
those that witness them, and those whose care is sought for them.
Seizures are symptoms of something wrong with the brain. Many different kinds of
perturbations in brain anatomy, chemistry, or physiology can produce seizures. For
many individuals, seizures occur in the context of an acute illness and will not recur
once that illness is treated. These individuals do not have epilepsy. They have transient
disturbances in brain function attributable to systemic medical conditions. It is
important to recognize these issues, because, first, the seizure may be the initial, or even
only, manifestation of the underlying medical problem and this needs to be recognized.
Second, if the underlying medical condition can be diagnosed and effectively treated,
the seizures often disappear and the patients do not need to take medication for long
periods of time, nor become disabled from their seizures. For other patients, epilepsy
will actually present in the context of a systemic illness, either coincident with the
illness or directly caused by the illness. These individuals will have multiple problems:
their primary illness and their epilepsy, and often both need to be evaluated and treated
separately.
What kinds of conditions cause seizures? Almost every variety of disturbance in
one's general medical state can result in seizures, including infections, drugs, meta
bolic disturbances, multiorgan failure, trauma, neoplasms, and so on. In Seizures:
Medical Causes and Management, Norman Delanty has brought together an impressive
panel of experts in various medical conditions that result in seizures, with the admirable
goal of bringing order to what, in many cases, is a chaotic, uneven, and widely dispersed
literature on the medical causes of seizures and their management. Seizures: Medical
Causes and Management is designed to elevate the expertise of both generalists (non
neurologists) and neurologists in the area of seizure evaluation and treatment. It addresses
issues not generally emphasized in either the general medical literature or in the
specialized neurology literature, and does so in sufficient detail to raise the discussion
several notches above that generally presented. Most textbooks will focus on a disease
and then perhaps mention in passing that seizures may be one of its symptoms. This
book focuses on the circumstances under which seizures develop in any given condition,
how to recognize this potential life-threatening complication, and how to effectively
treat it within the context of that disease. As such it is destined to become a "must have"
v
Foreword vi
book for almost anyone practicing medicine-in the office or in the hospital-regardless
of one's specialty or the mix of patients in one's practice.
Seizures are big events in the life of an individual. Seizures may have big conse
quences. Seizures deserve a big treatment. Norman Delanty has recognized this and
with this book has filled a significant hole in our medical literature.
Marc A. Dichter, MD, PhD
Preface
Seizures: Medical Causes and Management is intended to present a comprehensive
discussion of acute symptomatic seizures. These are common in clinical practice and
are encountered by a wide range of clinicians. I believe that a book such as this one is
needed as the topic appears to have fallen between the two stools of medicine and
neurology. Neurologists and epileptologists are frequently asked to assess and advise
on management of individuals with these situation-related seizures. This topic has
been given relatively scant treatment in the medical literature and in standard text
books, possibly because it straddles many specialties. The present book is intended at
least in part to address this shortfall. It aims to provide in one volume a comprehensive
treatment of the causes and management of symptomatic seizures associated with a
wide variety of medical disorders. It should prove a valuable resource to those caring
for patients who are at risk of seizures in the setting of systemic illness. I hope that
neurologists, intemists, anesthesiologists, and intensive care unit and emergency
physicians will all find it of value.
Chapter 1 serves as a broad introduction, discussing general principles and intro
ducing important terms and definitions. Chapter 2 is an attempt to unify a discussion
of the pathophysiology of acute symptomatic seizures, although this is also discussed
where appropriate in later chapters. Chapter 3 deals with acute symptomatic seizures
caused by underlying primary central nervous system insult. Chapters 4 to 16 are
divided into those dealing with specific etiologic areas of acute symptomatic seizures,
such as seizures resulting from organ failure, alcohol-related seizures, and seizures in
cancer patients. The important topic of the differential diagnosis between seizure and
syncope is discussed in Chapter 17. I felt it important to include a specific chapter on
seizures in the tropics (Chapter 18). Chapter 19 discusses issues pertaining to the
intensive care unit, and Chapter 20 deals with symptomatic status epilepticus. The
final chapter (Chapter 21) is a discussion of the use of anticonvulsants in systemically
sick patients. Although there is inevitable overlap between chapters, this has been kept
to a minimum.
I am grateful to all the authors, for both their excellent contributions and their
patience as I worked through this project while moving between continents. I am
delighted that Marc Dichter agreed to write the Foreword. I am especially grateful to
Paul Dolgert and Craig Adams at Humana Press for their help and understanding.
Finally, and most of all, I thank my wife, Breda, and children, Niamh and Saorlaith,
for tolerating and supporting me.
Norman Deianty, MB, FRCPI
vii
Contents
Foreword by Marc A. Dichter, MD, PIJ) ..................................................................... v
Preface ..................................................................................................................... vii
Contributors .............................................................................................................. xi
1 Definitions and Epidemiology
Norman Delanty, MB, FRCPI •••.••••••••••••••••.•••••••••.•••••••••••••••••••••••••••••••••••••••••••• 1
2 Pathophysiology of Acute Symptomatic Seizures
Carl J. Vaughan, MD, MRCPl and Norman Delanty, MB, FRCPl ..................... 7
3 Seizures in Acute Neurological Disorders
Peter B. Crino, MD, PhD ••••••••.•.•.••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 25
4 Seizures in Multisystem Disease Affecting the Nervous System
Joerg-Patrick Stiibgen, MD, FRCPC .............................................................. 49
5 Seizures and Organ Failure
lane Boggs, 71
MD ••••••••••••••••••••••••.••••••••••••••••••••••••••••••••••••••••••••.••••••••••••••••••••••
6 Seizures and Electrolyte Imbalance
Alvaro R. Gutie"ez, MD and Jack E. Riggs, MD ........................................ 85
7 Seizures and Endocrine Disorders
Cormac A. O'Donovan, MD and Ramel A. Carlos, MD ............................ 107
8 Seizures, Fever, and Systemic Infection
Kevin Murphy, MRCPl and Henry Fraimow, MD ....................................... 121
9 Medication-Associated Seizures
Paul A. Garcia, MD and Brian K. Alldredge, P1uumlJ ................................. 147
10 Alcohol and Seizures
Gail D'Onojrio, MD, Andrew S. Ulrich, MD, and Niels K. Rathlev, MD ....... 167
11 Seizures and Illicit Drug Use
John C. M. Brust, MD ................................................................................ 183
12 Seizures Attributable to Environmental Toxins
Fernando Cendes, MD, PIJ) ......................................................................... 193
13 Seizures in Cancer Patients
Myrna R. Rosenfeld, MD, PIJ) and Josep Dalmau, MD, PIJ) ....................... 207
14 Seizures Associated with Hypoxic-Ischemic
Cardiopulmonary Disorders
Muredach Reilly, MB, MRCPl ...................................................................... 233
ix
x Contents
15 Seizures, Hypertension, and Posterior Leukoencephalopathy
Norman Delanty, and Carl J. Vaughan, 251
MB, FRCP] MD, MRCPI .................
16 Seizures Following Organ Transplantation
Jane Boggs, MD .......................................................................................... 261
17 Seizures and Syncope
Suneet Mittal, MD and Bruce B. Lerman, MD ........................................... 271
18 Seizures in the Tropics
Nimal Senanayake, MD, PhD, DSc, FRCP, FRCPE ........................................... 285
19 Seizures in the ICU Patient
Michael M. Frucht, MD and Thomas P. Bleck, MD, FACP, FCCM, FCCP ..... 309
20 Status Epilepticus in the Critically III
Michael C. Smith, MD and Michele Del Signore, DO ............................... 319
21 Anticonvulsants in Acute Medical Illness
Colin Roberts, MD and Jacqueline A. French, MD ................................... 333
Index ...................................................................................................................... 357
Contributors
BRlAN K. ALLDREDGE, PharmD • Professor of Cinical Pharmacy and Neurology,
University of California, San Francisco, San Francisco, CA
THOMAS P. BLECK, MD, FACP, FCCM, FCCp· The Louise Nerancy Eminent Scholar
in Neurology and Professor of Neurology, Neurological Surgery, and Internal
Medicine; Director, Neuroscience Intensive Care Unit; Member,
F. E. Dreifuss Comprehensive Epilepsy Center; Department of Neurology,
The University of Virginia, Charlottesville, VA
JANE BOGGS, MD • Associate Professor of Neurology; Director, Neurophysiology
and Epilepsy Services, University of South Alabama, Mobile, AL
JOHN C. M. BRUST, MD • Director, Department of Neurology, Harlem Hospital
Center; Professor of Clinical Neurology, Columbia University College
of Physicians and Surgeons, New York, NY
RAMEL A. CARLOS, MD • Department of Neurology, Wake Forest University School
of Medicine, Winston-Salem, NC
FERNANDO CENDES, MD, PhD • Assistant Professor, Department of Neurology,
FCM-UNICAMP, Cidade Universitdria, Campinas-SP, Brazil
PETER B. CRlNO, MD, PhD • Penn Epilepsy Center, Neurological Intensive Care Unit,
Department of Neurology, Hospital of the University of Pennsylvania,
Philadelphia, PA
JOSEP DALMAU, MD, PhD • Department of Neurology, University ofA rkansas
for Medical Sciences, Little Rock, AR
NORMAN DELANTY, MB, FRCPI • Consultant Neurologist, Department of Clinical
Neurological Sciences, Royal College of Surgeons of Ireland, Beaumont
Hospital, Dublin, Ireland
MICHELE DEL SIGNORE, DO • Department of Neurology, Rush-Presbyterian
St. Luke's Medical Center, Chicago, IL
GAlL D'ONOFRlO, MD· Section of Emergency Medicine, Yale University School
of Medicine, New Haven, CT
HENRY FRAIMOW, MD • Associate Professor of Medicine, Division of Infectious
Disease, MCP-Hahnemann School of Medicine, Philadelphia, PA
JACQUELINE A. FRENCH, MD • Penn Epilepsy Center, Department of Neurology,
Hospital of the University of Pennsylvania, Philadelphia, PA
MICHAEL M. FRUCHT, MD· Fellow, F. E. Dreifuss Comprehensive Epilepsy Center;
Department of Neurology, The University of Virginia, Charlottesville, VA
PAUL A. GARCIA, MD • Associate Professor of Clinical Neurology, University
of California, San Francisco, San Francisco, CA
xi