Seizure Notes from JEMS/EMS Today

Here are my notes from Notes from Bob Page’s Whole Lotta Shaking Going On Presentation (any inaccuracies are my fault):

Seizure is a temporary malfunction of the brain, an “electrical storm in the brain.”

For every 1 time someone has a seizure and calls 911, there are 20 others who don’t call.

Idiopathic seizures (epilepsy) are easily controlled.

Symptomatic Seizures show an underlying injury or structural lesion. They are unpredicatable and difficult to control.

A partial seizure affects one side of the brain.

A generalized seizure affects both sides, and results in loss of conciousness or awareness.

A simple partial has no loss of conciousness. Usually lasts no more than 90 seconds, and can be characterized by sudden jerking and may have some temporary residual weakness.

A complex partial may alter conciousness. Lasts 1-2 minutes, often has an aura, patient may wander unaware, have amnesia of the event and mild confusion.

A gran mal has the tonic clonic activity. Usually 1-2 minutes. Followed by amnesia, confusion or deep sleep. may produce cyanosis. Patient does not breath during seizure. Often is incontinent and bits tongue.

A partial seizure may progress to a generalized seizure. That is called the “Jacksonian march.”

Eyewitness accounts are crucial for diagnosis of seizure. Ask what happened before, during and after the seizure.

Absense seizure, formally known as petite mal last from 2-15 seconds, may have eye lid fluttering, amnesia of event, but no confusion, patient picks up right where they left off.

Status epliepticus. 5% of epileptics may suffer from this. Has a 10-20% mortality rate due to anoxia and acidosis caused by not being able to breathe (get air in and out) during seizure. Greater than 30 minutes of continuous seizure or greater than two sequential seizures without full recovery of conciousness. Interceed if seizure has gone on for five minutes.

Psuedo seizures are intermitent behavioral changes that resemble a seizure. No organic cause. No EEG changes suggestive of epilepsy. usually due to a psychological conflict. Almost exclusively female. frequently have history of childhood physical or sexual abuse. It can take 3-10 years to diagnose. Treat it as if they are having a real seizure, err on the side of the patient.

Alcholoic withdrawl seizures need sugar, fluid, vitamins and lots of ativan.

People may stop seizing when their arms get tired, the seizure may still be seen in their hands, fingers.

tegretol is the drug of choice for partial seizures

Ethosuximide (Zarontin) is the drug of choice for absense seizures.

Dilantin is the I don’t know what else to give them seizure drug


I had more notes, but couldn’t make sense of them or my handwriting.

Again, Bob Page is a great presenter, and by all means try to take a class from him someday.

Here’s his download page. He has his entire presentation there available for download. You need Quicktime and some other type of software to see the videos, but it is worth a run through.

Bob Page’s Download Page


  • Anonymous says:

    Peter,I have only recently come across your blog. Nice work.After running a tonic clonic seizure call awhile back, I did some research.Our service recently introduced the mucosal atomizing device. It’s use is indicated for “excited delirium”. The only approved drug is midazolam. Seems the diazepam preparation we carry will not absorb through mucous membranes so Valium via the MAD is out.I came across some studies that show Versed as perhaps a better agent for seizure control in the field either by IM or IN route. The studies I read indicated that the age-old rectal route is now being reconsidered (Thank God!).I was wondering if you or your readers could comment on this.Thanks and keep up the good work.

  • PC says:

    Thanks for your comments.We have intranasal narcan in our protocols, but few services use it. Our plan was to go to intranasal Versed if the Narcan worked out, but there hasn’t been much of an outcry for it. Jim Page mentioned it in his lecture and said there were problems with it. You have to use a lot and it isn’t all absorbed.He also had some funny and very negative things to say about rectal valium.We use Versed IM if we can’t get a line and it works pretty well. Not as good as ativan IV in my opinion, but it is better than nothing.

  • Eric says:

    IM Versed can take up to 20 minutes to take effect. Most of the time it works fairly quickly, but be aware of that delay. I tried to get our doc to approve the MAD, but he felt it’s not as precise as IV administration. We’ve now got the EZ-IO, and I forsee some use with status seizure patients.

  • PC says:

    We are getting the EZ-IO soon and I agree status would be a good use for it. I have done IM Versed a few times and it is slow — I haven’t had the twenty minute wait yet — I have either done a repeat dose or gotten an IV by that time and given ativan.

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