[Leading symptom: motor manifestations with impaired consciousnes : Management of epileptic seizures and status epilepticus]

Abstract

Epileptic seizures, which are often accompanied by a reduction in vigilance, are a common emergency. Every first-time epileptic seizure should be investigated further. Particular attention should be paid to whether it is an acute symptomatic seizure, which is an acute event characterized by a metabolic disorder or acute cerebral damage within a certain period of time, or possibly epilepsy. In terms of differential diagnosis, psychogenic nonepileptic seizures also pose a challenge, as they are often not easy to distinguish from epileptic seizures, but require a different therapeutic approach. Persistent epileptic seizures in the sense of status epilepticus (duration: > 5 min) are also common in the (pre)clinical emergency situation and require immediate initiation of adequate therapy, which consists of rapid and sufficient administration of benzodiazepines. Nasal administration is a quick and simple option here, particularly in the prehospital setting. Furthermore, persistent reductions in vigilance are a not infrequently occurring phenomenon in the (pre)clinical setting, which is, however, based on numerous differential diagnoses. Here, nonconvulsive status epilepticus should be considered as a possible cause and rapid diagnosis using EEG should be sought in order to begin early treatment, which improves patient outcomes.

Keywords: Acute symptomatic seizures; Benzodiazepines; Convulsive syncope; Disorder of consciousness; Psychogenic nonepileptic seizures.