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48-year-old man unconscious. Was well 15min before. Paramedics noted 2…

- - - - Complex (40%)
      - Simple (20-30%)
      - Secondarily generalised tonic-clonic
  - - - reverberatory activity between cerebral cortex and thalamic nuclei
    - - Symptoms & signs: rigid (tonic phase), trunk and extremities extended, rhythmic (clonic) jerking of the trunk and extremities, apneic, maybe cyanotic, urinate, vomit. Deep, rapid breathing. Typical attacks last from 60-90s. Postictal confusion, myalgias, and fatigue may persist for several hours.
        Key diagnostic factors: focal neurological deficits, focal neurological symptoms (before or after seizure), premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu), temporary hemiparesis, temporary aphasia, fever, nuchal rigidity, altered mental status. Raised serum prolactin, lactate. CT/MRI Brain. Obtain radiographs of the cervical spine if there is suspicion of head or neck trauma. Biting tongue, eyes open.
        Strong risk factors: FHx (extended or immediate) of idiopathic generalised epilepsy, previous CNS infection, head trauma, prior seizure events or suspected seizure events,
        Weak risk factors: Hx of substance use, premature birth, multiple or complicated febrile seizures
      - Etiology
        
        Provoked seizure (caused by toxin, medication, or metabolic factors): Alcohol withdrawal, Barbiturate or benzodiazepine withdrawal, Metabolic encephalopathy (eg, hypo/hypernatremia, hypocalcemia, hypoglycemia, hyperglycemia, hypomagnesium), Uremia: confusion, depressed mental status; oliguria; tachycardia; pallor; fatigue; diffuse abdominal pain; thirst; excessive urination at night; Exam: diffuse abdominal pain, poor skin turgor, low blood pressure. Hypoxia, Hyperthyroidism, Dialysis disequilibrium syndrome, Porphyria, Drugs of abuse (eg, cocaine, amphetamines, phencyclidine), Medications (eg, tramadol, imipenem, theophylline, bupropion)
        
        Remote symptomatic seizure (unprovoked seizure) (caused by preexisting brain injury): Stroke (68.2%), Traumatic brain injury (25%), and CNS infection (6.8%)
        
        Acute symptomatic seizure (caused by acute illness): Stroke (34.7%)-ischemic/hemorrhagic esp lobar hemorrhage, Subdural hematoma, Subarachnoid hemorrhage. Traumatic brain injury (34.7%), CNS infection (30.6%) -meningitis/encephalitis/brain abscess . Hypoxic-ischemic injury.
        
        Epilepsy: criteria include •At least two unprovoked (or reflex) seizures occurring more than 24 hours apart. •One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (eg, ≥60 percent), occurring over the next 10 years. This may be the case with remote structural lesions such as stroke, central nervous system infection, or certain types of traumatic brain injury. •Diagnosis of an epilepsy syndrome.
        Cerebrovascular disease, Primary or metastatic brain tumors, Vascular malformations, Prior CNS infection, such as neurocysticercosis, head trauma, Neurodegenerative dementia, including Alzheimer disease. Mesial temporal lobe epilepsy (>80 percent of patients have seizure onset in adolescence, but presentation may be delayed into young adulthood).
    - - Juvenile Myoclonic Epilepsy (10%): onset in adolescence. Morning myoclonic jerks for years.
        Childhood Absence Epilepsy (5-10%)
        Juvenile Absence Epilepsy (2%)
        Generalized Tonic-Clonic Epilepsy (5%)