Is a seizure considered a severe neurological symptom?

From the Guidelines

A seizure is considered a severe neurological symptom that requires immediate medical attention. Seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, and levels of consciousness. While a single seizure may not necessarily indicate epilepsy, it always warrants thorough medical evaluation. According to the most recent guidelines, seizures can be classified into different types, including generalized tonic-clonic seizures, focal seizures, and unknown onset seizures 1.

Key Considerations

• If someone experiences a seizure, they should be placed on their side in the recovery position, have objects removed from around them to prevent injury, and should not have anything placed in their mouth.
• Emergency services (911) should be called if the seizure lasts longer than 5 minutes, if the person doesn't wake up after the seizure ends, if another seizure occurs shortly after the first, if the person is injured, pregnant, or has diabetes.
• Common medications used to treat seizures include levetiracetam (Keppra), lamotrigine (Lamictal), carbamazepine (Tegretol), and valproic acid (Depakote), though treatment depends on the underlying cause.
• Seizures can result from various conditions including epilepsy, brain injury, infections, stroke, tumors, or metabolic abnormalities, which is why proper diagnosis through EEG, brain imaging, and other tests is essential for appropriate management 1.

Management and Treatment

• The management of seizures involves providing stabilization and interventions to stop the seizure, preventing seizure-related complications, and identifying life-threatening processes for which a seizure may be a symptom 1.
• Status epilepticus, a life-threatening form of seizure, requires immediate medical attention and treatment with benzodiazepines and other medications as needed 1.
• In patients with drug-resistant focal epilepsy, epilepsy surgery is a promising option, with approximately 65% of patients becoming seizure-free 1.

Importance of Recent Guidelines

• The most recent guidelines, such as the 2024 American Heart Association and American Red Cross guidelines for first aid, emphasize the importance of prompt medical attention and proper management of seizures 1.
• These guidelines also highlight the need for thorough medical evaluation and diagnosis to determine the underlying cause of the seizure and to develop an effective treatment plan.

From the FDA Drug Label

The “gasping syndrome”, (characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine) has been associated with benzyl alcohol dosages greater than 99 mg/kg/day in neonates and low-birth-weight neonates Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse General Seizure activity and myoclonus have been reported to occur following administration of lorazepam injection, especially in very low birth weight neonates.

Severe neurological symptoms can include:

• Seizures
• Intracranial hemorrhage
• Gradual neurological deterioration A seizure is considered a severe neurological symptom 2, 2.

From the Research

Severe Neurological Symptoms

• Severe neurological symptoms can include seizures, coma, somnolence, obtundation, and cardiorespiratory distress 3, 4, 5, 6, 7
• A seizure is considered a severe neurological symptom, particularly in the context of hyponatremia 3, 5, 6, 7

Definition and Treatment

• Hyponatremia is defined by a serum sodium level of less than 135 mEq/L and can cause a range of symptoms from mild to severe 3
• Severe symptomatic hyponatremia, including seizures, is a medical emergency that requires prompt treatment with hypertonic saline to increase the serum sodium level 3, 4, 5, 6
• The goal of treatment is to correct the serum sodium level by 4-6 mEq/L within 1-2 hours, but not to exceed 10 mEq/L within the first 24 hours to avoid osmotic demyelination 3, 5

Management of Hyponatremic Seizures

• Hypertonic saline is a safe and effective treatment for hyponatremic seizures in children and adults 6, 7
• The use of anti-convulsants, such as benzodiazepines and phenobarbital, may be ineffective in managing hyponatremic seizures and can be associated with a high incidence of apnea 6
• A combination of hypertonic saline and anti-convulsants may be used to manage hyponatremic seizures, but careful monitoring of serum sodium levels is necessary to avoid overcorrection 7