For the next few months I’ll post “5 things criminal attorneys should know about …” and highlight some areas of medicine that often cross into the criminal fields. I did this series a few years ago and I think it’s time to do a little refresher. This is not meant to be an in-depth review, but rather just bullet pointed facts.
For this month we’re going to highlight Seizures.
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Causes
- Toxicology
- Seizure medication noncompliance
- Certain Medications: Tricyclic Antidepressants, anticholinergics, lithium
- Overdose OR withdrawal from many other medications/substances
- Poisoning – Pesticides or other substances
- Medical conditions
- Brain conditions such as hydrocephalus, tumors, stroke (Can be delayed)
- Traumatic brain bleed (Can be delayed)
- Pregnancy complications
- Kidney Failure
- Electrolyte imbalance – especially sodium, potassium
- Low blood sugar (diabetics and non-diabetics)
- Psychogenic (pseudo seizures)
Types
- Grand mal seizures are the most obvious; the entire body convulses. Loss of consciousness occurs. Common symptoms are incontinence and biting of the tongue.
- Partial Seizures affect only one part of the brain; so can present as a focal seizure to one limb, a change in sensation or emotion, or a change in speech. These are very difficult to diagnose because the symptoms may be very subtle.
- Absence seizures present as “spacing out” and the person is not aware of their actions during that time. The person may be completely functional, walk, talk, etc. An observer may not necessarily know the person is having a seizure.
Occurrence
- A person with no history of seizures can have a seizure at any time.
- People with a history of seizures that have not had a seizure for a long time can still have a seizure at any time.
- People on medications for seizures can have “break-through” seizures at any time.
Before and After
- Auras are a warning sign that a seizure is coming on. Not everyone gets auras. Auras can present as a headache, an odd taste in the mouth (like metal), vision changes, etc. Everybody’s aura is different and it can be anything.
- The “post-ictal period” is the timeframe after the seizure where the body and mind are recovering from the seizure. People may appear intoxicated; slur their speech, demonstrate confusion and are very commonly agitated or combative. Most postictal periods last about 15 minutes but they can last much longer – hours or days.
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