Seizure

What is Seizure?

Paroxysmal spells, or sudden, sporadic health episodes, can have various causes. Sometimes, they might result from issues in the central nervous system, heart problems, psychological factors or other causes. These spells can involve symptoms like fainting, shaking, uncontrollable movement disorders, episodes related to sleep, or psychologically-induced seizures. Epileptic seizures are one type of these episodes.

An epileptic seizure is a brief event that involves signs or symptoms because of abnormal brain activity. This means that there’s too much synchronized activity in the brain. There are numerous types of seizures, and they can broadly be classified into two categories – partial seizures or generalized seizures. In a partial seizure, a specific part of the brain’s surface, or cortex, is activated first, which might cause simple symptoms such as abnormal movements or strange sensations. This type of seizure can quickly spread and involve the entire brain. Generalized seizures, on the other hand, happen when there’s widespread activation in the brain right from the start.

The most common kind of seizure in adults starts in one part of the brain but quickly becomes generalized. Similarly, some seizures come with changes in awareness or consciousness, also known as complex partial seizures. These types can cause minor movements, like lip-smacking or small limb movements, or result in a state of confusion.

Epilepsy represents a condition where a person experiences regular seizures without a clear trigger. Identifying whether seizures are provoked (that is, caused by something) or unprovoked is crucial for the diagnosis and treatment.

Different types of epileptic syndromes help doctors categorize seizure information better. Some terms that doctors use to describe seizures include “localization-related”, which means the seizures originate from a particular part of the brain. There’s also “idiopathic epilepsy,” which includes seizures with no other symptoms, and “symptomatic epilepsy,” which includes seizures that are a sign of an underlying brain condition. There’s also “cryptogenic” epilepsy, which refers to seizures suspected to be a symptom of an unidentified brain condition. It’s typically specialists who diagnose these kinds of epileptic syndromes.

Lastly, there’s a condition called “status epilepticus,” which refers to a continuous state of seizures. This condition can present in as many forms as there are types of seizures. Intense, generalized seizures that last for more than five minutes or a series of seizures without gaining full consciousness is considered a medical emergency.

What Causes Seizure?

Seizures can be of two types: provoked or unprovoked. Provoked seizures, sometimes referred to as acute symptomatic seizures, can occur due to diverse factors. Electrolyte imbalances, toxicity, head injury, infection, abnormal blood vessels, tumors, and other forms of tissue damage are among these factors. Essentially, any disease complication can provoke a seizure. Some common causes include:

• Electrolyte disruptions like low sugar levels, low sodium, high sodium, low calcium, etc.
• Sudden toxic effects from antidepressants, sympathomimetics (drugs that stimulate the nervous system), and other substances.
• Withdrawal effects from substances such as alcohol, benzodiazepines (a type of medication used for sleep or anxiety disorders), and others.
• Difficulties with prescribed anti-seizure medication schedules.
• Sepsis, a severe response to infection.
• Infections within the central nervous system, the brain, and the spinal cord.
• Brain injury due to a lack of oxygen.
• Head injury as a result of trauma.
• Stroke, whether from a blood clot or a burst blood vessel.
• Tumor growth.
• Inflammation due to conditions like lupus, anti-NMDA receptor encephalitis, and others.

Other triggers can include fever and lack of sleep.

Epilepsy, on the other hand, is a condition that makes a person prone to seizures due to either genetic risks or a chronic illness. By definition, unprovoked seizures happen without an obvious trigger or more than a week after a brain injury or trauma such as a stroke. Recurring unprovoked seizures are what define epilepsy.

Among patients in U.S. general hospitals presenting with generalized convulsive status epilepticus (a condition where seizures last longer or occur close together), about one-fourth are patients with epilepsy experiencing breakthrough seizures, having inconsistencies with medication, or newly diagnosed with epilepsy. Another quarter are patients with seizures related to alcohol use, and half are patients with seizures triggered by various medical conditions.

Risk Factors and Frequency for Seizure

Epilepsy is a condition that varies in how often it occurs based on where you are in the world. In North America, the typical rates lie between 16 and 51 in every 100,000 people each year. It seems to occur more frequently among people who live in lower socioeconomic areas.

Furthermore, it seems that about 25% to 30% of new epilepsy cases result from another cause. Even though epilepsy can begin at any age, it often starts in younger people and those over 50. The main reason older people have seizures, and may develop epilepsy, is due to cerebrovascular disease, which refers to conditions that limit blood supply to the brain.

• The typical rates of epilepsy in North America lie between 16 and 51 in every 100,000 people each year.
• Epilepsy seems to occur more frequently among people in lower socioeconomic areas.
• About 25% to 30% of new epilepsy cases result from another cause.
• Even though epilepsy can start at any age, it often occurs in people who are younger or over 50 years old.
• The main reason older people experience seizures and may get epilepsy is due to conditions that affect the blood supply to the brain.

Signs and Symptoms of Seizure

When diagnosing medical conditions, it’s important first to take a detailed history. If someone has had what appears to be a seizure, certain signs help identify it. Typically, a seizure can cause a sudden change in consciousness and uncontrolled body movements. These movements might start with a phase of stiffening, followed by rhythmic movements. At the onset of a seizure, some people might produce a sound or cry. Others might have a feeling or sensation before the seizure—this is known as an aura. Some people might lose control of their bladder, and biting the tongue is also common. After a seizure, it’s normal for people to experience a period of confusion or altered consciousness.

There are different types of seizures, and any change in consciousness, unusual behavior, or change in perception could possibly indicate a seizure.

When diagnosing a seizure, it’s important to understand the person’s medical history, especially if they have any history of seizures. Other important factors include medication use, past medical history, and any history of alcohol or illicit drug use. If the person is known to suffer from epilepsy, knowledge about any irregularity with the medication becomes crucial. Often, people may have had periods of unconsciousness that were possible undiagnosed seizures.

Physical examination includes a general examination as well as a neurological exam to identify any deficits. If the person is witnessed during the seizure, they may display traits such as eyes wide open and no response to verbal or painful stimuli. Also, rhythmic in-phase movements might be seen.

For patients with suspected seizures who continue to have altered consciousness, a diagnosis of “status epilepticus”—a critical condition where seizures follow one another without recovery between—should be considered. Sometimes referred to as subtle status epilepticus, this condition may only manifest as eye movements, facial or limb twitching, or in some cases, no movement at all.

Testing for Seizure

When a doctor suspects that a person has had a seizure, more tests are advised. The purpose of these tests is to discover what caused the seizure. The doctor typically orders blood work, which includes electrolyte tests. A lumbar puncture, a test where a needle is used to take fluid from around the spinal cord, might be recommended for patients who have a fever, weakened immune system, or other symptoms suggesting a possible infection in the brain or spinal cord.

Imaging tests of the brain, like an MRI or CT scan, are often done to see if anything unusual caused the seizure. These scans are particularly important for those with a history of head injury, cancer, weakened immune systems, and persistent headaches, among other things.

For a healthy adult who has returned to normal after what seems to be a first seizure, the doctor will likely check blood glucose and sodium levels. For women of reproductive age, a pregnancy test is also recommended, as some seizures can be due to hormonal changes related to pregnancy.

An electroencephalogram, or EEG, is another test the doctor might perform. This test records the electrical activity of the brain and can help identify whether the person has epilepsy, a condition characterized by recurrent seizures.

If the person’s consciousness is still altered, or if they’re having more seizures, additional tests like brain scans and blood tests may be required. If there’s a chance the person is having continuous seizures that aren’t visible (known as nonconvulsive status epilepticus), the doctor will likely recommend to seek specialized care and potentially an EEG test as soon as possible.

Treatment Options for Seizure

If you experience a seizure that can be linked to a known cause, such as low blood sugar, you may be able to go home after receiving treatment, as long as your living environment is safe. For those who have had seizures before due to epilepsy, and are now back to their normal state, it might be necessary to adjust the doses or types of medication you’re taking. In some cases, a doctor may need to test the levels of medication in your body. If you’ve stopped taking your epilepsy medication for any reason, you should begin taking it again.

People who have had seizures caused by alcohol withdrawal might also be able to go home after they’ve been treated and observed in the hospital for a certain period. Lorazepam, a type of medicine, has been found to lower the chances of seizures happening again in these cases.

If you’ve had a seizure for the first time and there’s no apparent cause, you may not need to start treatment immediately if you’ve returned to your normal state. However, you should be careful with activities that could potentially be dangerous until you’ve had a follow-up visit with a doctor, had some additional tests, and your condition has been reassessed.

If, however, it’s decided that you do need medication to manage seizures or epilepsy, many options are available, which can be chosen based on their side effects and in consultation with a neurologist, a doctor who specializes in the brain and nervous system. These drugs can be grouped based on how they work. Some drugs block sodium channels, some enhance the effects of a brain chemical called GABA, while others have multiple mechanisms of action.

If you experience a condition called generalized convulsive status epilepticus, which is a type of severe, long-lasting seizure, immediate treatment will be needed while other diagnostic procedures are carried out. Basic care involves paying attention to the airway and your breathing and circulation. Medicines called benzodiazepines are usually the first choice to control ongoing seizures. Breathing problems are a common side effect with these medicines, so patients need careful monitoring. Sometimes, additional medication may be added if adequate doses of benzodiazepines do not control the seizures.

If seizures continue, more intensive treatments may be necessary, including maintaining the airway and possibly controlling blood pressure. Intensive care unit (ICU) admission would be necessary, with continuous monitoring of brain activity. Treatments for this situation could include certain types of strong medications. The best treatment for this severe form of seizures isn’t known, but options could include infusions of benzodiazepines or other anesthetic medicines.

What else can Seizure be?

Seizure-like episodes can arise from many different conditions. It’s crucial to distinguish between a seizure and a fainting spell, also known as a syncopal event. Both types of episodes occur suddenly, but a fainting spell usually has a trigger, lasts for a short period and recovery to full consciousness is quick without any confusion. Both a seizure and fainting spell can cause someone to lose control of their bladder. Sometimes, fainting can also have twitching or jerking movements that can look like a seizure.

Pivotal too is differentiating actual seizures from what’s referred to as psychogenic nonepileptic seizures. More detail on this is available in another chapter.

Here are some conditions that can be mistaken for seizures:

• Syncopal event or Convulsive syncope (fainting spell)
• Psychogenic nonepileptic seizures
• Convulsive concussion
• Movement disorders
• Sleep-related movements
• Repetitive concussion convulsions

What to expect with Seizure

The future health of patients who have had seizures depends largely on what caused the seizures in the first place. If a person’s seizures are due to medical conditions that can be treated, or harmful substances (toxicologic causes), treating these underlying issues should lead to a good outcome.

When it comes to people who have what’s known as ‘acute symptomatic seizures’, their health depends on the underlying disease that’s causing the seizures. For example, people whose seizures are caused by cancerous tumors (neoplastic causes) or injuries resulting in insufficient oxygen to the brain (hypoxic brain injury) will likely have a tougher time than many patients whose seizures are caused by metabolic issues.

The future health of a person who’s had a single seizure without a clear cause (an ‘unprovoked seizure’) is well-established. ‘Unprovoked’ means that no cause can be found after a thorough medical evaluation. If standard tests, like blood tests, medical imaging, and perhaps an EEG (a test that measures brain waves), don’t reveal anything out of the ordinary, it’s estimated that a similar seizure is likely to occur again within five years for about one-third to one-half of these patients. However, if the person has a second or third unprovoked seizure, the chance of more seizures happening increases to about three-quarters.

Possible Complications When Diagnosed with Seizure

Treatment for seizures isn’t only about taking epilepsy medication, but also about identifying and fixing anything that might be causing the seizures. Care is critical to avoid additional brain damage, which could mean taking steps to support breathing and heart health. Monitoring for low blood pressure and low oxygen levels is required, and any such issues should be immediately addressed.

Injury is a common complication of seizures. People might bite their tongues or cut their scalps during a seizure.

Seizures that involve convulsions often lead to brain damage and may even cause more seizures in the future. In critically ill patients, seizures might not be very noticeable but can be detected by an electroencephalogram (EEG), a test that detects electrical activity in the brain. Even these subtle seizures can contribute to brain injuries.

Common Seizure Issues:

• Treating causes, not just symptoms
• Preventing additional brain damage
• Support for breathing and heart health
• Monitoring and addressing low blood pressure and low oxygen levels
• Dealing with injuries caused by seizures, such as tongue and scalp cuts
• Preventing convulsive seizures that can cause brain damage and more seizures
• Monitoring for subtle, unnoticed seizures in critically ill patients

Preventing Seizure

With any health issue, it’s always better to prevent it rather than treat it after it has happened. There are certain conditions that lead to provoked seizures which may be preventable with preemptive measures. For example, seizures caused by withdrawal from alcohol or illicit drugs can be mitigated by seeking timely and proper treatment for these disorders.

In a certain study, it was found that almost two-thirds of patients, who came into emergency rooms with seizures, had insufficiently low levels of antiepileptic drugs. It reminds us how important it is for those with epilepsy to regularly take their medication and avoid triggers such as lack of sleep.

Patients who experience unexplained seizures or spells should be advised not to drive or operate dangerous machinery for their own and others’ safety. The regulations for reporting these incidents can vary from state to state.