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Seizures 

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Overview  

A seizure is characterized as an abrupt and uncontrollable surge of electrical activity occurring within the brain. It can lead to various alterations in behavior, movements, emotions, and consciousness levels. If an individual experiences two or more seizures, separated by at least 24 hours and without a known cause, this condition is classified as epilepsy.

There are numerous types of seizures, each with its own set of symptoms and severity. The symptoms can vary based on where the seizure originates in the brain and how far it spreads. Most seizures last from 30 seconds to two minutes, but if a seizure continues for more than five minutes, it requires immediate medical attention as it becomes a medical emergency. Common signs of seizures include convulsions, loss of consciousness, muscle spasms, altered sensations, and changes in behavior.

In many cases, seizure disorders can be managed with the use of medications. The prescribed drugs are effective in controlling seizures, but they may also have side effects that need to be taken into consideration. It is essential for individuals with epilepsy to work closely with their healthcare provider to strike a balance between seizure control and managing any medication–related side effects. Regular communication and follow–up appointments with the healthcare provider are crucial to monitor the effectiveness of the treatment and make any necessary adjustments to improve the individual’s quality of life. 

Symptoms  

Seizure symptoms can vary in severity and type, but they often include temporary confusion, staring spells, uncontrolled jerking movements of the arms and legs, loss of consciousness or awareness, and changes in cognitive or emotional states like fear, anxiety, or a feeling of deja vu. Healthcare providers classify seizures as focal or generalized based on where and how the abnormal brain activity originates, but if the exact onset is unknown, they are categorized as having an “unknown onset.” 

Focal seizures

Focal seizures arise from abnormal electrical activity in a specific area of the brain. These seizures can occur with or without a loss of consciousness: 

  • Focal seizures with impaired awareness: During these seizures, individuals experience a change or loss of consciousness, similar to being in a dream. They may appear awake but are unresponsive to their surroundings. Repetitive actions like hand rubbing, mouth movements, or walking in circles may occur. Afterward, they may have no memory of the seizure or even be unaware that it happened. 
  • Focal seizures without impaired awareness: These seizures can affect emotions and sensory perceptions. Things may appear, smell, feel, taste, or sound different during the seizure, but consciousness remains intact. Sudden emotional changes, like feeling angry, joyful, or sad, can also occur. Some individuals may experience vague sensations that are difficult to explain, along with trouble speaking and involuntary jerking of body parts such as arms or legs. Additionally, sensory symptoms like tingling, dizziness, or seeing flashing lights might be present. It’s crucial to differentiate focal seizures from other brain or nervous system disorders, such as migraines, narcolepsy, or mental illnesses, as their symptoms can sometimes overlap.

Generalized seizures

Generalized seizures are characterized by involving all areas of the brain from the start. There are several types of generalized seizures: 

  • Absence seizures: Also known as petit mal seizures, mostly affect children. During these seizures, a person may seem like they are daydreaming or staring into space without any response. The seizures are short and end quickly, so there is no recovery time needed. However, they can happen many times a day, which might be confusing, as it could be mistaken for being distracted or having a learning problem. 
  • Tonic seizures: Tonic seizures lead to muscle stiffening, typically affecting the back, arms, and legs. Individuals experiencing tonic seizures may lose consciousness and fall to the ground. 
  • Atonic seizures: Known as drop seizures, atonic seizures result in a sudden loss of muscle control, causing the person to suddenly fall down or drop their head. 
  • Clonic seizures: Clonic seizures are similar to tonic–clonic seizures, but they lack the initial stiffening of muscles (tonic phase). Instead, during clonic seizures, people lose consciousness and immediately experience convulsions with rapid jerking movements of their muscles. 
  • Myoclonic seizures: These seizures involve a sudden, brief jerk or twitch that affects either a single muscle or a group of connected muscles. If it affects the leg while standing, it can lead to a fall. 
  • Tonic–clonic seizures: Formerly referred to as grand mal seizures, are highly dramatic epileptic episodes. They are characterized by sudden loss of consciousness, body stiffening, and shaking. In some cases, individuals may experience loss of bladder control or accidentally bite their tongue during the seizure. These seizures can persist for several minutes and may initially begin as focal seizures before spreading to affect a large portion or the entire brain. 

If you or someone else experiences a seizure and any of the following conditions are present, it is crucial to seek immediate medical assistance: 

  • The seizure lasts longer than five minutes. 
  • The person stops breathing after the seizure ends. 
  • A second seizure occurs immediately. 
  • The seizure happens alongside a high fever or heat exhaustion. 
  • The individual is pregnant or has diabetes. 
  • The seizure results in an injury. 

Even if you experience a seizure for the first time, seeking medical advice promptly is essential. 

Causes  

Seizures can occur due to a multitude of factors, including genetic abnormalities that can contribute to various seizure disorders. While it’s important to note that not every individual who experiences a seizure has epilepsy, this condition is recognized as the most common underlying cause of seizures. 

Neurons in the brain generate, transmit, and receive electrical impulses. This allows the cells to communicate with one another. Anything that interferes with the communication routes can cause a seizure. Other known cause of triggers of seizures include: 

  • Aneurysms 
  • Brain tumors, including cancer 
  • Cerebral hypoxia or lack of oxygen 
  • Severe concussion and traumatic brain injury  
  • Degenerative brain diseases like Alzheimer’s disease or frontotemporal dementia  
  • High fevers, particularly febrile seizures which are common in children 
  • Brain infection, such as meningitis or encephalitis which can occur due to viruses, bacteria, parasites, or fungi 
  • Severe general sickness, including of COVID–19 infection  
  • Sleep deprivation  
  • Issues with electrolytes, particularly low sodium, calcium, or magnesium  
  • Certain medications used to treat pain, depression, or to assist individuals quit smoking  
  • Amphetamines, cocaine, and other narcotics  
  • Abuse of alcohol, including during withdrawal or excessive intoxication 
  • Hormone-related changes, especially catamenial epilepsy can affect people with a menstrual cycle

Diagnosis  

Diagnosing seizures typically involves a healthcare provider, often a neurologist, who relies on your reported symptoms and specific diagnostic tests to confirm the presence of a seizure and identify its potential cause. Genetic tests may also be utilized to uncover any hereditary conditions that could be responsible for the seizures, including the most likely type. One crucial aspect of the diagnosis is pinpointing a focal point, a specific region where the seizures originate, as this information greatly influences the course of treatment. The common diagnostic procedures for seizure include:  

  • Neurological examination: This can provide information about the health of the brain and neurological system. The behavior, motor skills, and cognitive function may be evaluated. 
  • Imaging tests:  
  • Magnetic resonance imaging (MRI): An MRI may reveal brain abnormalities that could lead to seizures. An MRI scan creates a detailed image of the brain by using powerful magnets and radio waves. 
  • Computerized tomography (CT): CT scans can detect changes in the brain such as tumors, hemorrhage, and cysts that could lead to a seizure. A CT scan takes cross–sectional photos of the brain using X–rays. 
  • Positron emission tomography (PET): This test aids in revealing active brain areas and detecting changes. It examines brain metabolism to determine the source of the seizures. It can reveal the locations in the brain where the seizure occurred. PET scans employ a little amount of radioactive material with a low dose. The substance is injected into a vein. This aids in visualizing active brain areas.  
  • Single–photon emission computerized tomography (SPECT): The scan reveals increased blood flow to the parts of the brain where the seizure starts. During the procedure, a tracer is injected into a vein to provide a detailed, three–dimensional map of blood flow in the brain during a seizure. A low–dose radioactive tracer is used in a SPECT test.  

An ictal SPECT or subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), is an advanced SPECT test that can provide even more detailed data. This test is usually performed in a hospital and includes overnight EEG recording.  

  • Blood tests: These tests are done to detect metabolic and blood chemical abnormalities, immune system issues, toxins, and poisons in the body. Specifically, the quantity of salts in the body, referred to as electrolytes, blood sugar levels and evidence of infections or genetic problems. A blood sample is extracted for laboratory analysis.   
  • Spinal tap: This procedure requires getting a sample of cerebrospinal fluid for testing to check for presence of bacteria, fungi or abnormal cells, glucose levels, protein types and levels, as well as white blood cell types and levels. This is often done if the healthcare provider believes an infection is the cause of the seizure. Spinal tap is also known as a lumbar puncture. 
  • Electroencephalogram (EEG):  In this test, special stickers are placed on your head to measure the electrical activity of your brain. This activity is shown as wavy lines on a recording. The test helps to see if a seizure may happen again. It also helps your healthcare provider check if other conditions that look like epilepsy are not causing the seizures. The test can be done at a clinic, overnight at home, or over a few nights in the hospital, depending on your seizure details. 

Treatment  

Not everyone who experiences a seizure will necessarily have another one. Sometimes, a seizure can be a one–time event, and your healthcare provider might choose not to begin treatment unless you’ve had multiple seizures. The main objective in treating seizures is to find the most effective therapy that can stop seizures while causing the fewest side effects. 

Medication 

The treatment of seizures typically involves the administration of anti–seizure medications, with numerous options available. For the majority of people with epilepsy, one or two medications prove effective in stopping seizures. The primary objective is to discover the most suitable medication that minimizes side effects. In some cases, healthcare providers may recommend a combination of medications to achieve optimal results. However, finding the right medicine and dosage can be a complex process. Common side effects include weight changes, dizziness, fatigue, and mood alterations, while severe side effects, like liver or bone marrow damage, are exceptionally rare. 

When prescribing medication, your healthcare provider will consider your specific condition, the frequency of seizures, your age, and other relevant factors. Additionally, they will thoroughly review any other medications you may be taking to ensure that the anti–seizure medicines do not interact adversely with them. By taking these aspects into account, the goal is to provide you with an effective treatment plan that minimizes seizures and promotes overall well–being.

Dietary therapy 

A ketogenic diet, which is high in fat and very low in carbohydrates, has been found to enhance seizure control. However, adhering to this diet can be challenging due to the limited range of allowed foods. There are variations of high–fat, low–carbohydrate diets, such as low glycemic index and Atkins diets, which may also be beneficial, though their effectiveness is still under study. 

Surgery

When at least two anti–seizure medications fail to effectively control seizures, surgery may be considered as an option. The primary objective of surgery is to prevent seizures from occurring. Surgical intervention is most successful for individuals whose seizures consistently originate from a specific area in the brain. Various types of surgeries exist, including: 

  • Lobectomy: In this procedure, surgeons identify and remove the specific brain region where seizures originate. 
  • Thermal Ablation (Laser Interstitial Thermal Therapy): This minimally invasive method uses concentrated energy to target and destroy the brain cells responsible for causing seizures. 
  • Multiple Subpial Transection: This surgery involves making several cuts in the brain’s areas to disrupt the pathways causing seizures when removing them is not possible. 
  • Corpus Callosotomy: By cutting the connections between the two halves of the brain, this surgery is used to treat seizures that spread from one side of the brain to the other. However, seizures may still occur on the original side after the procedure. 
  • Hemispherotomy: In cases where medications fail to manage seizures and they affect only half of the brain, this surgery disconnects that side from the rest of the brain and body. While this procedure may result in the loss of some daily functional abilities, rehabilitation can often help children regain those functions over time. 

Electrical stimulation 

When the area of the brain where seizures originate cannot be removed or disconnected, alternative approaches involving electrical stimulation devices may provide relief. These devices, used in conjunction with ongoing anti–seizure medication, aim to reduce seizures effectively. Some of the stimulation devices that offer seizure relief are as follows: 

  • Vagus Nerve Stimulation: An implantable device located beneath the skin of the chest stimulates the vagus nerve in the neck, transmitting signals to the brain that can inhibit seizures. 
  • Responsive Neurostimulation: This device is implanted either on the surface of the brain or within brain tissue. It can detect seizure activity and deliver electrical stimulation to interrupt the seizure. 
  • Deep Brain Stimulation: Surgeons insert thin electrode wires into specific areas of the brain to produce controlled electrical impulses. These impulses help regulate the brain activity responsible for seizures. The electrodes are connected to a pacemaker–like device, which is placed under the skin of the chest and controls the stimulation intensity. 

Pregnancy and seizure

While women with seizures can usually have healthy pregnancies, certain medications, like valproic acid used for generalized seizures, have been linked to birth defects and cognitive issues in babies. The American Academy of Neurology advises against using valproic acid during pregnancy due to these risks. It is crucial to discuss these concerns with your healthcare provider and create a pre–pregnancy plan. Pregnancy can also affect medication levels, so adjusting the seizure medicine dosage may be necessary. The goal is to use the safest and most effective medication at the lowest possible dose for seizure control. Taking folic acid before pregnancy can help prevent some complications associated with anti–seizure medicines during pregnancy, and it is recommended for all individuals of childbearing age taking such medications. 

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Diseases & Conditions Seizures