Overview
SEIZURES
A seizure is a surge of an abnormal electrical activity in the brain. There are several forms of seizures, which are classified into two broad classes. Outward effects of a seizure may vary from unregulated shaky movements to a subtle momentary loss of awareness, among other features.
Seizures, medically, are studied or placed under the specialty of neurology. Sometimes, they can be placed under emergency medicine. They occur with variable signs and symptoms. Seizures last for several minutes. Normally, it is less than 2 minutes. A seizure that lasts more that 5 minutes should be regarded as a medical emergency that needs medical attention.
Seizures may be provoked or unprovoked. Provoked seizures are said to be as a result of temporary events hypoglycaemia (low blood sugar), hyponatremia (low sodium ion concentration), fever and flashing images. Unprovoked seizures happen without a known cause; they may be exacerbated sleep deprivation or stress.
Epilepsy describes a brain condition in which surges of electrical activity in the brain cause repetitive seizures. A situation where there has been at least one unprovoked seizure and a high likelihood of additional seizures in the future may also be described as epilepsy.
Conditions such as tremor, fainting and non-psychogenic epileptic seizure resemble epileptic seizures but they are not.
Key Facts & Statistics
Key facts and statistics that surround seizures
- Provoked seizures happen in about 25 per 100,000 persons per year.
- Unprovoked seizures occur in about 42 per 100,000 persons per year.
- After occurrence of one seizure, there is 40% probability of experiencing a second seizure.
- At any moment, epilepsy affects almost 1% of the population.
- Seizures can occur in any organism that has a brain.
- According to studies performed about seizure treatment, an estimated 33% of individuals who take anti-seizure medications notice that the seizure symptoms stop completely. Another 335 say that they experience less frequent symptoms after taking these medications.
Risk Factors
What are the risk factors for a seizure?
- Any person, from any race, of any sex and age can have a seizure.
- The following factors can increase the risk:
- Underlying medical condition.
- Being a minor (under the age of 18 years old).
- Biological family history of seizures.
- Being 50 years and above.
Causes
What are the causes of a seizure?
- A surge of electrical activity in the brain causes a seizure.
- Provoked (non-epileptic) seizures are caused by a trigger such as stress, sleep deprivation or hypoglycemia.
- Unprovoked (epileptic) seizures occur randomly. They are the primary symptom of epilepsy.
- Seizures which occur without any known cause are referred to as idiopathic seizures.
Conditions that cause seizures
- Seizures can be caused by medical conditions.
- These are:
- Strokes.
- Genetic conditions.
- Diabetes.
- Aneurysms.
- Brain tumors.
- Cerebral hypoxia.
- Cerebrovascular disease.
- Alzheimer’s disease and other degenerative brain diseases.
- Electrolyte imbalances such as low sodium.
- Eclampsia.
- Epilepsy.
- Venomous bites.
- Poisons such as carbon monoxide poisoning.
- Infections such as sepsis and meningitis.
- Inflammation from auto-immune disorders.
- Hormonal changes.
Signs & Symptoms
What are the warning signs of a seizure?
Warning signs of a seizure may include:
- Sensory symptoms
- Autonomic changes.
- Emotional changes.
Sensory symptoms
Seeing distorted appearances of objects or hearing unexpected sounds or strange feeling on the skin (numbness).
Autonomic changes
- Too much salivation.
- Excessive sweating.
Emotional changes
- Strong emotions such as those of fear.
- Deja vu ( a new experience feels familiar).
- Jamais vu (a familiar experience feels new).
What are the signs and symptoms of a seizure?
- The signs and symptoms of a seizure can be variable depending on the type and severity.
- They are temporary and last shortly, basically a few seconds to minutes.
- They include:
- Staring.
- Unregulated/ uncontrollable movements (convulsions and muscle spasms).
- Clenching of the teeth.
- Abnornmal movements of the eyes.
- Grunting and snorting.
- Loss of bladder control.
- Loss of bowel control.
- Drooling.
- Sudden emotional changes (anxiety, confusion, joy).
Types
What are the most common types of seizures?
There are two most common classes of seizures. These describe the location where a seizure starts in the brain and how if affects an individual. They are:
- Focal onset seizures.
- Generalized onset seizures.
Focal onset seizures
2 sub-classes within this class are:
- Focal onset aware seizure.
- Focal onset impaired awareness seizure.
Generalized onset seizures
There are 6 types of generalized seizures:
- Absence seizures.
- Atonic seizures.
- Tonic seizures.
- Clonic seizures.
- Tonic-clonic seizures.
- Myoclonic seizures.
Stages
What are the stages of a seizure?
Stated and discussed below are the stages of a seizure:
- Prodrome phase.
- Aura phase.
- Ictal phase.
- Postictal phase.
Prodrome phase
Mood or behavioral changes, feeling light-headed or inability to focus moments before a seizure occurs.
Aura phase
Vision changes, fear, nausea and dizziness may be noticed right before the first symptoms begin.
Ictal phase
The moment when the seizure is happening and seizure symptoms can be witnessed or experienced.
Postictal phase
Feelings of confusion or exhaustion immediately after the end of a seizure.
Diagnostic Procedures & Tests
How are seizures diagnosed?
Procedures for diagnosis of a seizure include:
Physical and neurological examination.
During these exams, apart from symptoms, medical and family history are also relayed to the neurologist.
Testing.
- Tests can confirm if an individual actually had a seizure. They are also able to detect the cause.
- Tests carried out as part of seizure diagnosis are:
- Blood tests.
- Computed tomography (CT) scan.
- Electroencephalogram (EEG).
- Lumbar puncture.
- Magnetic resonance imaging (MRI).
Differential Diagnosis
- Syncope.
- Psychogenic non-epileptic seizure.
- Migraine aura.
- Transcient ischaemic attack.
Treatment and Management
How is a seizure treated?
Seizures are treated by the following ways:
- Management of underlying medical conditions
- Taking anti-seizure drugs
- Surgical operation
- Brain stimulation
Management of underlying medical conditions
Managing any underlying medical conditions such as hypoglycemia. This can help in prevention of future occurrences.
Taking anti-seizure drugs
Taking anti-seizure medications. These drugs must be taken under prescription. It should be noted that specific types of seizure have specific medicines.
Examples of anti-seizure drugs are:
- Benzodiazepines.
- Cabamazepine.
- Diazepam.
- Gabapentin.
- Lamotrigine.
- Valproic acid.
- Phenytoin.
- Pregabalin.
- Oxcarbazepine.
Surgical operation
Surgery can help to lower frequency of seizures and their severity by addressing the region of the brain where the seizures begin (Focal point).
Brain stimulation
A device is implanted into the brain to deliver a mild electrical current which interferes with and attempts to stop abnormal electrical activity. Vagus nerve(cranial nerve X) stimulation is one type of stimulation.
First Aid for a Seizure
Seizure First Aid Procedures
- Stay with the patient and start timing the seizure.
- Keep the person safe by removing any objects around.
- Turn the person onto their side if they are not awake or aware.
- Do not put anything such as food or drinks in their mouth.
- Do not restrain the patient.
- Stay with them until they recover from the seizure, awake and alert.
- Contact 911 or any other medical emergency helpline if the;
- Seizure lasts more than 5 minutes.
- Patient has repeated seizures.
- Patient has difficulty breathing.
- Seizure occurs in water. For example, a swimming pool.
- Person in injured, ill or expectant.
- Seizure is the first to occur in the person’s life.
- Person does not return to their usual state.
- Patient asks for medical assistance.
Complications
What are the complications of seizures?
The following are complications of seizures:
- Car accidents.
- Drowning in water, for instance in a swimming pool.
- Falling down.
- Status epilepticus. This is a situation where a seizure lasts for more than 5 minutes or more than one sizure occurs without allowing sufficient time between them for recovery.
- Brain damage. This can occur due to status epilepticus.
- Death. Death can occur due to status epilepticus.
Prevention
How do we prevent seizures?
- Seizures, being unpredictable occurrences, cannot be possibly completely prevented.
- Avoiding triggers is the best prevention measure.