Seizure Disorders

In Seizure Disorders, the brain’s electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction.

Many people have unusual sensations just before a seizure starts.

Some seizures caused uncontrollable shaking and loss of consciousness, but more often, people simply stop moving or become unaware of what is happening.

Doctors suspect the diagnosis based on symptoms, but imaging of the brain, blood tests, and electroencephalography (to record the brain’s electrical activity) are usually needed to identify the cause.

If needed, drugs can usually prevent seizures.

Normal brain function requires an orderly, organized, coordinated discharge of electrical impulses. Electrical impulses enable the brain to communicate with the spinal cord, nerves, and muscles as well as within itself. Seizures may result when the brain’s electrical activity is disrupted.

There are two basic types of seizures:

Epileptic: These seizures have no apparent cause (or trigger) and occur repeatedly. These seizures are called a “seizure disorder” or “epilepsy”.

Non-epileptic: These seizures are triggered (provoked) by a disorder or another condition that irritates the brain. In children, a fever can trigger a non-epileptic seizure.

Certain mental disorders can cause symptoms that resemble seizures, called psychogenic non-epileptic seizures.

About 2 % of adults have a seizure at some time during their life. Two third of these people never have another one. Most commonly seizure disorders begin in early childhood or in late adulthood.

Causes

Which causes are most common depend on when seizures start:

Before age 2: High fever or temporary metabolic abnormalities, such as abnormal  blood levels of sugar (glucose), calcium, magnesium, vitamin B6, or sodium, can trigger one or more seizures. Seizures do not occur once the fever or abnormality resolves. If the seizures recur without such triggers, the cause is likely to be an injury during birth, a birth defect, or a hereditary metabolic abnormality or brain disorder.

2 to 14 years: Often, the cause is unknown.

After age 25: A head injury, stroke, or tumor may damage the brain, causing a seizure. Alcohol withdrawal (caused by sudden stopping drinking) is a common cause of seizures. However, in about half of people in this age group, the cause is unknown.

Seizures with no identifiable cause are called idiopathic.

Conditions that irritate the brain such as injuries, certain drugs, sleeping deprivation, infections, fever or that deprive the brain of oxygen or fuel such as abnormal heart rhythms, a low level of oxygen in the blood, or a very low level of sugar in the flood can trigger a single seizure whether a person has a seizure disorder or not. A single seizure that results from such a stimulus is called a provoked seizure and this is a non-epileptic seizure). People with a seizure disorder are more likely to have seizure when they are under excess physical or emotional stress or deprived of sleep. Avoiding these conditions can help prevent seizures.

Rarely, seizures are triggered by repetitive sounds, flashing lights, video games, or even touching certain parts of the body. In such cases, the disorder is called reflex epilepsy.

Symptoms

In about 20% of people who have a seizure disorder, seizures are preceded by unusual sensations (called aura), such as the following:

Abnormal smells or tastes

Butterflies in the stomach

A feeling of déjà vu

An intense feeling that a seizure is about to begin.

Almost all seizures are relatively brief, lasting from a few seconds to a few minutes. Most seizures last between one and two minutes. When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue. These aftereffects are called the postictal state. In some people, one side of the body weak, and the weakness lasts longer than the seizure (a disorder called Todd’s paralysis). Most people who have a seizure disorder look and behave normally between seizures.

Symptoms vary depending on which area of the brain is affected by the abnormal electrical discharge as in the following.

An intensely pleasant or unpleasant taste if the part of the cerebrum called the insula is affected.

Visual hallucinations (seeing unformed images) if the occipital lobe is affected.

Inability to speak if the area that controls speech (located in the frontal lobe) is affected.

A convulsion (jerking and spasms of muscles throughout the body) takes place if large areas on both sides of the brain are affected.

Other possible symptoms include numbness or tingling in specific body part, brief episodes of unresponsiveness, loss of consciousness, confusion, and loss of muscle or bladder control.

Symptoms also vary depending on whether the seizure is partial or generalized. About 70% of people have only one type of seizure. The rest have two or more types.

Treatment

If the cause can be identified and eliminated, no additional treatment is necessary. For example, if a low blood sugar (glucose) level (hypoglycemia) cause the seizure, glucose is given, and the disorder causing the low level is treated. Other treatable causes include an infection, certain tumors, and an abnormal sodium level.

If people have a seizure disorder, general measures plus drugs are usually sufficient. If drugs are ineffective, surgery may be recommended.

General Measures: Exercise is recommended and social activities are encourages. However, people who have a seizure disorder may have to make some adjustments. For example, they should eliminate or limit their consumption of alcoholic beverages and should not recreational drugs. They should refrain from activities in which a sudden loss of consciousness could result in serious injury. For example, they should not bathe in a bathtub, climb, swim, or operate power tools. After seizures are controlled (typically for at least 6 months), they can do these activities if adequate precautions are taken. For example, they should swim only when lifeguards are present. In most states, laws prohibit people with a seizure disorder from driving until they have been free of seizures for at least 6 months to 1 year.

A family member or close friend should be trained to help if a seizure occurs. Attempting to put an object (such as a spoon) in the person’s mouth to protect the person’s tongue should not be tried. Such efforts can do more harm than good. The teeth may damage, or the person may bite the helper unintentionally as the jaw muscles contract. However, helpers should do the following during a seizure:

Protect the person from falling.

Loosen clothing around the neck.

Place a pillow under the head.

If a pillow is unavailable, helpers can put their foot or place an item of clothing under the person’s head.

People who lose consciousness should be rolled onto one side to ease breathing. People who have had a seizure should not be left alone until they have awakened completely or no longer confused, and can move about normally. Usually, their doctor should be notified.

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