Overview

A seizure is a sudden and uncontrolled burst of electrical activity in the brain, causing changes in behavior, movements, feelings, and awareness. How it shows up depends on which part of the brain is affected and how severe the burst is. Seizures can last from a few seconds to several minutes and can happen just once or repeatedly. When seizures happen often without any clear reason, it might indicate epilepsy, a long-term brain disorder.

Types of Seizures

Seizure classifications are broadly categorized into two main types based on how and where they originate in the brain:

– Focal Seizures (Partial Seizures)

These start in one specific area of the brain.

• Simple Focal Seizures: Do not cause loss of consciousness. They can alter emotions or affect the senses (taste, smell, sight, hearing, or touch).

• Complex Focal Seizures: Cause changes in consciousness or awareness. Individuals may stare blankly into space and not respond normally to their environment or perform repetitive movements.

– Generalized Seizures

Seizure that affects both sides of the brain from the onset.

• Absence Seizures (Petit Mal): Brief, sudden lapses in attention or staring spells, commonly seen in children.

• Tonic-Clonic Seizures (Grand Mal): Characterized by a combination of muscle stiffening (tonic phase) and rhythmic muscle contractions (clonic phase). They often involve loss of consciousness.

• Atonic Seizures: Sudden loss of muscle tone, leading to collapse or falls.

• Tonic Seizures: Sudden stiffening of muscles.

• Clonic Seizures: Repetitive, rhythmic jerking movements.

• Myoclonic Seizures: Sudden, brief jerks or twitches of the arms and legs.

Causes

Seizures can be caused by a wide range of factors, which can be broadly categorized into neurological, metabolic, structural, infectious, genetic, and external influences. Here is an overview of the primary seizure causes:

– Neurological Causes

• Epilepsy: A chronic condition characterized by recurrent, unprovoked seizures.

• Stroke: Disruption of blood flow to the brain can lead to seizures.

• Neurodegenerative Diseases: Conditions like Alzheimer’s disease can increase the risk of seizures.

– Metabolic Causes

• Hypoglycemia: Low blood sugar levels can trigger seizures.

• Hyponatremia: Low sodium levels in the blood can lead to seizures.

• Hypocalcemia: Low calcium levels can also cause seizures.

– Structural Causes

• Traumatic Brain Injury (TBI): Injury to the brain from accidents or blows to the head.

• Brain Tumors: Abnormal growths in the brain can disrupt normal electrical activity.

• Congenital Brain Malformations: Structural abnormalities present from birth.

– Infectious Causes

• Meningitis: Infection of the membranes covering the brain and spinal cord.

• Encephalitis: Inflammation of the brain tissue.

• Brain Abscess: A collection of pus within the brain due to infection.

– Genetic Causes

• Inherited Epilepsy Syndromes: Some forms of epilepsy have a genetic component.

• Genetic Mutations: Certain genetic disorders can predispose individuals to seizures.

– External Influences

• Drug or Alcohol Withdrawal: Seizures can occur when a person stops using drugs or alcohol after heavy or prolonged use.

• Medications: Certain medications can lower the seizure threshold.

• Toxins and Poisons: Exposure to toxic substances can provoke seizures.

– Other Causes

• Fever (Febrile Seizures): High fever, particularly in children, can trigger seizures.

• Sleep Deprivation: Lack of sleep can increase the likelihood of seizures in susceptible individuals.

• Hormonal Changes: For some women, seizures are linked to the menstrual cycle (catamenial epilepsy).

– Idiopathic

In many cases, especially with idiopathic epilepsy, the exact cause of seizures cannot be determined.

Symptoms

Seizure symptoms can vary widely depending on the type of seizure and the part of the brain involved. Here are the common signs of a seizure, according to seizure classification:

General Seizure Symptoms

• Temporary loss of consciousness or awareness of surroundings.
• Brief periods where the person appears to be staring into space.
• Sudden, involuntary muscle contractions, often in the arms and legs.
• Disorientation or inability to respond to questions.
• Unusual sensations (such as a strange smell, taste, or feeling) can precede a seizure.

Simple Focal Seizures

•  No loss of consciousness.
•  Altered emotions or sensations (e.g., sudden joy, anger, or fear).
•  Changes in sensory perceptions (e.g., hearing, taste, smell, vision, or touch).
•  Involuntary jerking of one part of the body, such as an arm or leg.

Complex Focal Seizures

• Altered consciousness or awareness (the person may seem awake but is not responsive).
• Repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles.
• Staring blankly into space.

 Absence Seizures (Petit Mal)

•  Sudden, brief lapses in awareness.
•  Staring spells are often accompanied by subtle body movements (e.g., blinking or lip-smacking).
•  Lasts a few seconds to half a minute.
•  Commonly occurs in children.

Tonic-Clonic Seizures (Grand Mal)

• Sudden loss of consciousness.
• Tonic phase: Body stiffening.
• Clonic phase: Rhythmic jerking of the limbs.
• Possible loss of bladder or bowel control.
• Confusion and fatigue following the seizure (postictal state).

Atonic Seizures

• Sudden loss of muscle tone.
• Dropping of the head or falling to the ground.

Tonic Seizures

• Sudden stiffening of muscles, usually in the back, legs, and arms.
• Possible falling to the ground if standing.

Clonic Seizures

• Repeated, rhythmic jerking movements of muscles on both sides of the body.

Myoclonic Seizures

•  Sudden, brief jerks or twitches of the muscles.
•  Can occur in clusters.

Additional Seizure Symptoms

• Repeated, automatic movements such as lip smacking or hand rubbing.
• Hallucinations (visual, auditory, olfactory), numbness, tingling.
• Sudden feelings of fear, anxiety, or déjà vu.
• Memory lapses, confusion, or difficulty speaking.

Diagnosis

Diagnosing seizures involves a combination of medical history review, physical and neurological examinations, and various diagnostic tests. The goal is to determine whether a person has had a seizure, identify the types of seizures, and uncover any underlying seizure causes. Here is an overview of the diagnostic process:

Medical History

• Collecting detailed accounts of the seizure events, including the duration, type of movements, and any preceding sensations or auras.
• Accounts from people who witnessed the seizure can provide valuable information about the behavior and actions during the episode.
• Information about personal medical history, family history of seizures or epilepsy, and any previous head injuries or illnesses.

Physical and Neurological Examination

• A general physical examination is to check for any signs of injuries or medical conditions that could contribute to seizures.
• Assessment of neurological function, including reflexes, muscle strength, sensory perception, coordination, and mental status.

Diagnostic Tests

• Electroencephalogram (EEG)
• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT) Scan
• Blood Tests
• Lumbar Puncture (Spinal Tap)
• Neuropsychological Tests
• Video-EEG Monitoring
• Sleep Deprivation EEG

Treatment

The seizure treatment aims to control and prevent seizures, reduce their frequency and severity, and improve the overall quality of life for individuals affected by them. The seizure treatment approach can vary depending on the underlying seizure causes, the frequency and types of seizures, and the patient’s overall health. Here is an overview of the primary seizure treatment:

– Medications

• Antiepileptic Drugs (AEDs): The first line of seizure treatment. These medications help to stabilize electrical activity in the brain and prevent seizures.

• Common AEDs: Carbamazepine, Valproate, Phenytoin, Levetiracetam, Lamotrigine, Topiramate, and Clonazepam.

– Surgery

• Resective Surgery
• Lobectomy
• Lesionectomy

– Vagus Nerve Stimulation (VNS)

A small device implanted under the skin in the chest, connected to the vagus nerve in the neck.

– Responsive Neurostimulation (RNS)

An implanted device that monitors brain activity and delivers electrical stimulation to prevent seizures.

– Behavioral and Lifestyle Modifications

• Identifying Triggers
• Regular Sleep
• Stress Management
• Safety Measures

When To See A Doctor

Visit a primary care physician if you experience a seizure for the first time, have recurrent seizures, or if a seizure lasts more than five minutes. Immediate medical attention is also needed if multiple seizures occur without recovery in between. Always seek medical advice for any unusual or concerning signs of a seizure.

If you experience symptoms such as a fever, cough, or shortness of breath and believe you have been into contact with someone who has COVID-19, see your doctor about your treatment options.

Disclaimer

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about a seizure or any other medical condition, please see a doctor for an accurate seizure diagnosis and personalized seizure treatment suggestions.