Seizures

Overview

A seizure is a sudden imbalance occurring in the brain. It can happen due to uncontrollable electrical impulses within the brain, causing behavioural changes and, in extreme cases, unconsciousness. Patients can suffer mood swings and even a permanent change in their movements due to the disorder.

Types of seizures:

Seizures can be of various types, depending on their symptoms and severity. Generalised seizures can be categorised into the following types:

• Absence seizures: Absence seizures are also known as petit mal seizures and can occur during early childhood. Common symptoms of the disorder involve staring into space, eye blinking, and lip-smacking. The attacks can last up to five to ten seconds but frequently happen throughout the day. The attacks can even come in clusters and make the patient unconscious.
• Atonic seizures: Also known as drop seizures, atonic seizures can cause muscle control loss. As a result, patients tend to collapse rapidly, risking a head injury that can worsen the matter.
• Tonic seizures: Tonic seizures occur in the arms, legs, and back muscles. These, too, can make an individual unconscious all of a sudden.
• Clonic seizures: Clonic seizures are defined by their rhythmic pattern and constant muscle spasms. The attack usually affects the face, arms, and neck.
• Myoclonic seizures: Myoclonic seizures occur in brief spasms or twitches of the arms and legs. However, patients suffering from this disorder do not permanently lose consciousness.
• Tonic-clonic seizures: Previously called grand mal seizures, tonic-clonic seizures are the most severe of all the types. This is the most common type of seizure in epileptic patients and causes abrupt unconsciousness and body stiffening.

Symptoms of Seizures:

Many people experience a period where they can feel that a seizure is going to happen. That lead-up time, known as prodrome (rhymes with "dome"), can sometimes include something called an "aura." An aura is actually a symptom of a focal seizure, which only affects one side of your brain. When focal seizures don’t spread, an aura is the only effect of the seizure. When focal seizures do spread throughout your brain, an aura is more like a warning sign that a more severe seizure is about to happen. The signs include:

• Blind spots (scotomas), which are sometimes outlined by simple geometric designs.
• Zigzag lines that gradually float across your field of vision.
• Shimmering spots or stars.
• Changes in vision or vision loss.
• Flashes of light.

Causes:

Seizures may caused by several reasons:

Abnormal levels of sodium or glucose in the blood.
Brain infection, including meningitis and encephalitis.
Brain injury that occurs to a baby during labour or childbirth.
Brain problems that occur before birth (congenital brain defects)
Brain tumour (rare)
Drug abuse.
Electric shock.
Epilepsy.

Risk factors:

• Risk Factors for Seizures and Epilepsy:
• Babies born small for their age;
• Infants who have seizures in the first month of life;
• Babies born with abnormalities in the brain;
• Bleed into the brain;
• abnormal blood vessels in the brain;
• severe brain injury or a lack of oxygen to the brain;
• Brain Tumors;
• Brain infections include abscess, meningitis, and encephalitis;
• Stroke caused by blockage of arteries;
• Cerebral Palsy;
• Conditions involving intellectual and developmental disabilities;
• Seizures occurring within days of a head injury ("early posttraumatic seizures");
• Possible risk factors include a family history of epilepsy or fever-related seizures, as well as late-stage Alzheimer's disease;
• Autism spectrum disorder;
• Status epilepticus refers to prolonged, fever-related seizures;
• Using illegal drugs, such as cocaine;

Mild head injuries, such as a concussion with a brief loss of consciousness, do not result in epilepsy. However, the effects of repeated mild head injuries and epilepsy remain unknown. 

Possible Complications: 

• It is difficult to learn;
• During a seizure, food or saliva may enter the lungs, resulting in aspiration pneumonia;
   
• Falls, bumps, self-inflicted bites, and driving or operating machinery while having a seizure can all cause injury;
• Permanent brain injury (stroke or other damage);
• Side effects from medications. 
   

Prevention:

Seizures are often unpreventable. However, maintaining a healthy lifestyle will give you the best chance of lowering your risk. You can accomplish the following:
Get lots of sleep. 
Maintain a healthy diet and drink plenty of fluids. 
Exercise regularly. 
Practice stress-reduction techniques. 
Do not use illegal substances. 
If you are taking medication for epilepsy or another medical condition, follow your doctor's instructions. 
 

When to Consult a Doctor?

An individual may need to consult a doctor under the following circumstances:

On Experiencing Symptoms: An individual must consult a neurologist whenever he/she feels the oncoming of a seizure attack or has faced them previously. Epileptologists are neurologists with expertise in treating seizure attacks. The doctor may also question family history and medical history before treating the condition.

Medical assistance is mandatory if the patient:

• Has difficulty breathing 
• Has a seizure lasting for more than five minutes 
• Has repetitive seizure attacks 
• Suffers an injury due to a seizure attack 
• Becomes unconscious or confused frequently

During Pregnancy: Pregnant women must undergo a seizure diagnosis, especially if she has a history of epilepsy. Patients who suffer from insomnia or sleeplessness or forget to take their medication usually suffer more frequently from seizures. Pregnancy can aggravate the condition even more.

Diagnosis:

Diagnosis is integral to confirming the type of seizure and providing proper treatment. For instance, there are over 20 types of anti-seizure medications available. So, the doctor needs to understand the variety to offer the appropriate remedy. There are also other factors to consider, such as the patient's age and whether he/she suffers from other medical conditions.

Physical Examination: Physical examination involves checking for asterixis, lateral tongue bites, or nuchal rigidity. The neurologist or epileptologist may also check for any signs of bruises if the patient has suffered a sudden fall or injury. Signs of the neurocutaneous syndrome are also reviewed. These symptoms appear on the skin and may cause persistent focal asymmetry and back pain. Urinary incontinence is also checked during the physical examination.

Diagnostic Tests

Neurological Examination: Neurologists check the patient's motor abilities, behaviour, and mental functionality when examining seizures. This can confirm any problem in the nervous system or brain. 
Blood Tests: Blood tests are also conducted on the blood sample collected from the patient. This is done to check the sugar levels in the blood. The tests also confirm any signs of infection or genetic anomaly that may cause the seizure attacks. 
Lumbar Puncture: If the blood tests indicate an infection as the cause of the seizure, the doctor may further acquire a cerebrospinal fluid sample. This test confirms any bleeding in the brain and traces of cord cancers.

Doctors may even test for the inflammatory condition of the nervous system if they suspect it to be an underlying cause of the seizures.

Imaging Tests

Magnetic Resonance Imaging (MRI): An MRI test is done using powerful magnets and radio waves. The test produces a much more detailed view of the brain. A neurologist can then look for any abnormality in the brain.

Computerised Tomography (CT): Computerised tomography or a CT scan is a type of x-ray of the brain that produces cross-sectional images. A CT scan is also helpful for examining brain abnormalities like cyst formation, tumours, or bleeding.

Positron Emission Tomography (PET): A Positron Emission Tomography or PET test is usually done by injecting small doses of radioactive material into the patient's vein. The low dose of the radioactive element helps highlight the affected areas of the brain that exhibit the abnormalities.

Magnetoencephalography (MEG): Magnetoencephalography (MEG) is a non-invasive diagnostic method that uses magnetic fields to measure the movement of the brain. The electrical currents produced by the brain are projected via the brain mapping function. This helps doctors identify the specific locations of occurrence of epileptic seizures.

Advanced Tests

Electroencephalogram (EEG): An electroencephalogram or EEG is one of the most common imaging tests for testing epilepsy. During this test, electrodes are attached to the scalp, and a paste-like substance is applied. The electrodes then can record the electrical activities occurring within the brain, which is demonstrated as EEG recordings for further study. The test is highly advantageous for understanding the conditions that may cause epileptic behaviour in patients. This test is the most accurate in diagnosing seizures to date.

Single-Photon Emission Computerised Tomography (SPECT): A single-photon emission computerised tomography or SPECT test is similar to the PET test. Like the PET test, a small dose of radioactive materials is injected into the vein. However, in the SPECT test, a 3D mapping of the blood flow activity within the brain is produced. This test, also known as subtraction ictal SPECT, is conducted with an MRI (SISCOM). The result is a high-resolution image that helps localise the areas of seizure occurrence.

Treatment

Unfortunately, a seizure is a lifelong problem with no permanent cure. However, with proper medical care, the severity and frequency of the attacks can be reduced. There are a few treatment methods available for the various types of seizures.

Home Care: Despite routine medical intervention, taking care of patients with seizures at home is essential. The level of care depends on the frequency and severity of the seizure attacks. However, one of the most common precautions the caregivers can take is providing a cushion to protect the head during a collapse.

Medication: Medications such as Carbamazepine, Valproic acid or Depakene, Phenytoin, Gabapentin, Oxcarbazepine, Lamotrigine, Zonisamide, and Phenobarbital are prescribed commonly in seizure patients. However, patients or caregivers must never self-medicate. Always get diagnosed by a licensed neurologist and only consume prescribed medication according to dosage. Usually, the doses start small, and a doctor may increase the dosage gradually while keeping the attacks within control.

Surgical Treatment

Resective Surgery: Under extreme circumstances, surgery may be the only viable option for treating seizure patients. Among all the surgical treatments available, resective epilepsy surgery is the most common. The doctor removes a small portion of the brain by cutting into the tissue where the seizures may occur. This is done if the doctor suspects a tumour formation or a brain injury. The surgery is performed on the temporal lobe area, which is responsible for controlling emotions, language comprehension, and visual memory.

Disconnective surgery: Instead of removing a portion of your brain, the surgeon will cut the connections between the nerves in your brain that are causing your seizures.

Laser interstitial thermal therapy (LITT): LITT or laser interstitial thermal therapy is a less invasive surgical procedure. As the name suggests, the process uses a laser that pinpoints and kills a small portion of the brain. The surgery is guided with the help of an MRI.

Corpus callosotomy: Corpus callosotomy surgery allows partial removal of the corpus callosum. This is the part of the brain tissue that connects the nerves on the left and right hemispheres. Usually, this surgery is done on child patients who suffer from brain abnormalities.

Hemispherectomy: A hemispherectomy surgery allows the neurologist or epileptologist to operate on the brain's cerebral cortex. This is also done on child patients who suffer from sudden seizure attacks. The doctor can recommend this procedure if they suspect that the seizure occurrence is on one side of the hemisphere. This surgery effectively treats congenital problems, that is, a seizure disorder occurred at birth.

Deep Brain Stimulation: Deep brain stimulation or DBS is done with the help of electrodes and a neurostimulator device. This is a type of neuromodulation therapy conducted under the supervision of an experienced epileptologist. The process aims at altering the networks within the brain with the help of electrical stimulation.

Functional Hemispherectomy: The procedure removes the connective nerves without damaging the brain. A doctor may prescribe this surgical treatment to control severe seizure attacks in children. However, some risks are involved with this invasive process like loss of movement, loss of visual fluid, and bleeding.

Lifestyle Modifications:

Lifestyle modifications may include:

• Adequate sleep: Fatigue is one of the most common seizure triggers, and interrupted sleep can make the brain more susceptible to misfiring.
• Drugs and alcohol should be avoided: Because they can cause seizures in epilepsy patients. Even one or two drinks can result in seizures.
• Reduced emotional stress: Although there is no conclusive evidence that stress causes seizures, those who maintain healthy stress levels report that it lowers their risk.
• The frequency of exercise: Regular exercise has a variety of health benefits, including lowering the risk of seizures. However, you should consult your doctor before beginning a new exercise routine, as some exercises can occasionally cause seizures.

Additional Information

Movement disorders vs seizures: Certain involuntary movement disorders (MD) like tics and tremors can be mistaken for a focal or myoclonic seizure. Other disorders that share common symptoms of seizures are Huntington's disease, Parkinson's disease, and Tourette's syndrome. All of these are brain disorders, but their causes and treatments vary.

Nicotine and seizure: There are still controversial results on research done on the impacts of smoking on seizure patients. However, tobacco and nicotine have proconvulsant effects that can disrupt the function of anti-seizure drugs. So, seizure patients are especially recommended not to smoke.