SEIZURES

A seizure is a sudden, uncontrolled burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings, and levels of consciousness.There are many types of seizures, and they have a range of symptoms and severity. Seizure types vary by where they begin in the brain and how far they spread. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency.

DIFFERENCE BETWEEN SEIZURES AND EPILEPSY

• Seizures, abnormal movements or behavior due to unusual electrical activity in the brain, are a symptom of epilepsy.
• Epilepsy is a brain condition that puts you at risk of having spontaneous,. recurrent unprovoked seizures.
• Provoked seizures: These happen because of some conditions or circumstances (high fevers, alcohol or drug withdrawal, low blood sugar).
• Unprovoked seizures: These aren’t symptoms of a current medical condition or circumstance and occur when a person’s brain can more easily produce spontaneous seizures. This also includes seizures that happen more than seven days after a specific cause (like a head injury or stroke).

TYPES OF SEIZURES

There are focal onset seizures, generalized onset seizures, and unknown onset seizures.

1. Focal onset seizures: Focal onset seizures begin in only one small area of the brain but can affect large areas. It is also referred to as partial seizures.

Focal onset seizures are  two types:

1. Focal aware seizures: During a focal aware seizure, you’ll remain fully conscious,
2. Focal awareness-impaired seizures:

• This type of seizure affects your consciousness.
• During a focal impaired-awareness seizure, you may not be able to move, talk, or hear as you did before.
• You may also not be able to remember the event.
• The symptoms of a focal aware seizure will depend on which part of the brain the seizure starts.

1. Generalized onset seizures

These seizures start in both sides of the brain simultaneously. Among the more common types of generalized onset seizures are:

• Tonic: Tonic seizures will result in your muscles stiffening up.
• Clonic: The convulsions in clonic seizures may cause abnormal, jerky movements of your limbs. You will likely lose consciousness during these seizures that can last for a few minutes.
• Tonic-clonic: Tonic-clonic seizures include a combination of both tonic and clonic symptoms.
• Myoclonic: During a myoclonic seizure you may experience sudden muscle spasms. These are typically too short-lived to affect consciousness and pass quickly. Myoclonic seizures may be of generalized onset as well as focal onset.
• Absence: People may also refer to these as petit mal seizures. Absence seizures last for only a few seconds. They can cause you to blink repeatedly or stare into space. Other people may mistakenly think you’re daydreaming.
• Atonic: During atonic seizures your muscles suddenly go limp. Your head may nod, or your entire body could fall to the ground. Atonic seizures are brief, lasting about 15 seconds.

1. Unknown onset seizures

Sometimes no one witnesses the beginning of a seizure. For example, someone may wake up in the middle of the night and observe their partner having a seizure.

Symptoms

• A convulsion with no fever
• Short blackouts or confused memory
• Intermittent fainting spells, during which they lose bowel or bladder control, frequently followed by extreme tiredness
• Temporary unresponsiveness to instructions or questions
• Sudden stiffness for no apparent reason
• Sudden falling for no apparent reason
• Sudden bouts of blinking without apparent stimuli
• Sudden bouts of chewing without any clear reason
• Temporarily seeming dazed and unable to communicate
• Repetitive movements that seem involuntary
• Fearfulness for no apparent reason
• Panic or anger
• Peculiar changes in senses, such as smell, touch, and sound
• Jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies.

CAUSES

Seizures can happen for many different reasons. These include:

• Metabolic problems, especially high blood sugar (hyperglycemia)or low blood sugar (hypoglycemia)
• Electrolyte problems, especially low sodium (hyponatremia), calcium or magnesium.
• Drugs and alcohol (this includes prescription medications, recreational drugs, and even caffeine), alcohol withdrawal
• Fevers, especially high grade they’re very common in children, and having these slightly increases the risk of having seizures or epilepsy later in life.
• Cerebral hypoxia(lack of oxygen).
• Aneurysms
• Brain tumors (including cancer).
• Severe concussion and traumatic brain injury.
• Degenerative brain diseases like Alzheimer’s disease or frontotemporal dementia.
• Eclampsia (a condition where high blood pressure can cause seizures in pregnant people).
• Sensitivity to flashing or flickering light.
• Genetic disorders (conditions you have at birth that you inherited from one or both parents).
• Infections (especially encephalitis or meningitis). Infections can happen because of viruses, bacteria, parasites, or fungi.
• Inflammation from autoimmune conditions (where your immune system attacks your brain).
• Mental health problems (known as psychogenic seizures) like conversion disorder.
• Sepsis.
• Strokes or transient ischemic attacks (TIAs).
• Toxins and poisons (such as carbon monoxide poisoningor heavy metal poisoning).

DIAGNOSIS

Your healthcare provider may recommend specific tests to accurately diagnose a seizure and help ensure that the treatments they recommend will be effective. Will take your complete medical history, the events leading up to the seizure and may do lab tests to rule out other conditions that can cause seizure-like activity.The tests may include:

• Blood testing to check for electrolyte imbalances
• A spinal tap to rule out infection
• A toxicology screening to test for drugs, poisons, or toxins
• An Electroencephalogram (EEG)to diagnose a seizure. This test measures your brain waves. Viewing brain waves during a seizure or after can help your healthcare provider to diagnose the type of seizure. An EEG can show evidence of seizure activity even when a person isn’t having a seizure.
• Imaging scans, such as a CT scan or MRI scan, can also help by providing a clear picture of the brain. These scans help to see abnormalities like brain damage or a tumor.

TREATMENT

After one seizure, not everyone will have more of them. Your doctor may opt to wait until you’ve had more than one seizure before starting therapy because a seizure may be an isolated episode.Finding the greatest therapy to prevent seizures with the fewest adverse effects is the ideal objective in seizure management.

Medications

These are the first line of treatment for people with epilepsy.Different kinds of medications can stop seizures as they happen, and other kinds can prevent seizures or make them happen less frequently.Intravenous (IV) medications can treat a seizure while it’s happening. Your healthcare provider may also prescribe daily medications to help prevent seizures or decrease how often they happen.

Dietary therapy

Dietary changes may help people manage epilepsy and reduce seizure frequency long term. Following a ketogenic diet can improve seizure control. A ketogenic diet is high in fat and very low in carbohydrates. But it can be challenging to follow because there’s a limited range of foods allowed.

Surgery

Surgery may sometimes needed to control seizures when drugs are ineffective by removing or disconnecting the problematic portion of the brain from the rest of the brain. If you’ve tried two anti-seizure drugs at prescribed dosages and still experience seizures, medical professionals will often advise you evaluated for epilepsy surgery.

Electrical stimulation

• If the area of the brain where seizures start is unable to be removed or disconnected, devices that provide electrical stimulation may help.
• They can reduce seizures along with continued anti-seizure medicine use.
• This treatment uses a device implanted into your brain that delivers a mild electrical current. That current interferes with and tries to stop the electrical activity of a seizure.
• Two forms of brain stimulation, deep brain stimulation and responsive neurostimulation, are currently available.
• Vagal nerve stimulation– The 10th cranial nerve, the vagal nerve, connects directly to your brain. Electrical stimulation on the left side of this nerve can help reduce how often your seizures happen.

First aid for seizure

Generalized tonic-clonic seizure:

• Protect the person from injury. Clear the area of harmful objects. Cradle the head with a pillow.
• Don’t restrain the person’s movements.
• Don’t put anything into the person’s mouth.
• Turn the person onto one side with the head down to allow saliva drainage and prevent vomit inhalation.
• Stay with the person until they are fully recovered. He or she will probably feel very tired for several hours. Muscle aches and headaches are common.

Non-convulsive seizures:

Move harmful objects out of the way and gently guide the person out of danger. Be reassuring.

After the seizure

Once a seizure is over, you should:

• check the person for injuries
• turn the person on their side, if not already
• clear their mouth of vomit or saliva
• stay with them until they’re fully awake and alert
• provide them with a safe area to rest
• not offer them anything to eat or drink until they’re fully conscious

WHEN TO CALL FOR EMERGENCY MEDICAL HELP?

• A seizure lasts 5 minutes or longer
• One seizure happens right after another without the person regaining consciousness (“coming to”) between seizures.
• The person has trouble breathing
• The person appears to be choking
• The seizure happens in water, like a swimming pool or bathtub
• The person is injured during the seizure
• You believe this is the first seizure the person has had
• The person asks for medical help

OUTLOOK

• Seizures are not an uncommon neurological condition.
• It can be challenging to live with epilepsy. But if you have the right support, it’s possible to live a full and healthy life.
• Most seizure disorders can be controlled with medicine.
• Take prescribed medications.
• Avoid triggers– Some people may be able to identify specific triggers for their seizures. Avoiding these triggers may help you to manage your condition. These can include Stress, Drinking Alcohol, and Lack of sleep.
• You can work with your healthcare provider to balance seizure control and medicine side effects.