Ethan Rhodes
Seizures are characterised by uncontrolled muscle spasms or convulsions, often caused by abnormal electrical activity in the brain. They can be caused by epilepsy, head injuries, brain tumours, lead poisoning, inadequate brain development, genetic deficiencies, infectious diseases, fevers, alcohol abuse, Alzheimer’s Disease, lupus, kidney failure, stroke and other illnesses. In around 50% of seizures, no cause is identified. Seizures are typically treated in a hospital setting, with doctors evaluating symptoms, taking a medical history, and performing neurological exams. EEGs, brain scans, blood tests, and electrocardiograms may also be ordered. Treatment may include anti-seizure medications, electrical stimulation, or surgery.
| Characteristics | Values |
|---|---|
| First response | Move harmful objects out of the way, cushion the head and protect the person from falling, loosen neckwear, make sure the airway is clear and the person is breathing |
| Diagnosis | Testing, evaluating symptoms, taking a medical history, neurological exam, EEG, brain scan, blood tests, ECG, MRI |
| Treatment | Antiseizure medicine, electrical stimulation, surgery, short-term rescue medications, benzodiazepines, AEDs, Phenytoin, phenobarbitone |
| Post-ictal period | Recovery period for the brain, may last from a few seconds to several hours, may involve combativeness |
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Diagnosis and testing
Medical History and Symptoms Evaluation
Healthcare providers begin by taking a detailed medical history, enquiring about the patient's general health, symptoms, and the pattern of seizure occurrences. They may ask about factors that could have triggered the seizures, such as high fever, blood sugar levels, alcohol or drug withdrawal, or a concussion. This information helps in understanding the context and potential causes of the seizures.
Neurological Exam and Brain Imaging
A neurological exam is often conducted to assess the patient's neurological function. This may include evaluating motor skills, sensory abilities, reflexes, and cognitive function. Additionally, brain imaging techniques such as magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and functional MRI (fMRI) are employed to visualize the brain and identify any structural abnormalities, lesions, or areas of abnormal electrical activity that could be causing the seizures.
Electroencephalogram (EEG)
An EEG is a crucial test in the diagnosis of seizures. It involves attaching electrodes to the patient's scalp to record their brain's electrical activity. This helps in identifying abnormal electrical patterns associated with seizures. Prolonged EEG monitoring, sometimes combined with video recording, may be necessary for several days to capture the onset and characteristics of seizures, especially if initial routine EEG results appear normal.
Blood and Urine Tests
Blood tests are often performed to check the levels of medication in the patient's body, assess the medication's impact on other organs, and monitor potential side effects. Urine tests may also be conducted to evaluate how the patient's body is reacting to the medication.
Intracranial Monitoring and Ictal SPECT
Intracranial monitoring involves inserting electrodes through small holes in the skull and the coverings of the brain. These electrodes record brain wave activity during and between seizures, providing valuable data for epilepsy surgery planning and predicting its impact on language and memory function. Ictal SPECT is a procedure that can detect changes in cell metabolism, blood flow, or transmissions between brain cells during a seizure, helping identify seizure-causing conditions in individual patients.
Lumbar Puncture (Spinal Tap)
In some cases, a lumbar puncture may be necessary to measure the pressure in the brain and spinal canal and test the cerebrospinal fluid for infection or other abnormalities that could be contributing to the seizures.
Accurate diagnosis and testing are crucial for developing an effective treatment plan for seizures, which often involves medication, electrical stimulation, or surgery, depending on the specific type and cause of the seizures.
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Treatment with medication
If you experience a seizure, it is important to inform your primary care physician. They will help you determine whether you need to see a neurologist and provide a referral if necessary. A neurologist will review your medical history, perform an exam, and use diagnostic tools and tests to determine if you require ongoing treatment or are at a higher risk of experiencing another seizure.
Medications successfully control symptoms in about two-thirds of people with seizures. Antiseizure medications are typically used to treat seizures lasting longer than five minutes or for multiple seizures. For a person with epilepsy, a neurologist will prescribe medications to prevent or reduce the frequency of seizures. For those who have epilepsy and experience a seizure, emergency medicine may be given as per a pre-agreed care plan.
In the case of a first seizure, patients should undergo routine blood tests to exclude infection or metabolic disturbance and have an electrocardiogram (ECG). An EEG (electroencephalography) or brain scan may also be ordered. In most cases, urgent brain imaging is not required before discharge, but an MRI is the preferred imaging method to investigate seizures.
For short-term rescue medications required for safe discharge, clobazam 10 mg may be prescribed as a temporary add-on therapy prior to specialist advice. In adults, treatment typically starts with benzodiazepines—usually up to two doses of 4 mg of lorazepam or 10 mg of midazolam. Phenytoin and phenobarbitone are currently the only AEDs licensed for ongoing seizures, with speed and adequate dosing likely being more important than the specific medication.
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Surgery
There are several types of epilepsy surgery, and the neurosurgeon will select the safest option for the patient. The most common surgical procedure is the removal of a small portion of the temporal lobe, called a temporal lobe resection. Other types of surgical resection include lesionectomy, lobectomy, multilobar resection, and hemispherectomy. Surgical disconnection involves disconnecting parts of the brain to stop the spread of seizures, and laser interstitial thermal therapy uses MRI scans to guide a small laser probe to destroy nerve cells at the seizure site.
In some cases, a procedure to implant a device that can manage seizures may be a better option, such as in neuromodulation, where a device and electrodes are implanted to send electrical signals to block or disrupt seizure activity at its source. Multiple subpial transections can help reduce or eliminate seizures in vital, functional areas of the brain.
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Recovery
After a seizure, the patient may feel disoriented and confused. They may also experience a period of combativeness. It is important to ensure that the patient is in a safe place and is comfortable. The patient should not be given any food or water until they have fully recovered consciousness. It is also important to ensure that their airway remains clear. If the person is vomiting, they should be rolled onto their left side to protect their airway and help drain away any mouth secretions.
The patient should be taken to the emergency room to rule out any serious medical problems, especially if it is their first seizure. If the patient has epilepsy, it is important to follow their care plan, which may include giving them emergency medicine. The patient will likely be given a referral to a neurologist, who can help determine the cause of the seizure and predict the likelihood of recurrence. Medication is the most common treatment for epilepsy, but there are other treatments available if medication is ineffective.
The number one cause of seizure recurrence is stress and a lack of sleep, so it is important to address lifestyle issues in addition to taking medication. Connecting with others and getting active can help combat the fear of having another seizure.
If someone is experiencing a seizure that lasts longer than two minutes, or they lose consciousness and do not regain it right after the seizure, emergency medical attention is required.
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Prevention
For individuals with epilepsy, it is crucial to follow the prescribed treatment plan and take medications as directed. Maintaining a consistent medication regimen can help prevent seizures and reduce their frequency. Additionally, keeping a seizure diary or journal can aid in recognizing patterns, triggers, and any unusual behaviors. This information can be invaluable for medical professionals in managing epilepsy effectively.
Lifestyle modifications can also play a significant role in seizure prevention. Getting adequate sleep, maintaining a regular schedule, and minimizing stress are recommended. Alcohol consumption and recreational drug use should be avoided, as they can increase the risk of seizures.
To ensure safety and prevent injuries during a seizure, it is advisable to make environmental modifications. This includes replacing glass doors with safety glass or plastic to prevent injury from broken glass. Keeping bathroom and bedroom doors unlocked and unobstructed is crucial for easy access and to prevent entrapment. Taking showers instead of baths reduces the risk of drowning in case a seizure occurs.
For those with epilepsy, wearing a medical ID bracelet or carrying a card that indicates their condition can help bystanders and medical professionals provide appropriate assistance during a seizure. Additionally, it is important to be cautious when engaging in activities where loss of consciousness could be dangerous. This may include avoiding certain contact sports or activities involving water unless supervised by a lifeguard or buddy. Flashing lights and contrasting patterns, such as checks or stripes, should be approached with caution, as they can trigger seizures in some individuals with epilepsy.
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Frequently asked questions
If someone is having a seizure, you should first move them away from any harmful objects and cushion their head to protect them from falling. Loosen any tight clothing around their neck and make sure their airway remains clear. Do not put anything in their mouth and do not attempt to restrain their convulsions. After the seizure, roll the person onto their left side to help drain any mouth secretions.
Most seizures do not require urgent medical attention. However, you should go to the hospital or seek emergency care if the person experiences persistent confusion or remains unconscious, has a fever, is pregnant, is a diabetic, is injured, or appears to be in a life-threatening condition. Additionally, if this is the person's first seizure or represents a change from their typical seizure pattern, it is recommended to seek medical attention.
In a hospital setting, doctors will typically perform tests, evaluate symptoms, take a medical history, and conduct a neurological exam to help make a diagnosis. This may include routine blood tests, electrocardiograms (ECG), electroencephalograms (EEG), or brain scans. For seizures lasting longer than five minutes or multiple seizures, antiseizure medications may be administered.
Seizures are characterized by uncontrolled muscle spasms or convulsions resulting from abnormal electrical activity in the brain. The most common types of seizures are partial, petit mal, and grand mal. Seizures can be further classified as epileptic or non-epileptic, with epileptic seizures associated with a change in electrical brain activity.
Seizures can have various causes, including head injuries, brain tumors, lead poisoning, inadequate brain development, genetic deficiencies, infectious diseases, fevers, alcohol abuse, Alzheimer's Disease, lupus, kidney failure, and stroke. In about 50% of cases, no specific cause can be identified.
