Seizures

Our brain is composed of nerve cells that communicate with each other through electrochemical signals. Messages are transmitted in the form of electrochemical impulses that travel from one neuron to another. In seizure episodes, there is an upsurge of electrical activity in the brain leading to abnormal body movement, sensation, or awareness. Seizures per se are not a disease; rather, seizures are an indication of an underlying disease.

Seizure and epilepsy are two terms that are commonly used interchangeably by many people. However, not all patients who develop seizures have epilepsy. Strictly speaking, epilepsy is the tendency to develop recurrent seizures with no specific determined cause.

Causes

Seizures can be caused by many factors. Virtually, anything that can disrupt the balance of chemicals and the signaling in the brain can cause seizures. Most seizures have unknown cause or are unprovoked. Some of the common identified causes of seizures are:

• Stroke
• Brain injury
• Brain tumor or other mass
• Electrolyte imbalance
• Hypoglycemia (low blood sugar)
• Fever
• Infection

Types

Seizures can be classified according to the area of brain involvement and according to the resulting symptom. Generalized seizures are seizures that involve both sides of the brain whereas Partial seizures are seizures that involve only one side or a small portion of the brain. Most generalized seizures are accompanied by a loss of consciousness or lack of awareness during the episode. Some examples of generalized seizures are:

• Generalized tonic-clonic seizures - This is also known as “grand mal” seizures. This is characterized by loss of consciousness, causing the patient to fall to the ground, followed by episodes of body stiffening (tonic) and episodes of violent body movements (clonic). This usually lasts for a few minutes, after which the patient will regain consciousness, extremely tired and  may be unaware of what happened  (post-ictal).
• Absence seizures - Absence seizures are episodes of loss of awareness that lasts for a few seconds. This is common in children and is usually characterized by episodes of blank stares. This type of seizure happens abruptly and the patient is often unaware of its occurrence making it very difficult to diagnose. Some children who are labeled to have attention problems in school actually may be suffering from absence seizures.
• Myoclonic seizures - Myoclonic seizures are characterized by sudden jerking movements of a group of muscles that last only for a few seconds.
• Clonic seizures - Clonic seizures are characterized by repeated contraction and relaxation of muscles on both sides of the body.
• Tonic seizures  - Tonic seizures are characterized by stiffening or increased tone of the muscles for several seconds that usually happen during sleep
• Atonic seizures - Atonic seizures are characterized by a loss of tone or sudden limping of the body which causes the patient to fall to the ground.

Partial seizures can be divided into three:

• Simple partial seizure - Simple partial seizures are seizures that affect an isolated portion of the body. Depending on the affected area, this type of seizure can be further classified into sensory (such as smell), motor, or autonomic simple partial seizure. The patient is aware of the seizure episode in this type of seizure.
• Complex partial seizure - Complex partial seizures involve isolated areas and are associated with a lack of awareness of the episode.
• Partial seizures with secondary generalization - This type of seizure start with an isolated body part and with intact awareness of the patient which proceeds to a generalized state and will be accompanied by a loss of consciousness.

Diagnosis

Identification of the type of seizure is important in the management of seizure disorders. Observing that a patient is having seizures is easy; however, identifying the patient’s particular type of seizure can be difficult especially since most seizures do not occur in front of healthcare professionals. Therefore, most of the information and description of the seizure will come from the relative and friends of the patient. A video of the seizure episode will provide great assistance to the doctor in diagnosing the patient’s condition. As necessary, your doctor (usually a neurologist or internal medicine specialist) might also request some tests to help determine the cause of the seizure episode. These tests can include blood tests to check for sugar and electrolyte levels, brain imaging studies like MRI or CT scan, and electroencephalogram (EEG) to document the electrical impulses in the brain.

Treatment

Seizures are treated based on the underlying cause. Addressing or removing the cause usually treats provoked seizures. Unprovoked seizures (epilepsy) are treated by taking anti-convulsants, which may include one or more of valproic acid, phenobarbital, clonazepam, gabapentin, lamotrigine, phenytoin, and many other medications. Some seizures that are refractory to medications can benefit from brain surgery especially for those patients whose seizures are structural in origin.

First aid/Home remedies

Because most seizures happen outside the hospital setting, it is important that everyone knows how to give first aid to a person who is having seizures. The following are some recommendations when attending to a patient with seizure:

• Stay calm. Do not panic.
• Accompany the patient throughout the attack, noting that serious injuries can happen during the seizure episode.
• Protect the patient’s head and prevent it from banging into hard objects. Remove sharp and hard objects from the scene.
• Do not attempt to stop the person from moving. Holding a patient down during a seizure episode will not stop the seizures and will only lead to injuries.
• Always check for airway and breathing. Make sure that the patient can breathe properly and that nothing is obstructing his/her airway. Do not put anything into the mouth of the patient during the episode.
• Take note of the duration of the seizure episode. Most seizures do not last for more than a few minutes. If it last for more than 5 minutes, call for emergency help immediately.