Seizures

Brain activity sometimes suddenly surges, causing a seizure. This surge can lead to changes in how you act, move, feel, and even how aware you are. Epilepsy is when you have two or more seizures at least a whole day apart, and doctors can't find a clear reason for them. Importantly, not all seizures mean you have epilepsy.

Seizures come in different forms, each with varying symptoms and effects on daily life. Where the surge starts in the brain and how far it spreads can affect the type of seizure. Most seizures typically last between half a minute and two minutes. If a seizure lasts longer than five minutes, it's a serious medical situation, and you need immediate help.

Sometimes, seizures happen after a stroke, a head injury, or an infection like meningitis. Other illnesses can also trigger them. But in many cases, doctors can't pinpoint the exact cause.

Many seizures can be controlled with medication, but medicines can have side effects. It's crucial to work closely with your doctor to find a balance between managing your seizures and dealing with any side effects of the medicine.

Seizures: Understanding Symptoms and Types

Seizures are episodes of unusual electrical activity in the brain. Symptoms vary greatly, depending on the type of seizure and can range from mild to severe. People experiencing a seizure might:

• Feel confused briefly.
• Stare blankly for a short time.
• Have uncontrollable jerking movements in their arms and legs.
• Lose consciousness or awareness.
• Experience changes in their thoughts or emotions, including fear, anxiety, or a feeling of familiarity (deja vu).

Doctors classify seizures into two main groups: focal and generalized. This classification depends on where in the brain the abnormal electrical activity starts. If the origin is unknown, it's called an unknown-onset seizure.

Focal Seizures:

Focal seizures begin in a specific part of the brain. They can cause a wide range of symptoms, sometimes with or without a loss of consciousness.

• Focal Seizures with Impaired Awareness: In these seizures, the person might seem awake but is not fully aware of their surroundings. They might stare blankly into space, not respond to others, and engage in repetitive movements like rubbing their hands or making mouth movements. They might walk in circles or repeat words. Crucially, they often don't remember the seizure afterwards.

• Focal Seizures Without Impaired Awareness: In these seizures, the person remains conscious. However, they might experience changes in their senses (sight, smell, touch, taste, or sound), or unusual emotions (anger, joy, sadness). Some people describe odd sensations or nausea. These seizures can also cause problems with speech, jerking of a limb, or sudden symptoms like tingling, dizziness, or seeing flashing lights.

It's important to note that focal seizure symptoms can sometimes mimic other conditions like migraines, mental health issues, or narcolepsy (a sleep disorder).

Generalized Seizures:

Generalized seizures involve widespread electrical activity across the brain. These seizures include various types:

• Absence Seizures (formerly called petit mal seizures): Common in children, these seizures usually involve staring blankly into space or minor body movements (eye blinking, lip smacking). They typically last 5 to 10 seconds but can occur repeatedly throughout the day in clusters. Brief loss of awareness is often part of these seizures.

• Tonic Seizures: These seizures cause a sudden stiffening of muscles, often in the back, arms, and legs. The person might lose consciousness and fall to the ground.

• Atonic Seizures (Drop Seizures): A sudden loss of muscle tone, most often in the legs, causing the person to collapse.

• Clonic Seizures: Characterized by rhythmic jerking movements, often affecting both sides of the neck, face, and arms.

• Myoclonic Seizures: Involve sudden, brief, jerking movements of the arms and legs. Loss of consciousness isn't usually a feature of these seizures.

• Tonic-Clonic Seizures (formerly called grand mal seizures): The most common type of generalized seizure. They involve a loss of consciousness, muscle stiffness (tonic phase), followed by rhythmic jerking (clonic phase). These seizures can last several minutes and may result in urination, biting the tongue, or other complications. They can sometimes begin as a focal seizure and spread throughout the brain.

Phases of a Seizure:

Seizures have three phases:

• Prodrome: This is the period before the seizure, often hours or even days beforehand. People might feel a strange sensation, changes in behavior, or an aura (an initial warning symptom). Auras can include feelings of familiarity (deja vu), unfamiliarity, fear, panic, unusual smells, sounds, tastes, or visual disturbances. Headaches, numbness, tingling, nausea, or dizziness are also possible. Not everyone experiences a prodrome or aura.

• Ictal Phase: This is the active seizure phase, lasting from the first symptom (including the aura) until the seizure ends. The symptoms depend on the specific seizure type.

• Postictal Phase: This is the recovery period after the seizure, which can last from minutes to hours. During this time, people may experience confusion, memory problems, difficulty speaking or moving, sleepiness, dizziness, sadness, fear, anxiety, nausea, headaches, or weakness. They might also feel thirsty or urinate. The length of the postictal phase depends on the type of seizure and the part of the brain affected.

If you have a seizure, or see someone having one, get medical help right away. This is especially important if:

• The seizure lasts longer than five minutes: A seizure lasting this long can be a sign of a serious problem.
• Breathing stops after the seizure: If the person isn't breathing when the seizure ends, immediate help is crucial. Call emergency services (like 911) immediately.
• Another seizure happens right away: This is called a seizure "series" and needs immediate attention.
• The person has a very high fever: Fevers can sometimes trigger or worsen seizures.
• The person is showing signs of heat exhaustion (overheating): This is a serious condition that requires immediate medical attention.
• The person is pregnant: Pregnancy can affect how the body responds to seizures.
• The person has diabetes: People with diabetes may need special care during a seizure.
• The seizure causes an injury: Injuries from seizures, like bumps or falls, need immediate medical attention.
• The seizure happens in water: Seizures in water can be dangerous and require immediate help to avoid drowning.

If it's your first seizure, it's essential to see a doctor or other healthcare professional as soon as possible to determine the cause and get appropriate care.

Want to stay informed about epilepsy treatment, care, and management? Sign up for our free newsletter and get the latest updates delivered to your inbox.

Brain activity glitches can cause seizures. Your brain's nerve cells, called neurons, constantly send electrical signals to each other. These signals let different parts of the brain talk to each other. If something disrupts this communication, a seizure can happen. Sometimes, these problems are caused by changes in a person's genes.

While epilepsy is a common reason for seizures, not everyone who has a seizure has epilepsy. Many other things can trigger a seizure, including:

• High fever: A high fever can sometimes cause a seizure, which is called a febrile seizure. This is more common in young children. The fever disrupts the brain's electrical signals.

• Brain infection: Infections like meningitis or encephalitis can inflame the brain, disrupting its normal electrical activity and causing seizures.

• Serious illness: Severe illnesses, including COVID-19, can also cause seizures. The illness can affect the balance of chemicals in the brain.

• Lack of sleep: Not getting enough sleep can disrupt the brain's normal electrical patterns, leading to seizures.

• Low blood sodium: Your body needs the right amount of sodium. If your sodium levels get too low, it can disrupt brain function and cause a seizure. This can sometimes happen if you're taking medications that increase urination, leading to sodium loss.

• Brain injury: A new brain injury, such as a head trauma, can cause bleeding or damage in the brain, leading to seizures. A stroke can also cause seizures.

• Drug use: Using illegal drugs like amphetamines and cocaine can disrupt brain chemistry and trigger seizures.

• Alcohol misuse: Drinking too much alcohol or suddenly stopping drinking alcohol (withdrawal) can disrupt brain function and cause seizures. The disruption can be severe.

Several factors can make someone more likely to have a seizure. These include:

• Head or brain injuries: Any kind of blow to the head, even a seemingly minor one, can sometimes increase the risk of seizures. This includes injuries from falls, accidents, or sports. Damage to the brain tissue can disrupt normal electrical activity, potentially leading to seizures.

• Cognitive problems: Difficulties with thinking, memory, and learning can sometimes be linked to a higher risk of seizures. Conditions like dementia (including Alzheimer's disease) often involve damage to brain cells, which can trigger seizures.

• Stroke: A stroke occurs when blood flow to the brain is interrupted. This damage can lead to abnormal electrical activity and seizures.

• Alzheimer's disease: This progressive brain disorder involves the gradual loss of brain cells. This damage makes seizures more likely as the disease progresses.

• Brain tumors: A tumor growing in the brain can put pressure on brain tissue and disrupt its normal functioning. This can trigger seizures.

• Alcohol or drug abuse: Using alcohol or illegal drugs can affect the brain's chemistry, making seizures more likely. This is particularly true for heavy or long-term use. Some drugs, in particular, are known to significantly increase seizure risk.

• Family history of seizures: If someone has a close relative who has had seizures, they may have a slightly higher risk of developing them themselves. This is because some genetic factors can increase a person's susceptibility to seizures.

Seizures can sometimes lead to problems that could hurt you or others. Here are some things to be aware of:

• Falls: If you have a seizure and fall, you could hurt your head or break a bone. This is a serious risk. It's important to be cautious and have help available if possible.

• Drowning: Having a seizure in the water, like a pool or bath, could put you at risk of drowning. Taking extra precautions around water when you have seizures is crucial.

• Car Accidents: A seizure can make you lose awareness or control of your body, which could lead to a car accident. If you have epilepsy and drive, it's essential to talk to your doctor about the risks and what precautions you should take. This might include not driving at all if your seizures are frequent or severe.

• Pregnancy Issues: Seizures during pregnancy can be dangerous for both the pregnant person and the baby. Some anti-seizure medications can also increase the risk of birth defects. If you have epilepsy and are planning to get pregnant, it's very important to work closely with your doctor to make sure your medication is safe and appropriate during pregnancy. They can help you adjust your treatment plan if needed.

• Sudden Unexpected Death in Epilepsy (SUDEP): In rare cases, a seizure can lead to sudden, unexpected death. This is called SUDEP. There are several factors that contribute to the risk of SUDEP, including not managing seizures well. While experts don't fully understand the exact causes or risk levels, good seizure management is essential to help reduce the risk of SUDEP. Talk to your doctor if you have any concerns about SUDEP.

If you've had more than one seizure, it's important to avoid things that might trigger another. This means taking steps to prevent situations that could cause a seizure.

Some common triggers include:

• Lack of sleep: Getting enough rest is crucial. Not getting enough sleep can weaken your body and make you more vulnerable to seizures. Aim for a regular sleep schedule and a good night's rest.

• Alcohol and drugs: Using alcohol or illegal drugs can significantly increase the risk of seizures. If you're prone to seizures, it's best to avoid these substances entirely.

• Stress: Stress can have a negative impact on your health, potentially triggering a seizure. Finding ways to manage stress, such as relaxation techniques, exercise, or talking to a therapist, can be very helpful.

• Flashing lights: Some people are sensitive to flashing lights and patterns. If you know you react poorly to bright, rapidly changing lights, try to avoid them whenever possible. This could mean adjusting your surroundings, or making specific choices about where you go.

Diagnosing Seizures: A Guide to Common Tests

Seizures can be frightening, but understanding the tests used to diagnose them can ease your worries. This guide explains some common procedures used to identify the cause and potential for future seizures.

Brain Activity Recording (EEG):

An EEG, or electroencephalogram, is a test that measures the electrical activity in your brain. Small, flat metal discs called electrodes are attached to your scalp. These electrodes connect to a machine that records the electrical signals. Sometimes, a special elastic cap with electrodes is used instead of individual stickers. The EEG can help doctors see patterns of brain activity, which can be helpful in diagnosing conditions like epilepsy, a disorder that causes seizures. The test may be done at a clinic, at home overnight, or for several nights in a hospital.

Imaging Tests to See Inside the Brain:

Several imaging tests can help doctors see the structure and function of your brain:

• CT Scan: A CT scan uses X-rays to create detailed cross-sectional images of your brain. It can show things like tumors, bleeding, and cysts that might be causing seizures.

• MRI Scan: An MRI scan uses powerful magnets and radio waves to create very detailed images of your brain. It's a non-invasive way to see the soft tissues of your brain and identify structural abnormalities that could be associated with seizures.

• SPECT Scan: This test uses a small amount of radioactive material to show how blood flows in your brain. A special type of SPECT called subtraction ictal SPECT coregistered with MRI (SISCOM) combines SPECT images with MRI images to pinpoint the exact location of seizure activity. This is often done overnight in a hospital, often with an EEG recording.

• PET Scan: A PET scan uses a small amount of radioactive material to detect active areas in the brain. This can help identify areas of the brain that might be involved in seizures.

Other Important Tests:

Besides these imaging tests, your healthcare provider might also order:

• Neurological Exam: This exam evaluates your behavior, muscle control, and how well your brain functions.

• Blood Tests: These can check for infections, blood sugar levels, and electrolyte imbalances that could be contributing to seizures.

• Spinal Tap (Lumbar Puncture): This procedure involves collecting a sample of spinal fluid for testing. A spinal tap can help determine if an infection is the cause of seizures.

Preparation for Imaging Tests (like MRI):

Before an MRI scan, it's crucial to complete a safety screening form. This is to ensure that metal in your body doesn't interfere with the scan or cause safety problems. Tell your healthcare team about any metal implants, including dental work, as well as any other metal objects. You may need to remove jewelry, clothing with metal closures, and avoid bringing any metal objects into the MRI room. You'll be given earplugs to help with the loud noises the machine makes. The scan itself is painless, and you'll be closely monitored throughout the procedure. The entire MRI process typically takes 30-50 minutes, but can be longer depending on the complexity of the scan.

Important Note: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider for any health concerns or before making any decisions related to your health or treatment.

Managing Epilepsy: Understanding Treatments and Considerations

Epilepsy is a condition where a person experiences seizures, which are sudden bursts of abnormal electrical activity in the brain. While not everyone who has one seizure will have more, repeated seizures often require medical attention. The goal of treatment is to reduce seizures as much as possible with the fewest side effects.

Medications: Anti-seizure medications (also called anti-epileptic drugs or AEDs) are a common first line of treatment. Many different types exist, and finding the right medication and dosage can take time. Some people need to try several different medications before finding one that works well. Common side effects include weight changes, dizziness, fatigue, and mood swings. Rarely, more serious side effects like liver or bone marrow damage can occur. Doctors carefully consider factors like frequency of seizures, age, and overall health when choosing medications. They also check for potential interactions with other medicines you might be taking.

Dietary Approaches: The ketogenic diet, which is very high in fat and very low in carbohydrates, can sometimes help manage seizures. Other high-fat, low-carbohydrate diets, such as the low glycemic index diet and Atkins diet, may also be helpful, but more research is needed. These diets can be challenging to maintain due to limited food choices.

Surgical Options: If medication doesn't control seizures, surgery may be an option. Surgery is most effective when seizures consistently originate in a specific area of the brain. Surgical procedures include:

• Lobectomy: Removing the part of the brain where seizures begin.
• Thermal Ablation (or Laser Interstitial Thermal Therapy): Using focused energy to destroy the brain cells causing seizures. This is a less invasive approach than a lobectomy.
• Multiple Subpial Transection: Making controlled cuts in the brain to prevent seizures. This is often used when removing the seizure focus is not safe.
• Hemispherectomy: Separating one side of the brain from the rest of the body. This is typically only considered when seizures are severe and confined to one side of the brain and medications aren't working. This procedure can lead to some functional loss, but rehabilitation can often restore some abilities, especially in children.

Stimulation Devices: When surgical removal or separation isn't possible, electrical stimulation devices can help reduce seizures. These devices work alongside medication to lessen seizure activity. These include:

• Vagus Nerve Stimulation: A device implanted under the skin of the chest stimulates the vagus nerve, sending signals to the brain to decrease seizure activity.
• Responsive Neurostimulation: A device placed in or on brain tissue monitors for seizure activity and delivers electrical stimulation to stop it.
• Deep Brain Stimulation: Thin electrodes are placed in specific areas of the brain. A pacemaker-like device under the skin controls the electrical stimulation delivered to the brain.

Pregnancy and Epilepsy: Women with epilepsy can usually have healthy pregnancies. However, some medications used to treat seizures can pose risks to a developing fetus. Valproic acid, for example, is linked to potential cognitive issues and birth defects. Doctors recommend avoiding valproic acid during pregnancy. It's crucial to discuss any potential risks with your healthcare provider before becoming pregnant and to develop a plan for managing medications during pregnancy. Adjusting medication dosages may be necessary during pregnancy. The goal is to use the lowest effective dose of the safest medication. Taking folic acid supplements before and during pregnancy can help mitigate some risks associated with anti-seizure medications.

Ongoing Research: Researchers continue to explore new therapies for epilepsy, including non-surgical methods like MRI-guided focused ultrasound. This technique uses sound waves to target and destroy brain tissue causing seizures without invasive surgery.

Important Note: This information is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of epilepsy.

Managing Seizures: A Guide for Everyday Life

Seizures can be challenging, but with proper management, you can lead a full and safe life. Here are some key steps to help you:

Medication Management:

• Take your medicine as prescribed. Don't change your dosage without talking to your doctor first. If you feel your medication needs adjusting, always discuss it with your healthcare provider. Following the prescribed dosage is crucial for controlling seizures.

• Prioritize Sleep: Getting enough sleep is essential. Lack of sleep can trigger seizures. Aim for a consistent sleep schedule to minimize this risk.

Safety Precautions:

• Wear a Medical Alert Bracelet: This alerts emergency responders to your condition, enabling them to provide the appropriate care in case of a seizure.

• Healthy Lifestyle Choices: Stress management, responsible alcohol consumption, and avoiding smoking are crucial for overall well-being and seizure control. A healthy lifestyle supports your body's ability to manage seizures.

Preventing Injuries During Seizures:

• Water Safety: Avoid swimming alone, and be cautious around water. Never use water-based recreation equipment without a companion or someone nearby.

• Protective Gear: Wear a helmet during activities like cycling or sports. This helps protect your head if you fall.

• Home Safety: Make your home safer by removing sharp corners and using furniture with rounded edges. Thick carpets can also provide cushioning. Using chairs with armrests can prevent falls. Avoid working at heights or using heavy machinery.

• Inform Others: Create a list of seizure first-aid tips and keep it in a visible location. Include emergency contact numbers.

Seizure Detection Devices:

• Technology to Aid in Early Detection: Some devices can detect potential seizures. The EpiMonitor, for example, is a watch-like device that alerts caregivers if a tonic-clonic seizure is imminent. This allows for prompt action to ensure your safety. Another device, the Brain Sentinel SPEAC, attaches to a muscle in your arm to monitor seizure activity. Talk to your doctor about whether these devices might be suitable for you.

What to Do if You See Someone Having a Seizure:

• Safe Positioning: Carefully roll the person onto their side.
• Head Support: Place something soft under their head.
• Comfort: Loosen any tight clothing, especially around the neck.
• Avoid Interference: Do not put anything in their mouth. Do not try to restrain them.
• Clear the Area: Remove anything that could cause injury if the person moves.
• Stay with Them: Remain with the person until medical help arrives.
• Observation and Reporting: Observe the seizure and note its duration. This information can be crucial for medical professionals.
• Stay Calm: Maintaining calm is crucial for both you and the person experiencing the seizure.

Important Considerations:

• Mental Health: Living with a seizure condition can be stressful. Talk to your doctor about any feelings of anxiety or depression. Seek support if needed.

• Family and Friends: Involve your family and friends. They can provide emotional support and learn about your condition. Encourage open communication and answer their questions.

• Workplace Considerations: Discuss your condition with your supervisor and co-workers. Explain what support you need at work in case of a seizure. Open communication with colleagues can help create a supportive environment.

• Support Groups: Connect with support groups, either online or in your community. Sharing experiences and advice with others facing similar challenges can be incredibly helpful.

Remember, having seizures doesn't mean you can't live a fulfilling life. By taking these steps and seeking support, you can effectively manage your condition and maintain your well-being.