Health news of the week: Seizure; Types, causes, symptoms and more.
What is a Seizure?
Seizures are caused by abnormal electrical activity in the brain. In the healthy brain, electrical and chemical signals are fired between nerves called neurons to drive the brain’s ability to think, feel and send instructions to parts of the body, such as the muscles. Seizures occur when this electrical system in the brain malfunctions.
There are many causes of seizure including fever, injury, disease and the use of certain medications. When seizures occur on a regular basis due to a brain disorder, this is called epilepsy.
Symptoms of seizures
Seizures may cause dramatic symptoms such as uncontrollable muscle movement, frothing at the mouth and violent shaking, along with blackout and confusion. However, symptoms can also be mild, with few physical symptoms and a person merely appearing to stare into space and not be paying attention.
There are several types of seizure including non-epileptic seizures which may arise from a head injury or illness, for example, as well as partial and generalized seizures, which are associated with epilepsy. Partial seizures arise from abnormal activity in one part of the brain.
Symptoms may vary according to where exactly that abnormality is, but examples include a wave-like sensation, a sense of déjà vu, numbness, tingling and visual disturbances such as hallucination.
Abnormal electrical activity involving a larger portion or the whole of the brain are referred to as generalized seizures. Examples of generalized seizure include:
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Absence seizure – Where a person appears inattentive for a short period.
Myoclonic seizure – Characterized by muscle twitching.
Clonic seizure – Where the sufferer experiences involuntary muscle spasms.
Tonic-clonic seizure – the form most commonly associated with epilepsy. In tonic-clonic seizure, the skeletal muscles stiffen up causing the body to contract (tonic phase) and this is followed by convulsions and vibration of the stiffened limbs (clonic phase).
Another type of generalized seizure is atonic seizure, also called a drop seizure, which is usually noticeable as a drooping of the head as strength in the head and neck muscles is lost. Although the seizure itself is not damaging, the loss of muscle tone can cause a person to fall and hurt themselves. Warning signs that may precede a seizure include a sense of fear or anxiety, nausea, dizziness and visual disturbances.
Diagnosis
Recurrent and unprovoked seizures are diagnostic for epilepsy but seizures may also occur in people who do not have epilepsy due to other causes such as severely low blood sugar, brain tumours, infection or injury. Therefore, diagnosis of epilepsy involves ruling out any other such underlying causes.
Diagnosis involves an assessment of clinical symptoms and the details of the seizure experienced, followed by an electroencephalogram (EEG) to examine the brain’s electrical activity.
A large range of antiepileptic medications are available. These medications prevent repeated firing of the electrical impulses in the brain. Regular use of antiepileptic drugs can prevent the complications of epilepsy such as accidents brought about during convulsions or sudden loss of muscle tone.
Most antiepileptic drugs, however, are not free from side effects, especially in the case of long-term use. Some examples of antiepileptic agents include phenytoin, carbamazepine, sodium valproate, topiramate and lamotrigine.
Treatment
Not everyone who has one seizure will have another one, and because a seizure can be an isolated incident, your doctor may not decide to start treatment until you’ve had more than one.
The optimal goal in seizure treatment is to find the best possible therapy to stop seizures, with the fewest side effects.
Medication
Treatment for seizures often involves the use of anti-seizure medications. Several options exist for anti-seizure medications. The goal is to find the medicine that works best for you and that causes the fewest side effects. In some cases, your doctor might recommend more than one medication.
Finding the right medication and dosage can be complex. Your doctor will consider your condition, your frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won’t interact with them.
Surgery and other therapies
If anti-seizure medications aren’t effective, other treatments may be an option:
Surgery. The goal of surgery is to stop seizures from happening. Surgeons locate and remove the area of your brain where seizures begin. Surgery works best for people who have seizures that always originate in the same place in their brains.
Vagus nerve stimulation. A device implanted underneath the skin of your chest stimulates the vagus nerve in your neck, sending signals to your brain that inhibit seizures. With vagus nerve stimulation, you may still need to take medication, but you may be able to lower the dose.
Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure.
Deep brain stimulation. Doctors implant electrodes within certain areas of your brain to produce electrical impulses that regulate abnormal brain activity. The electrodes attach to a pacemaker-like device placed under the skin of your chest, which controls the amount of stimulation produced.
Dietary therapy. Following a diet that’s high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, though less effective, aren’t as restrictive as the ketogenic diet and may provide benefit.
Pregnancy and seizures
Women who’ve had previous seizures typically are able to have healthy pregnancies. Birth defects related to certain medications can sometimes occur.
In particular, valproic acid — one possible medication for generalized seizures — has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. Discuss these risks with your doctor. Because of the risk of birth defects and because pregnancy can alter medication levels, preconception planning is particularly important for women who’ve had seizures.
In some cases, it may be appropriate to change the dose of seizure medication before or during pregnancy. Medications may be switched in rare cases.
Contraception and anti-seizure medications
Some anti-seizure medications can alter the effectiveness of birth control (oral contraceptive) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.
Lifestyle and home remedies
Here are some steps you can take to help with seizure control:
Take medication correctly. Don’t adjust the dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.
Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.
Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly if you have another seizure.
Be active. Exercising and being active may help keep you physically healthy and reduce depression. Make sure to drink enough water and rest if you get tired during exercise.
Make healthy life choices. Managing stress, limiting alcoholic beverages and avoiding cigarettes all factor in to a healthy lifestyle.
Personal safety
Seizures don’t usually result in serious injury, but if you have recurrent seizures, injury is a possibility. These steps can help you avoid injury during a seizure:
Take care near water. Don’t swim alone or relax in a boat without someone nearby.
Wear a helmet for protection during activities such as bike riding or sports participation.
Take showers instead of baths, unless someone is near you.
Modify your furnishings. Pad sharp corners, buy furniture with rounded edges and choose chairs that have arms to keep you from falling off the chair. Consider carpet with thick padding to protect you if you do fall.
Display seizure first-aid tips in a place where people can easily see them. Include any important phone numbers there, too.
Seizure first aid
It’s helpful to know what to do if you witness someone having a seizure. If you’re at risk of having seizures in the future, pass this information along to family, friends and co-workers so that they know what to do if you have a seizure.
To help someone during a seizure, take these steps:
Carefully roll the person onto one side
Place something soft under his or her head
Loosen tight neckwear
Avoid putting your fingers or other objects in the person’s mouth
Don’t try to restrain someone having a seizure
Clear away dangerous objects, if the person is moving
Stay with the person until medical personnel arrive
Observe the person closely so that you can provide details on what happened
Time the seizure
Stay calm
Coping and support
If you’re living with a seizure disorder, you may feel anxious or stressed about what your future holds. Stress can affect your mental health, so it’s important to talk with your health care professional about your feelings and seek ways you can find help.
At home
Your family can provide much-needed support. Tell them what you know about your seizure disorder. Let them know they can ask you questions, and be open to conversations about their worries. Help them understand your condition by sharing any educational materials or other resources that your health care professional has given you.
At work
Meet with your supervisor and talk about your seizure disorder and how it affects you. Discuss what you need from your supervisor or co-workers if a seizure happens while at work. Consider talking with your co-workers about seizure disorders — you can widen your support system and bring about acceptance and understanding.
You’re not alone
Remember, you don’t have to go it alone. Reach out to family and friends. Ask your health care professional about local support groups or join an online support community. Don’t be afraid to ask for help. Having a strong support system is important to living with any medical condition.
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