Understanding Seizures: Causes, Symptoms & Management

Overview

Introduction

A seizure is a sudden and synchronous blow-up of electrical activity in brain cells ¹Introduction | Researched based study from National Health Services .  Different types of seizures exist depending on the brain area that is concerned. Seizures can affect anyone, primarily children whose brains are still developing. A repetition (at least two) of unprovoked seizures that involves body muscles is called epilepsy1Introduction | Researched based study from National Health Services.

Causes

Causes and Triggers of Seizures

Seizures occur when brain cells are overly excited ¹Causes | Researched based study from National Health Services . The factors that cause an increase in excitation can be acquired or linked to genes. The causes of seizures are ²Causes | Researched based study from National Health Services :

• Structural: These are anomalies of brain structure that increase the risk of seizure. They include traumatic brain injuries, tumors, blood vessel malformations, et cetera.
• Infectious: Some brain diseases like meningitis, the human immunodeficiency virus (HIV), and brain abscesses may present with seizures.
• Immune: About 30% of people with new-onset seizures may have a disease in which the body’s fighting cells assault healthy body cells (autoimmune). Examples include rheumatoid arthritis, systemic lupus, etc. ⁷Causes | Researched based study from National Health Services
• Genetic: Several gene variations that cause seizures in some people have been identified. Besides, parents may or may not transmit the disease to their offspring. This is because some changes in genes can occur spontaneously in children without being present in either of the parents.
• Metabolic: Some metabolic diseases can cause a seizure such as a decrease in blood sugar, an accumulation of metabolic wastes (like ammonia), or diseases related to some nutrients (amino acids for instance).
• Unknown causes: In many cases, the cause of the seizure might be unidentified.

Several reversible and short-lived insults can trigger seizures in some people. These include –

• Fever (especially in children)
• Alcohol
• Recreational drugs
• Lack of sleep
• Stress
• Flashing lights
• Not taking medications (If you have a seizure related disease)³Causes | Researched based study from Epilepsy

Signs

Signs of Seizures

Every part of the brain can be affected by a seizure ¹Signs| Researched based study from National Health Services . The signs can be –

• Motor (involving body muscles)
• Non-motor (not involving body muscles)

Motor signs include –

• Uncontrolled muscle jerks
• Stiffening

Nonmotor signs include –

• Visual changes like a starring spell
• Memory changes such as having the feeling you have already lived a situation—known as déjà vu
• Skin sensations like a feeling of “pins and needles ¹Signs | Researched based study from National Health Services .”

If you experience a focal-onset seizure, you might have a feeling that it is about to happen. This is called an aura and can last for several seconds to about an hour ¹ Signs | Researched based study from National Health Services .

An aura can present itself in several ways:

• flashing lights
• A strong emotion of fear
• Hearing voices

Types

Types of Seizures

There are two main types of seizures:

• Focal-onset seizures
• Generalized-onset seizures
• Unknown-onsetx

When the cause of the seizure is still to be identified, the seizure is classified as unknown ²Types | Researched based study from National Health Services .

A focal seizure can subsequently become generalized—a seizure known as a focal to bilateral tonic-clonic seizure.

Focal Onset Seizure:

The burst of electrical activity starts in brain cells limited to one part of the brain. Focal-onset seizures may be motor or non-motor and the patient may or may not remain conscious.

Motor focal-onset seizures include:

• Tonic-clonic: Seizure movements present as stiffening and jerking of some parts of the body.
• Myoclonic: Patients who experience myoclonic seizures stay aware and experience twitches in some body parts.  
• Atonic: In an atonic seizure, there is a sudden loss of strength in one part of the body.
• Automatisms: Automatisms manifest as a repetition of clichéd behaviors associated with a loss of awareness—patients do not remember what happened during the seizure.
• Hyperkinetic: It is characterized by intense motor activity involving the limbs and the trunk: gesticulation, bizarre movements, agitation, et cetera.
• Epileptic spasms: Epileptic spasms are a series of sudden flexion, extension, or a combination of both movements of muscles of the trunk and limbs, lasting a few seconds and usually occurring on waking.

Nonmotor seizures include:

• Autonomic: If seizures cause symptoms such as increased heartbeat, goosebumps, breath changes, sexual arousal, a sense of heat or cold, et cetera, they are classified as autonomic seizures.
• Behavior arrest: These are focal seizures that express themselves through a pause in activities or freezing.
• Cognitive: Patients with seizures often experience cognitive impairment—a situation marked by an intellectual disability.
• Emotional: Focal emotional seizures very often manifest as mood swings and stress-related symptoms such as dry mouth, over-breathing, and sweating.
• Sensory: Sensory seizures may concern any of the five senses (hearing voices, blurriness, et cetera).

Generalized Onset Seizure:

• Here, the burst of electrical activity starts in all parts of the brain at once. This causes the patient to lose consciousness.
• Generalized-onset seizures may also be motor or nonmotor.
• Motor generalized-onset seizures are similar to motor focal-onset seizures but involve all the limbs.
• Nonmotor generalized-onset seizures are also called absence seizures. Absence seizures involve gazing with unresponsiveness to external verbal stimuli, sometimes with the eye blinking or the head nodding.

Unknown Onset Seizure:

• Once further information is available after investigating the seizure, a seizure of unknown onset can be relabeled as either focal- or generalized-onset.
• After adequate investigation, your doctor will identify the type of seizure and propose appropriate tests and treatment.

Complications

Complications of Seizures

There exist several complications of seizures, related to either the seizure itself or the medications used to treat seizures. They include : ⁴Complications| Researched based study from MayoClinic

• Falling: This increases the risk of physical trauma (head and bone injury)
• Drowning:  Having a seizure while swimming can be life-threatening
• Car accidents: Especially seizures that cause loss of consciousness or the inability to control the vehicle.
• Emotional complications: like Depression and anxiety.
• Pregnancy and seizures ⁵ Complications | Pregnancy and Seizures| Researched based study from Medscape : Despite the triggering factors already mentioned, hormonal changes associated with pregnancy may elicit seizures in pregnancy. The use of seizure drugs before and after conception may affect the baby and cause malformations like facial changes, restricted growth, and defects of the nervous system. Your doctor will supplement folic acid to your diet and assess your condition to determine if a different treatment is possible.

Diagnosis

Diagnosis of Seizures

If you have a seizure, especially for the first time, your doctor will thoroughly assess your medical history and examine your nervous system—cornerstones of the diagnosis of seizures ¹Diagnosis | Researched based study from National Health Services . Important features of your medical history include the context in which the seizure occurred, warning signs, and details of the seizure itself.

Your doctor may then propose several tests to determine the cause of the seizure. These tests may include:

Electroencephalogram (EEG):

• The EEG will record your brain’s electrical activity and detect areas of high electrical activity, which appear as focal or diffuse spikes.
• It can be repeatedly normal. Your doctor may ask you during the test to breathe fast if he suspects you may have an absence seizure.

Lumbar Puncture:

• A lumbar puncture can be done to assess an infection of the central nervous system, such as meningitis.

Blood Tests:

• Your doctor may ask you for a blood sugar test or screen for specific substances in your blood, such as amino acids and some toxic waste (e.g., ammonia).

Imaging Tests:

Signs of focal-onset seizures on physical examination require imaging tests to localize and describe the brain injury. They include:

• Computerized Tomography (CT) Scan: A CT scan is particularly sensitive for brain structural injuries such as tumors and bleeding.
• Magnetic Resonance Imaging (MRI): MRI is the first-choice imaging technique because it best evaluates the brain and gives more information on brain injuries compared to CT scans.
• Positon Emission Tomography (PET) Scan:  A PET scan can help localize seizure areas by assessing blood sugar consumption in specific regions of the brain.
• Single-photon Emission Computerized Tomography (SPECT): A SPECT scan describes blood flow changes in the brain and is mainly used for seizure cases that require surgery.
• Gene Tests: Your doctor may order gene tests to determine the types of genes involved as well as other associated disease conditions.

Management

Management of Seizures

Medical treatments and surgery are available to manage seizures and their underlying causes. These treatments seek to decrease the overexcitation of brain cells. Your doctor’s decision to begin one medication over another will depend on your age, seizure type, other medical conditions, and side effects.

Lifestyle Changes and Home Remedies:

Several lifestyle changes may reduce the risk and frequency of seizures. They include ⁶Treatment | Lifestyle modifications| Researched based study from Epilepsy :

• Healthy eating
• Exercising regularly: Regular aerobic exercises (running, walking, or cycling) that supply oxygen to the brain can significantly reduce seizures.
• Psychiatric care for stress management counseling
• Adequate sleep
• Avoiding drugs or alcohol

Outlook

Outlook

Seizures are common, especially in children whose brains are developing. Several treatment options are available to treat seizures and simple lifestyle changes can help improve the quality of life.