Epileptic Seizures

The words "epilepsy" and "seizure" may seem similar to some. However, the two have different but related meanings.

"Epilepsy is a neurological condition involving the brain which makes people more likely to have seizures. Normal brain function is made possible by millions of tiny electrical charges occurring between nerve cells in the brain and to all parts of the body. When someone has epilepsy, this pattern may be interrupted by intermittent bursts of electrical energy that are much more intense than usual. They may affect a person's consciousness, bodily movements or sensations for a period of time," says Dr. Batool Kirmani, Director of Scott & White Epilepsy Center. Dr. Kirmani also notes that, "individuals who experience two or more seizures are diagnosed with epilepsy. Approximately three million Americans of all ages, races and ethnicity live with the condition."

"Fortunately, epilepsy is highly treatable with appropriate, professional medical intervention," says Dr. Kirmani. "Effective diagnosis and treatment for this neurological condition is available at Scott & White Neurosciences Institute."

Types of Seizures

Generalized Seizures

Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure. They produce loss of consciousness, either briefly or for a longer period of time and are sub-categorized into several major types: generalized tonic clonic, myoclonic, absence and atonic.

  • Generalized tonic clonic seizurues (grand mal). The most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase). They can last from a few seconds to a few minutes.
  • Absence (petit mal) seizures. Commonly present with an empty stare that lasts a few seconds. They can also present with eyes fluttering and automatisms (such as lip smacking, picking at clothes, fumbling) if prolonged.
  • Myoclonic seizures. Rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot. People usually think of them as sudden jerks or clumsiness. A variant of the experience, common to many people who do not have epilepsy, is the sudden jerk of a foot during sleep. First aid is usually not needed, however, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.
  • Atonic seizures. Produce an abrupt loss of muscle tone. Other names for this type of seizure include drop attacks, astatic or akinetic seizures. They produce head drops, loss of posture, or sudden collapse. Because they are so abrupt, without any warning, and because the people who experience them fall with force, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy. No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the person should be given a thorough medical evaluation.
  • Absence seizures (petit mal). Lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds. There is no warning and no after-effect. More common in children than in adults, absence seizures are frequently so brief that they escape detection, even if the child is experiencing 50 to 100 attacks daily. They sometimes occur for several months before a child is sent for a medical evaluation.
  • Infantile spasms. Clusters of quick, sudden movements that start between three months and two years. If a child is sitting up, the head will fall forward and the arms will flex forward. If lying down, the knees will be drawn up, with arms and head flexed forward as if the baby is reaching for support. What to do: No first aid, but doctor should be consulted.
  • Partial Seizures. In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which consciousness is retained); and complex partial seizures (in which consciousness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized.

    Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucination.
    • Simple (partial) seizures. These normally last less than one minute and produce different symptoms, depending on the part of the brain involved. If the abnormal electrical brain function is in the back part of the brain involved with vision, then sight is affected. More commonly, the person's muscles are affected-with seizure activity limited to isolated muscle groups such as the fingers or larger muscles in arms and legs. Consciousness is not altered, although the person may also experience sweating and nausea.
    • Complex (partial) seizures. Complex seizueres occur in a focal area of the brain, but contrary to simple partial seizures, they impair consciousness. Duration is one to two minutes. Behaviors may include automatisms such as chewing movements, picking clothes or more complex behaviors such as gagging, running, screaming, crying and/or laughing. Individuals may feel tired or sleepy afterward.

Causes of seizures

While the exact cause(s) of seizures may not always be known, some of the more common causes are:

  • In newborns: birth trauma, congenital (present at birth) problems, fever/infection, metabolic or chemical imbalances in the body
  • In children, adolescents and adults: alcohol or drugs, head trauma, infections, congenital conditions, genetic factors, strokes, among others
  • Other causes: brain tumor, neurological problems, medications or drug withdrawal

Symptoms

Symptoms or warning signs of seizures may include:

  • Head turning abruptly to one side
  • Unpleasant smells
  • Epigastric sensation
  • Panic attack (short duration)
  • Visual distortions (color lights, changes in visual perception)
  • Staring
  • Jerking
  • Body stiffening
  • Loss of consciousness
  • Breathing problems or breathing stops
  • Loss of bowel/bladder control
  • Falling
  • Not responding to noise or words
  • Appearing confused or hazy
  • Sleepiness and irritability upon awakening
  • Head nodding
  • Rapid eye blinking and staring
  • Movements of tongue and mouth

Seizure symptoms may mimic other problems or medical conditions. Consult your physician for a diagnosis.

Diagnosis

The doctor's main tool for diagnosing epilepsy is a careful medical history with as much information as possible about what the seizures looked like and any warning signs prior to their occurrence. Your doctor will also perform a thorough physical examination, especially of the nervous system, and will possibly recommend a laboratory examination.

The most commonly employed technique for diagnosing epilepsy is the electroencephalogram (EEG). This machine records brain waves registered by tiny wires taped to the head. Electrical signals from brain cells are recorded in the machine for analysis. Brain waves during or between seizures exhibit special patterns which will help the doctor decide the symptoms are consistent with epilepsy.

Other imaging methods such as CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be used to search for brain lesions such as growths, scars or other anomalies that may be causing the seizures. Which tests and how many of them are ordered may vary, depending on how much each test reveals.

Some centers will also employ Positron Emission Tomography (PET) scans, which unlike other scanning techniques, shows images containing more or less intense color to provide information about chemical activity within organs and tissues, including the brain. PET scanning is useful in evaluating a variety of neurological conditions, such as epilepsy.

Treatment

Treatment for seizures is based on age, health, medical history, seizure type and frequency, patient tolerance (for medications, procedures and therapies) and expectations for the course of the condition. Treatment may include:

  • Medications based on the type and frequency of seizure, patient age, side effects, cost and patient adherence to prescribed medicine schedule for optimal seizure control. Different tests-including blood work, urine tests and EEG's may be done to monitor medication effectiveness.
  • Surgery may be considered in a patient who has seizures uncontrolled by medications; has seizures that always start in one area of the brain; or has a seizure in a part of the brain that can be removed without disrupting speech, memory or vision. Surgery is not an option for everyone with seizures. Discuss it with your physician.
  • Vagus Nerve Stimulation (VNS). This procedure is only used for patients over 12 who have partial seizures not controlled by other methods, including medication. The procedure attempts to control seizures by sending small energy pulses to the brain from the vagus nerve, which is a large nerve in the neck. To accomplish this, a small battery is placed in the chest wall. Tiny wires are attached to the battery and placed under the skin around the vagus nerve. The battery is then programmed to send energy impulses to the brain. Patients feeling a seizure coming on may activate the impulses by holding a small magnet over the battery.

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