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Seizures

Overview

Seizures are unforeseen, uncontrolled, and successive electrical disturbances in the brain. These can manifest into abnormal behavior, movements, and sensations. Of particular note and concern are the changes in levels of consciousness.
A condition characterized by two or more seizures that occur 24 hours apart and are brought about by no identifiable cause is classed as Epilepsy.
While most seizures last from 30 seconds to two minutes, seizures vary in symptoms and severity according to where in the brain they begin and how far they spread.
According to WHO, epilepsy affects around 50 million people worldwide, making it one of the most common neurological diseases globally. A person can have seizure-free life if diagnosed and treated properly.
Seizures that  cannot be attributed to epilepsy should make you explore other common causes, which include stroke, a closed head injury, an infection of the brain such as meningitis, or another illness

Causes

While epilepsy is the main cause of seizures, seizures can also be caused and precipitated by the following conditions ;

  • High fever, due to an infection such as meningitis and encephalitis, etc
  • Insufficient sleep
  • visual stimulants such as flashing sharp lights and moving patterns
  • Low blood sodium (called hyponatremia), which can happen with diuretic therapy(drugs that increase urination) and dehydration
  • High blood sodium
  • Insufficient oxygen
  • Low blood glucose, such as in patients with Diabetes Mellitus
  • Low blood calcium
  • Renal failure/dysfunction
  • Liver failure
  • Medications, such as certain pain relievers and antidepressants
  • Severe bleeding head trauma
  • Trauma during birth, low birth weight, etc
  • Abnormal brain blood vessels
  • Autoimmune disorders, including systemic lupus erythematosus and multiple sclerosis
  • Stroke
  • Brain tumor
  • Use of illegal or recreational drugs, such as amphetamines or cocaine
  • Alcohol misuse
  • Certain genetic disorders
  • COVID-19 virus infection
  • In 50% of the cases, the cause is unknown

Types

Seizures can be categorized into two groups:

  • Generalized seizures which affect both sides of the brain include:
  • Absence seizures (petit mal seizures) involve rapid blinking or a few seconds of staring into space
  • Tonic-clonic seizures (grand mal seizures) can manifest in as:
  • Crying out
  • Losing consciousness
  • Falling to the ground
  • Having muscle jerks or spasms
    exhausted after a tonic-clonic seizure.
  • Focal seizures or partial seizures are restricted to one area of the brain
  • Simple focal seizures may make you feel twitching or a change in sensation, such as a strange taste or smell.
  • You may feel confused or dazed after a complex focal seizure
  • Secondary generalized seizures consist of having a focal seizure, followed by a generalized seizure

Risk Factors And Epidemiology

 Epilepsy affects around 50 million people worldwide such that every 4 to10 per 100 people suffer from epilepsy
Interestingly, low- and middle-income countries see as high as 139 per 100 000 cases with seizures. This may be attributed to certain risk factors being endemic to such countries, such as malaria, road traffic accidents causing injuries, and birth-related injuries. This explains why around 80% of people with epilepsy live in low- and middle-income countries.

Signs And Symptoms

  • Seizure signs and symptoms may range from mild to severe and may be characterized by:
  • Temporary confusion
  • A blank stare for a short duration
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Cognitive or emotional symptoms, such as fear, anxiety, or deja vu
    Seizures may also be shortly followed by complications such as fractures and bruising from injuries related to seizures, anxiety and depression. There is an increased risk of premature death of babies in people with epilepsy

Diagnosis

  • Diagnosis of seizures is made with the aid of the following diagnostic tests. Epilepsy is confirmed based on the exclusion of all other causes of seizures:
    Blood tests:
  • Blood glucose level
  • Serum sodium, calcium, creatinine, etc
  • Renal and hepatic function tests
  • Urine Analysis
  • Toxicology
    Imaging:
  • CT SCAN of the head
  • MRI of the head
    After all the tests have turned out to be normal, is it advised to run ELECTROENCEPHALOGRAM, which can then be used to diagnose epilepsy.

Differential Diagnosis

Based on signs and symptoms, family, medical and drug history, along with diagnostic tests, seizures can be distinguished from similar conditions, which include:

  • Syncopes (temporary loss of consciousness due to fall in the blood pressure): vasovagal syncope, cardiac arrhythmias, orthostatic syncope (fainting upon standing)
  • Psychological disorders: panic attack, hyperventilation (increased breathing out)
  • Metabolic disturbances: alcoholic blackouts; drop in blood glucose; drop in blood oxygen
  • Sleep disorders
  • Movement disorders
  • Transient ischemic attack ( temporary loss of consciousness due to decreased blood flow to the brain)

Treatment

As a seizure might be an isolated event, your doctor may wait until you've experienced more than one before deciding to start therapy. Finding the best possible therapy to stop seizures with the fewest side effects is the main objective in seizure treatment.
A person who is actively seizing is treated in stages, starting with the initial response and progressing through the first line, second line, and third-line treatments. The initial response includes ensuring the person is safe from potential injury (such as surrounding objects) while managing their airway, breathing, and circulation as soon as possible. Airway management should entail laying the person on their side, often known as the recovery position to avoid choking. They may require treatments to open their airway if they cannot breathe due to something blocking their airway.
Seizures and Epilepsy can be managed with a proactive approach if the causes have been short-listed. For instance, proper adherence to anti-diabetic medications, monitoring of blood glucose levels regularly, and following a healthy lifestyle of nutrition, sleep, and physical activity can dodge an upcoming episode of seizure. Interestingly, a healthy lifestyle can potentially delay and prevent an epileptic episode the same way a poor lifestyle can bring about it.

Medications

Medications for seizures and epilepsy are diligently determined based on your age, type, severity, symptoms of the condition, tolerance to, and side-effects of medications. If a single drug is ineffective, an alternate drug is used. If the alternate drug is inefficient alone, it is combined with another drug. If multi-drug therapy fails, surgical correction is considered.
Anti-epileptic drugs include levetiracetam, phenytoin, valproic acid, carbamazepine, ethosuximide, with levetiracetam having the fewest side effects. Treatment can be discontinued after a seizure-free period of 2 years.

Procedures

Surgery is ideal for you if seizures are restricted to the same small area in the brain; that area is not critical to normal brain function and can be safely removed in the surgery. Surgical procedures to treat seizures are as follows:

  • Temporal Lobe Resection
  • Laser Thermoablation Therapy
  • Responsive Neurostimulation
  • Vagus Nerve Stimulation
  • Extratemporal Resection
  • Corpus Callosal Section
  • Resection of Structural Focal Lesion
  • Modified Hemispherectomy

Prognosis

Depending on the cause, seizures can be cured, prevented, and at the very least managed with medications, lifestyle changes, devices, and or surgery.
While more seizures do not harm the brain tissue, persistent and untreated episodes can damage the brain resulting in varying degrees of disability. Of more significant concern are children's behavioral and emotional problems developed due to seizures. These issues are further worsened with the stigma attached to seizures, leading to social isolation, bullying, and frustration. Hence, seizures must be detected, and appropriate management modalities should be engaged promptly.

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