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Seizure
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SEIZURE

Introduction

A seizure is the outward sign of a malfunction in the electrical system that controls the brain. A single seizure can have many causes, such as high fever or lack of oxygen or poisoning; seizures that occur more than once, without a special cause, are called epilepsy (also called a seizure disorder).

Seizures may be convulsions, brief stares, muscle spasms, odd sensations, or episodes of automatic behavior and altered consciousness.

What is a Seizure?

 More than 2.5 million Americans, and nearly 50 million people worldwide, have epilepsy. Despite its frequency, epilepsy remains a feared and poorly understood disease. This article is a brief overview of definitions, common risk factors, and treatments for epilepsy.

A seizure is a transient event caused by abnormal excitability of all or part of the brain. The principal cells of the brain, or neurons, use several different types of chemicals (called neurotransmitters) to communicate with each other. These chemical messages are translated into electrical signals, which allow neurons in different parts of the brain to work together and perform tasks: to move your arm, read a book, or tell a story. Normal balancing mechanisms ensure that these signals travel in an orderly fashion. When the brain is injured or when there is an abnormality of the brain's neurotransmitters, normal brain activity is interrupted and replaced by giant waves of electrical impulses that flood the brain's circuits. This abnormal electrical activity is a seizure.

Not all seizures look the same. What you experience or what others see during a seizure, depends on the type of seizure. There are two main types of seizures:

  • generalized and
  • partial.  

Generalized seizures

Generalized seizures involve the entire brain immediately, causing loss or alteration of consciousness. Generalized seizures include grand mal seizures, during which a person falls down unconscious and the body stiffens and jerks. Petit mal, or absence seizures, are generalized seizures during which there is momentary loss of consciousness without abnormal body movements.

Partial seizures

Partial, or focal seizures, begin in one part of the brain. They cause varied symptoms, including auras (unusual warning sensations such as sounds, smells, or a funny feeling in the stomach), staring, chewing, lip smacking, shaking or stiffening of part of the body, wandering, or confusion. A partial seizure may remain in one part of the brain or spread to the rest of the brain. Most seizures last only seconds or a few minutes, but may be followed by sleep or confusion for several hours.

Symptoms of a Seizure

A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, middle, and end

When an individual is aware of the beginning, it may be thought of as a warning or aura. On the other hand, an individual may not be aware of the beginning and therefore have no warning. 

Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor. 

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion. 

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti-seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below. 

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings)
Sensory/Thought Emotional Physical Warning

Jamais vu  Smell Sound Taste Visual loss or blurring Racing thoughts Stomach feelings Strange feelings Tingling feeling 

Fear/Panic Pleasant feeling Dizziness Headache Lightheadedness Nausea Numbness Sometimes seizures come with no warning
Seizure Symptoms
Sensory/Thought Emotional Physical

Black out Confusion Deafness/ Sounds Electric Shock Feeling Loss of Consciousness Smell Spacing out Out of body Experience Visual loss or Blurring

 

Fear/Panic Chewing movements Convulsion Difficulty talking Drooling Eyelid fluttering Eyes rolling up Falling down Foot stomping Hand waving Inability to move Incontinence Lip smacking Making sounds Shaking Staring Stiffening  Swallowing Sweating Teeth clenching/grinding Tongue biting Tremors Twitching movements Breathing difficulty Heart racing      
After-Seizure Symptoms (post-ictal)
Sensory/Thought Emotional Physical
Memory loss Writing difficulty Confusion Depression and sadness Fear Frustration Shame/Embarrassment Bruising Difficulty talking Injuries Sleeping Exhaustion Headache Nausea Pain Thirst Weakness Urge to urinate/defecate  
   

Causes of Seizure & Epilepsy

There is a fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighboring cells at once. This linkage of electrical discharges creates a "storm" of electrical activity in the brain. This is a seizure. When a person has had at least two of these seizures, that's called epilepsy.

The reasons why epilepsy begins are different for people of different ages. But what's true for every age is that the cause is unknown for about half of everyone with epilepsy.

Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy. Severe head injury is the most common known cause in young adults. In middle age, strokes, tumors, and injuries are more frequent. In people over 65, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer's disease.

Often seizures do not begin immediately after a person has an injury to the brain. Instead, a seizure may happen many months later. We do not have a good explanation for this common observation, but scientists are actively researching this subject.

Risk factors for epilepsy & Seizure

Risk factors for epilepsy & Seizure are following:-

  • Babies who are small for their gestational age
  • Babies who have seizures in the first month of life
  • Babies who are born with abnormal brain structures
  • Bleeding into the brain 
  • Abnormal blood vessels in the brain
  • Serious brain injury or lack of oxygen to the brain
  • Brain tumors
  • Infections of the brain: abscess, meningitis, or encephalitis
  • Stroke resulting from blockage of arteries
  • Cerebral palsy
  • Mental handicap
  • Seizures occurring within days after head injury ("early posttraumatic seizures") 
  • Family history of epilepsy or fever-related seizures
  • Alzheimer's disease (late in the illness)
  • Fever-related (febrile) seizures that are unusually long
  • Use of illegal drugs such as cocaine      

Other Risk factors for epilepsy & Seizure

  • Missed medication
  • Lack of sleep
  • Illness (both with and without fever)
  • Severe psychological stress
  • Heavy alcohol use
  • Use of cocaine and other recreational drugs such as Ecstasy 
  • Over-the-counter or prescription medications or supplements that decrease the effectiveness of seizure medicines 
  • Nutritional deficiencies: vitamins and minerals
  • The menstrual cycle 

Epilepsy and the Brian

Epilepsy is a disorder of the central nervous system, specifically the brain. In simple terms, our nervous system is a communications network that controls every thought, emotion, impression, memory, and movement, essentially defining who we are. Nerves throughout the body function like telephone lines, enabling the brain to communicate with every part of the body via electrical signals. In epilepsy, the brain's electrical rhythms have a tendency to become imbalanced, resulting in recurrent seizures.

If you have seen a picture of the brain before, it probably looked like this one, which illustrates the outer surface of the upper brain. This outer surface contains numerous folds that increase the surface area and allow more cerebral cortex to be packed into the skull, giving us more "brain power."   

The brain is an extraordinarily complex organ. When it comes to understanding epilepsy, there are several concepts about the brain you'll need to learn.

The first is that the brain works on electricity. Normally, the brain continuously generates tiny electrical impulses in an orderly pattern. These impulses travel along the network of nerve cells, called neurons, in the brain and throughout the whole body via chemical messengers called neurotransmitters. A seizure occurs when the brain's nerve cells misfire and generate a sudden, uncontrolled surge of electrical activity in the brain.

Another concept important to epilepsy is that different areas of the brain control different functions.

If seizures arise from a specific area of the brain, then the initial symptoms of the seizure often reflect the functions of that area. The right half of the brain controls the left side of the body, and the left half of the brain controls the right side of the body. So if a seizure starts from the right side of the brain, in the area that controls movement in the thumb, then the seizure may begin with jerking of the left thumb or hand.

Sleep and Epilepsy

We all know that we think more clearly, react more quickly, and generally perform better after a good night's sleep. And while a good night’s sleep plays a key role in the overall well-being and health of all people it is even more vital in people with epilepsy. One reason why is because a lack of sleep or poor quality of sleep can in turn increase frequency of seizures. The reasons why sleep deprivation provokes seizures are unclear. However, what we do know is that the sleep-wake cycle is associated with prominent changes in brain electrical activity, so seizures and the sleep-wake cycle are often clearly related. We also know that most types of seizures are affected by sleep, although the degree varies greatly from type to type and patient to patient. Further, there are hormonal changes during sleep that could possibly be related to seizures. Finally, the effects of seizures and seizure medicines on the quality of your sleep can make the relationship even more complicated. In this section we will explore all the different aspects of the sleep-epilepsy connection. Let’s get started with an introductory look at how sleep and epilepsy are connected.  

Diagnosis

Usually it is easy for a doctor to tell whether a patient has epilepsy. But sometimes other disorders can cause sudden changes in behavior that may be confused with epilepsy. The patient's treatment depends on an accurate diagnosis: does the patient have epilepsy or some other disorder? If the diagnosis is epilepsy, the choice of treatment also depends on accurately identifying the specific type (or types) of seizure. Different types respond best to different seizure medicines. Some types can even be made worse by particular medicines.

The doctor seldom gets to see the patient have an actual spell, so the information provided by the patient and family members or other witnesses is extremely important. No matter how accurate and complete the information, however, some episodes are difficult to diagnose correctly, even for experts. Every epilepsy specialist has had patients whose spells were so confusing that the first diagnosis was incorrect. This is one reason that follow-up care, and the additional information it can provide, is so important.

The diagnosis of epilepsy depends largely on your medical history. Because your doctor will probably never see one of your seizures, an accurate description of what happens, either from you or from someone who witnesses your seizure, is essential. Additional tests will help to confirm the diagnosis and to determine which type of epilepsy you have.

EEG

An EEG (electroencephalogram) measures the electrical activity in your brain. The presence of abnormal electrical activity, or "spikes," can help to determine if you have epilepsy, and help to identify the region of the brain where your seizures begin. Longer EEG recordings over several days, known as ambulatory EEG or video-EEG monitoring may show abnormal activity even when the first EEG was normal.

Brain imaging

Brain images are pictures of your brain that are taken in order to look for areas of abnormality that might account for the seizures. The most common type of brain scan is CT (computerized tomography). A more sensitive type of scan is MRI (magnetic resonance imaging), which produces a high-quality image of your brain. Most patients with partial seizures will have brain imaging.

Blood tests

A blood sample may be taken to look for any medical conditions that may be the cause of the seizures.  

Treatment

First aid for a seizure as it's occurring is certainly an important part of treating epilepsy. But taking a longer view, we see that the real objective of treatment for epilepsy is not to extend life or relieve pain. Instead, the goal is to enable people with epilepsy to lead full and unrestricted lives according to their own wishes.

"No seizures, no side effects" is the motto for epilepsy treatment. Not every person with epilepsy is able to reach that goal right now, but with research, more achieve it every year. Doctors keep working with the others to help them achieve the best possible quality of life—measured not by the number of seizures but by how close they come to achieving their own individual aims.

For some people, the treatment of epilepsy consists of taking a pill once or twice a day for a few years. No seizures, no side effects.

Others take many pills year after year. Lots of seizures, plenty of side effects. They may move on to other kinds of treatment. Sometimes they work well and sometimes they do not. People in this situation can get help from a team of health professionals who not only will help them find the most effective treatment to stop seizures, but also will help them to live as well as they can while the search continues. 

Who needs medication?

Not all patients with seizures require treatment with antiepileptic drugs, and some patients need only one or two years of drug therapy. Most patients with epilepsy, however, will require one or more drugs for many years. Overall, there is about a 60 percent chance of good seizure control with a single drug, and about 75 percent with additional drugs.

Other Treatments

Vitamin therapy. Unfortunately, when it comes to epilepsy, high doses of vitamins do not usually do any good. This is often a disappointment to people who would like to have what they think of as a more "natural" kind of treatment than taking medicines every day. Special diets (except for the ketogenic diet) don't seem to have any antiseizure effects, either.  

Help with how you feel. Some people with seizures may need other kinds of treatment -- like counseling for emotional problems or help with anxiety or depression, help with finding jobs, or special education services. This type of treatment may help you cope with this disorder and get on track to a more normal life. But the first priority is to get up-to-date medical care and the best seizure control possible.

Other Treatment Options

About 20 to 25 percent of patients will continue to have seizures despite treatment with antiepileptic medications. For these patients, several other therapies are available, including:-

Ketogenic diet

This is a high-fat, low-carbohydrate, no-sugar diet that is effective for some children with hard-to-control seizures. The diet is very strict, can be difficult to follow, and does not work for every child. It must be monitored closely by your doctor and nutritionist. The diet seems to be more effective for children than adults. 

Vagus nerve stimulation

This treatment involves electronic stimulation of the brain using an implanted device, like a pacemaker. Placement of the stimulator has been shown to reduce the frequency of seizures by about 50 percent in carefully selected patients.

Epilepsy surgery

Some patients with frequent partial seizures may be candidates for brain surgery. This procedure removes the part of the brain that is causing the seizures or prevents the spread of seizure activity from one part of the brain to another. Epilepsy surgery has its own risks and benefits, and is not appropriate for every patient with epilepsy.

Conclusion

Epilepsy is a common neurological disease. If it isn't adequately treated, it can be disabling. Frequent seizures can lead to social isolation, poor school or job performance, restriction of driving privileges, family stress, and loss of independence and self-esteem. Exciting advances in the past 10 years, however, offer many new options for the treatment of epilepsy, including new medications, the ketogenic diet, vagal nerve stimulation, and epilepsy surgery. If you or someone you know has epilepsy, talk to a doctor about treatment options. Most patients can achieve acceptable seizure control with one or more of these treatments.

References:- http://abcnews.healthology.com http://www.epilepsyfoundation.org http://www.epilepsy.com     

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