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Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. When people
think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably. Not all seizures cause
convulsions. There are many types of seizures and some have mild symptoms. Seizures fall into two main groups. Focal seizures,
also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides
of the brain.
Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. However, it is a medical emergency if seizures last
longer than 5 minutes or if a person has many seizures and does not wake up between them. Seizures can have many causes,
including medicines, high fevers, head injuries and certain diseases. People who have recurring seizures due to a brain disorder
have epilepsy.
Epilepsy
Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or
neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They
may have violent muscle spasms or lose consciousness.
Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is
unknown.
Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for
epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices
such as vagus nerve stimulators may help. Special diets can help some children with epilepsy.
"Seizure" is a general term that refers to a sudden malfunction in the brain that causes someone to collapse,
convulse, or have another temporary disturbance of normal brain function, often with a loss or change in
consciousness.
Seizure Basics
Most seizures are caused by abnormal electrical discharges in the brain or by fainting (decrease in blood flow to the
brain). Symptoms may vary depending on the part of the brain involved, but often include unusual sensations,
uncontrollable muscle spasms, and loss of consciousness.
Some seizures may be the result of another medical problem, such as low blood sugar, infection, a head injury,
accidental poisoning, or drug overdose. They also can be due to a brain tumor or other health problem affecting
the brain. And anything that results in a sudden lack of oxygen or a reduction in blood flow to the brain can cause
a seizure. In some cases, a seizure's cause is never discovered.
When seizures occur more than once or over and over, it may indicate the ongoing conditionepilepsy.
Some kids under 5 years old have febrile seizures, which can occur when they develop a medium or high fever —
usually above 100.4° F (38° C). While terrifying to parents, these seizures are usually brief and rarely cause any
life-threatening, serious, or long-term problems, unless the fever is associated with a serious infection, such
as meningitis.
In kids under 5 years old, breath-holding spells can cause seizures. These aren't the spells where kids hold their
breath to get back at their parents. Instead, these occur in kids who have an exaggerated reflex so that when
they're hurt or emotionally upset they stop taking in a breath (with or without crying hard first). They then turn
blue or very pale, often pass out, and might have a full convulsion-like seizure in which the body is stiff and they're
unconscious and not breathing. While scary to parents, these spells usually stop on their own and the kids almost
never suffer any harm from them. Call your doctor if such a spell occurs.
In older kids, about 10% or more have standard fainting spells (also called syncope), which is often associated
with a brief seizure or seizure-like spell. A child may stiffen or even twitch or convulse a few times. Fortunately,
this rarely indicates epilepsy. Most kids recover very quickly (seconds to minutes) and don't require specialized
treatment.
If Your Child Has a Seizure
A child who is having a seizure should be placed on the ground or floor in a safe area, preferably on his or her right
side. Remove any nearby objects. Loosen any clothing around the head or neck. Do not try to wedge the child's
mouth open or place an object between the teeth, and do not attempt to restrain movements.
Once the seizure seems to have ended, gently comfort and protect your child. It's best for kids to remain lying
down until they have recovered fully and want to move around.
Call 911 immediately if your child:
has difficulty breathing
turns bluish in color
has sustained a head injury
seems ill
has a known heart condition
has never had a seizure before
might have ingested any poisons, medications, etc.
If your child has previously had seizures, call 911 if the seizure lasts more than 5 minutes or is for some reason
very alarming to you and you're worried for your child's safety.
If your child is breathing normally and the seizure lasts just a few minutes, you can wait until it lets up to call your
doctor.
Following the seizure, kids are often be tired, confused, or exhausted and may fall into a deep sleep (called the
postictal period). You do not need to try to wake your child as long as he or she is breathing comfortably. Do
not attempt to give food or drink until your child is awake and alert.
For a child who has febrile seizures, the doctor may suggest giving fever-reducing medicine (such as ibuprofen or
acetaminophen), followed by a lukewarm sponge bath if medication doesn't bring the fever down.
After a seizure — particularly if it is a first or unexplained seizure — call your doctor or emergency
medical services for instructions. Your child will usually need to be evaluated by a doctor as soon as
possible. Definition
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain.
See also:
Generalized tonic clonic seizure
Partial (focal) seizure
Petit mal (absence) seizure
Epilepsy
Fever (febrile) convulsions (seizures in children with high fever)
Symptoms
Simple partial seizures can be caused by congenital abnormalities(abnormalities present at birth), tumor growths, head
trauma, stroke, andinfections in the brain or nearby structures. Generalized tonic-clonic seizures are associated with drug
and alcohol abuse, and low levels of blood glucose (blood sugar) and sodium. Certain psychiatric medications, antihistamines, and
even antibiotics can precipitate tonic-clonic seizures. Absence seizures are implicated with an abnormal imbalance of certain
chemicals in the brain that modulate nerve cell activity (one of these neurotransmitters is called GABA, which functions as an
inhibitor). Myoclonic seizures are commonly diagnosed in newborns and children.
Symptoms for the different types of seizures are specific.
Causes & Risk Factors
A seizure may be related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or
abnormal levels of sodium orglucose in the blood. If the repeated seizures do not happen again once the underlying problem is
corrected, the person does not have epilepsy.
In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be abnormally excited.
In some people, a problem that is passed down through families (inherited) affects nerve cells in the brain, which leads to seizures.
In these cases, the seizures happen spontaneously, without an immediate cause, and repeat over time. This is epilepsy.
Idiopathic seizures are chronic seizures that occur without an identifiable cause. They usually begin between ages 5 and 20, but can
occur at any age. The person can have a family history of epilepsy or seizures.
Other more common causes of seizures include:
Tumors (such as brain tumor) or other structural brain lesions (such as bleeding in the brain)
Traumatic brain injury, stroke, or a transient ischemic attack (TIA)
Stopping alcohol after drinking heavily on most days
Illnesses that cause the brain to deteriorate
Dementia such as Alzheimer's disease
Problems that are present from before birth (congenital brain defects)
Injuries to the brain that occur during labor or at the time of birth
Low blood sugar or sodium levels in the blood
Kidney or liver failure
Use of cocaine, amphetamines, or certain other recreational drugs
Stopping certain drugs, such as barbiturates and benzodiazepines, after taking them for a period of time
Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)
Phenylketonuria (PKU) can cause seizures in infants.
Tests & Diagnostics
Patients seeking help for seizures should first undergo an EEG that records brain-wave patterns emitted between nerve cells.
Electrodes are placed on the head, sometimes for 24 hours, to monitor brain-wave activity and detect both normal and abnormal
impulses. Imaging studies such as magnetic resonance imaging (MRI) and computed axial tomography (CT)—that take still
"pictures"—are useful in detecting abnormalities in the temporal lobes (parts of the brain associated with hearing) or for helping
diagnose tonic-clonic seizures. A complete blood count (CBC) can be helpful in determining whether a seizure is caused by a
neurological infection, which is typically accompanied by high fever. If drugs or toxins in the blood are suspected to be the cause of
the seizure(s), blood and urine screening tests for these compounds may be necessary.
Antiseizure medication can be altered by many commonly used medications such as sulfa drugs, erythromycin, warfarin,
and cimetidine. Pregnancy may also decrease serum concentration of antiseizure medications; therefore, frequent monitoring and
dose adjustments are vital to maintain appropriate blood concentrations of the antiseizure medication—known as the therapeutic
blood concentration. Diagnosis requires a detailed and accurate history, and a physical examination is important since this may help
identify neurological or systemic causes. In cases in which a central nervous system (CNS) infection
(i.e., meningitis or encephalitis) is suspected, a lumbar puncture (or spinal tap) can help detect an increase in immune cells (white
blood cells) that develop to fight the specific infection.
Treatments
If someone who has never had a seizure before has one, call 911 or your local emergency number immediately.
Persons with epilepsy should always wear a medical alert tag.
Most seizures stop by themselves. However, a person having a generalized seizure may be injured; breathe food, fluid, or vomit into
the lungs; or not get enough oxygen. During a generalized seizure, it is important to protect the person from injury. Turn the person
on the side, so that any vomit leaves the body and does not enter the lungs. See: Seizure first aid
After a generalized seizure, most people go into a deep sleep. Do not prevent the person from sleeping. The person will probably be
disoriented, or possibly agitated for awhile after awakening.
EMERGENCY FIRST AID
Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the teeth. You can cause more
damage than you can prevent.
Do not try to hold the person down during the seizure.
Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is
over.
If the person having a seizure turns blue or stops breathing, try to position their head to prevent their tongue from
blocking their airways. Breathing usually starts on its own once the seizure is over.
CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may
develop a severe lack of oxygen. This an emergency situation. Seek immediate medical help.
AFTER THE SEIZURE
Treat any injuries from bumps or falls. Record details of the seizure to report to the person's primary health care provider. You
should note the following details:
How long it lasted
What body parts were affected
Type of movements or other symptoms
Possible causes
How the person behaved after the seizure
Complications
About 30% of patients with severe seizures (starting in early childhood), continue to have attacks and usually never achieve a
remission state. In the United States, the prevalence of treatment-resistant seizures is about one totwo per 1,000 persons. About
60–70% of persons achieve a five-year remission within 10 years of initial diagnosis. Approximately half of these patients become
seizure-free. Usually the prognosis is better if seizures can be controlled by one medication, the frequency of seizures decreases,
and there is a normal EEGand neurological examination prior to medication cessation.
People affected by seizure have increased death rates compared with the general population. Patients who have seizures of
unknown cause have an increased chance of dying due to accidents (primarily drowning). Other causes of seizure-associated death
include abnormal heart rhythms, water in the lungs, or heart attack.
Prevention
Instructions for taking any prescribed medications should be strictly followed. Family members should observe and record any
seizure information to make sure the person gets proper treatment.
Good health habits may help to control seizures. Because sleep deprivation, stress, and a poor diet can contribute to increased
seizures, good sleep habits, stress reduction, proper exercise, and sound nutrition may help.
There is no specific way to prevent all seizures. Use helmets when appropriate to prevent head injury. This will lessen the likelihood
of a brain injury and subsequent seizures. Avoid recreational drugs. People with epilepsy should take medication as directed and
avoid excessive amounts of alcohol.
People with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of
seizures are allowed to drive. People with uncontrolled seizures also should avoid activities where loss of awareness would cause
great danger, such as climbing to high places, biking, and swimming alone.
Types of Seizures
Seizures take many forms. Before your doctor can prescribe the right treatment, he or she must figure out which type (or types) you
have. That's the purpose of all the tests discussed in the Diagnosis section—not just to tell whether you have epilepsy but also to tell
what kind.
There are so many kinds of seizures that neurologists who specialize in epilepsy are still updating their thinking about how to
classify them. Usually, they classify seizures into two types, primary generalized seizures and partial seizures. The difference
between these types is in how they begin:
Primary generalized seizures
Primary generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Hereditary
factors are important in many of these seizures.
Partial seizures
Partial seizures begin with an electrical discharge in one limited area of the brain. Some are related to head injury, brain infection,
stroke, or tumor, but in most cases the cause is unknown.
One question that is used to further classify partial seizures is whether consciousness (the ability to respond and remember) is
"impaired" or "preserved." The difference may seem obvious, but really there are many degrees of impairment or preservation of
consciousness.
Identifying certain seizure types and other characteristics of a person's epilepsy like the age at which it begins, for instance, allows
doctors to classify some cases into epilepsy syndromes. This kind of classification helps us to know how long the epilepsy will last
and the best way to treat it.
Primary Generalized Seizures
Absence seizures
Atypical absence seizures
Myoclonic seizures
Atonic seizures
Tonic seizures
Clonic seizures
Tonic-clonic seizures
Partial Seizures
Simple partial seizures
Complex partial seizures
Secondarily generalized seizures
Absence Seizures
What are they like?
Here's a typical story: Frank, a 7-year-old boy, often "blanks out" anywhere from a few seconds to 20 seconds at a time. During a
seizure, Frank doesn't seem to hear his teacher call his name, he usually blinks repetitively, and his eyes may roll up a bit. During
shorter seizures, he just stares. Then he continues on as if nothing happened. Some days Frank has more than 50 of these spells.
How long do they last?
Usually less than 10 seconds, but it can be as long as 20. They begin and end suddenly.
Tell me more
Absence seizures are brief episodes of staring. (Although the name looks like a regular English word, your neurologist may
pronounce it ab-SAWNTZ.) Another name for them is petit mal (PET-ee mahl). During the seizure, awareness and responsiveness
are impaired. People who have them usually don't realize when they've had one. There is no warning before a seizure, and the
person is completely alert immediately afterward.
Simple absence seizures are just stares. Many absence seizures are considered complex absence seizures, which means that they
include a change in muscle activity. The most common movements are eye blinks. Other movements include slight tasting
movements of the mouth, hand movements such as rubbing the fingers together, and contraction or relaxation of the muscles.
Complex absence seizures are often more than 10 seconds long.
Who gets them?
Absence seizures usually begin between ages 4 and 14. The children who get them usually have normal development and
intelligence.
What's the outlook?
In nearly 70% of cases, absence seizures stop by age 18. Children who develop absence seizures before age 9 are much more
likely to outgrow them than children whose absence seizures start after age 10.
Children with absence seizures do have higher rates of behavioral, educational, and social problems.
What else could it be?
Absence seizures can resemble some complex partial seizures or episodes of daydreaming:
Questions to Ask Daydreaming Seizures
How frequent are the episodes? Not frequent. Complex partial: Rarely more than several times per day or week.
Absence: Could be many times per day.
In what situations do they occur? Boring situation. Any time, including during physical activity; often with
hyperventilation (deep or rapid breathing.)
Do they begin abruptly? No. Usually yes. Some complex partial seizures begin slowly with a
warning.
How long do they last? Until something interesting Complex partial: Up to several minutes
happens. Absence: Rarely more than 15-20 seconds
Does the person do anything during Probably just stares. Complex partial: Automatisms are common.
the episode? Absence: Just stares.
How frequent are the episodes? Not frequent. Complex partial: Rarely more than several times per day or
week.
Absence: Could be many times per day.
In what situations do they occur? Boring situation. Any time, including during physical activity.
Do they begin abruptly? No. Usually yes. Some complex partial seizures begin slowly
with a warning.
How long do they last? Until something interesting Complex partial: Up to several minutes.
happens. Absence: Rarely more than 15-20 seconds.
Does the person do anything during the Probably just stares. Complex partial: Automatisms are common.
episode? Absence: Just stares.