SEIZURES

Definition
Classification
Signs and Symptoms
Causes
Treatment
First Aid

Outline:

 sudden surge of electrical activity in the brain

usually affects how a person appears or acts for a short time
Many things can occur during a seizure; whatever the brain and body can do
normally can also occur.

Definition of seizure:

 1) Focal (partial) seizures

Types of focal (partial) seizures are:
> Focal seizure
>Focal dyscognitive seizures

Classification:

 2) Generalised seizures
Absence
- Typical
- Atypical absence
- Absence with special features
- Myoclonic absence
- Eyelid Myoclonia
Tonic-Clonic
Clonic
Tonic
Atonic
Myoclonic
- Myoclonic
- Myoclonic atonic
- Myoclonic tonic

 3) Unknown
a grouping of seizures that cannot be diagnosed as either a focal or generalized
seizure and are thus grouped as unknown

 The pathways for information exchange between the brain and musculature can be divided into two general groups: the afferent
(sensory) and output or efferent (motor)
A neuron or group of neurons in the brain can become hyperexcitable or irritable due to hypoxia, ischemia, hypoglycemia, or
electrolyte abnormalities. These affect the action potential and cause these nerve cells to discharge action potentials irregularly. If
this occurs, the corresponding muscle fascicles may begin to contract inappropriately, thus producing seizure-like activity.
Depending on where the focus of this aberrant discharge is in a particular region of the brain, the corresponding motor or sensory
area will be affected, leading to either motor symptoms such as tonic-clonic contractions or sensory manifestations of seizure-like
activity, such as paresthesia, dj vu, or hallucinations.
The focus may spread and involve various areas of the brain, leading to chaotic, uninhibited discharge of electrical activity of
various neurons in the brain. The resultant motor and/or sensory activity manifested by and experienced by the patient is clinically
described as a seizure.
Control of the seizure can be accomplished by suppressing the action potential via manipulation of sodium and potassium ion
permeabilities. This will render the axon refractory to the action potential, or block the neurotransmitter from binding to its receptor site.

Anatomy and Physiology

Some seizures occur with warning signs before the seizure takes place. This include:
Sudden feelings of fear and anxiousness
Feeling sick to your stomach
Dizziness
Changes in vision
Symptoms that indicate a seizure is in progress:
A blackout of time, followed by confusion
Uncontrollable muscle spasms
Drooling or frothing at the mouth
Sudden falling
Experiencing a strange taste in your mouth
Clenching teeth
Sudden, rapid eye movements
Making unusual noises, such as grunting
Losing control of bladder or bowel movement
Sudden mood changes

Signs and Symptoms:

Symptoms occur suddenly and may include:

Changes in behavior such as picking at ones clothing
Eye movements
Grunting and snorting
Shaking of the entire body
Temporary stop in breathing
Uncontrollable muscle spasms with twitching and jerking limbs

Generalized Seizures
(Produced by the entire brain)

Symptoms

Grand Mal or Generalized Tonic-Clonic

Absence

Unconsciousness, convulsions, muscle rigidity

Brief loss of consciousness

Myoclonic
Clonic
Tonic
Atonic

Sporadic (isolated), jerking movements

Repetitive, jerking movements
Muscle stiffness, rigidity
Loss of muscle tone

Common symptoms before a seizure:

Awareness, Sensory, Emotional or Thought Changes:
Dj vu
Jamais vu
Smells
Sounds
Tastes
Visuals loss or blurring
Strange feelings
Fear/panic
Pleasant feelings
Racing thoughts
Physical Changes:
Dizzy or lightheaded
Headache
Nausea or other stomach feelings
Numbness or tingling in part of the body

Common symptoms during a seizure:

Awareness, Sensory, Emotional or Thought Changes:
Loss of awareness
Confused, feeling spacey
Periods of forgetfulness or memory lapses
Distracted, daydreaming
Loss of consciousness, unconscious, or pass out
Unable to hear
Sounds may be strange or different
Unusual smells
Unusual tastes
Loss of vision or unable to see
Blurry vision
Flashing lights
Formed visual hallucinations
Numbness, tingling, or electric shock like feeling in body, arm or leg
Out of body sensations
Feeling detached
Body parts feels or looks different
Feeling of panic, fear, impending doom

Physical Changes:
Difficulty talking
Unable to swallow, drooling
Repeated blinking of eyes, eyes may move to one side or look upward, or staring
Lack of movement or muscle tone
Tremors, twitching or jerking movements
Rigid or tense muscles
Repeated non-purposeful movements, called automatisms, involve the face, arms or legs, such as
Lip smacking or chewing movements
repeated movements of hands, like wringing, playing with buttons or objects in hands, waving
dressing or undressing
walking or running
Repeated purposeful movements
Convulsion
Losing control of urine or stool unexpectedly
Sweating
Change in skin color
Pupils may dilate or appear larger than normal
Biting of tongue
Difficulty breathing
Heart Racing

Common symptoms after a seizure:

Awareness, Sensory, Emotional or Thought Changes:
Slow to respond or not able to respond right away
Sleepy
Confused
Memory loss
Difficulty talking or writing
Feeling fuzzy, lightheaded or dizzy
Feeling depressed, sad, upset
Scared
Anxious
Frustrated, embarrassed, ashamed
Physical Changes:
May have injuriesMay feel tired, exhausted or sleep for minutes or hours
Headache or other pain
Nausea or upset stomach
Thirsty
General weakness or weak in one part or side of the body
Urge to go to the bathroom or lose control of bowel or bladder

Abnormal level of sodium or glucose in the blood

Brain infections, including meningitis
Brain tumor
Drug abuse
Electric shock
Epilepsy
Heart disease
Heat illness
Poisoning
Stroke

Causes:

First aid

If someone is having a seizure:

Loosen clothing around the person's neck.
Do not try to hold the person down or restrain them. This can result in injury.
Do not insert any objects in the person's mouth. This can also cause injury.
Remove sharp objects (glasses, furniture, and other objects) from around the person to prevent injury.
After the seizure, it is helpful to lay the person on their side to maintain an open airway and prevent the person
from inhaling any secretions.
If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
After a seizure, the person may be confused and should not be left alone.
Bring the Patient to the hospital if:
seizure lasts longer than 5 minutes or
if another seizure begins soon after the first, or
if the person cannot be awakened after the movements have stopped

Treatment

Carbamazepine (Carbatrol, Tegretol) is widely prescribed for trigeminal neuralgia, which causes searing facial pain
that feels like an electric shock.
*Carbamazepine: blocks voltage-activated sodium channels; produce less pronounced frequency-dependent block

the use of the anticonvulsants gabapentin (Neurontin) or pregabalin (Lyrica) to help relieve pain caused by damaged
nerves.

*Gabapentin and pregabalin: act by binding to a2d proteins, which are believed to be accessory subunits of voltage-dependent calcium
channels that exist in four homologous forms; only types 1 and 2 bind them with high affinity

Because these drugs have few side effects and are usually well tolerated, they are often the first medications to try for
neuropathic pain. You may experience side effects, such as drowsiness, dizziness, confusion or swelling in the feet
and legs. These side effects are limited by starting with a low dosage and slowly increasing it.

Medications from other drug classes with distinct mechanisms of pain relief (such as antidepressants) may be used
in combination with anti-seizure class medications if anti-seizure medications fail to control your pain.