Seizures

Answer 1

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)

Alternative Names

Secondary seizures; Reactive seizures; Seizure - secondary; Seizure - reactive

Considerations

There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are involved. Many, if not all, types of seizures cause loss of awareness and some cause twitching or shaking of the body.

However, some seizures may be hard to notice because they consist of staring spells that can easily go unnoticed. Occasionally, seizures can cause temporary changes in sensation or vision.

Symptoms of seizures come on suddenly, over just seconds to a minute, and may include:

• Change in consciousness, so that you can't remember some period of time
• Change in emotion, like unexplainable fear, panic, joy, or laughter
• Change in sensation of the skin, usually spreading over the arm, leg, or trunk
• Changes in vision, including flashing lights, or (rarely) hallucinations (seeing things that aren't there)
• Loss of muscle control and falling, often very suddenly
• Muscle movement such as twitching that might spread up or down an arm or leg
• Muscle tension/tightening that causes twisting of the body, head, arms, or legs
• Tasting a bitter or metallic flavor

Symptoms may stop after a few minutes, or continue for 15 minutes. They rarely continue longer.

Shaking of the entire body when it occurs should last a few minutes and stop within 5 minutes.

Common Causes

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 or glucose 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, painkillers (morphine, gabapentin) and sleeping pills, after taking them for a period of time
• Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)
• Phenylketonuria (PKU), which can cause seizures in infants

Home Care

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 is 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

Call your health care provider if

If this is the first time someone has ever had a seizure, or if this is an unusually long seizure in someone who has a seizure disorder, call 911 or your local emergency number immediately. These symptoms can be caused by life-threatening conditions, such as a stroke or meningitis.

Report all seizures (even a mild one) to the health care provider. If the person is known to have epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or other instructions given.

What to expect at your health care provider's office

Often, a person who has had a new or severe seizure will be seen in an emergency room, rather than a doctor's office.

The health care provider will try to diagnose the type of seizure based on the symptoms.

Other medical conditions that can cause a seizure or similar symptoms will be ruled out. Disorders that may cause similar symptoms include fainting, TIA or stroke, rage or panic attacks, migraine headaches, sleep disturbances, and conditions that cause loss of consciousness.

The following tests may be done:

• Blood tests
• CT scan of the head or MRI of the head
• EEG (usually not in the emergency room)
• Lumbar puncture(also called a spinal tap)

The need for further tests or treatment depends on a number of factors.

• A single seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating or avoiding that trigger.
• A new seizure without an obvious trigger will require further testing and possible treatment.
• A seizure in a person with known epilepsy will require tests to make sure the patient is taking the correct dose of their medicines. A possible change in medicines may be needed.

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.

References

Duvivier EH, Pollack CV Jr. Seizures. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 100.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1991-2007.

Rubin DH, Kornblau DH, Conway EE Jr, Caplen SM. Neurologic Disorders. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 173.

Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG. 2009 May;116(6):758-67.

Answer 2

Definition

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain.

The term "seizure" is often used interchangeably with "convulsion." Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms and no body shaking.

See also:

• Generalized tonic clonic seizure
• Partial (focal) seizure
• Petit mal (absence) seizure
• Epilepsy
• Fever (febrile) convulsions (seizures in children with high fever)

Alternative Names

Secondary seizures; Reactive seizures; Seizure - secondary; Seizure - reactive; Convulsions

Considerations

It may be hard to tell if someone is having a seizure. Some seizures only cause a person to have staring spells. These may go unnoticed.

Specific symptoms depend on what part of the brain is involved. They occur suddenly and may include:

• Brief blackout followed by period of confusion (the person cannot remember a period of time)
• Changes in behavior such as picking at one's clothing
• Drooling or frothing at the mouth
• Eye movements
• Grunting and snorting
• Loss of bladder or bowel control
• Mood changes such as sudden anger, unexplainable fear, panic, joy, or laughter
• Shaking of the entire body
• Sudden falling
• Tasting a bitter or metallic flavor
• Teeth clenching
• Temporary halt in breathing
• Uncontrollable muscle spasms with twitching and jerking limbs

Symptoms may stop after a few seconds minutes, or continue for 15 minutes. They rarely continue longer.

The person may have warning symptoms before the attack, such as:

• Fear or anxiety
• Nausea
• Vertigo
• Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)

Common Causes

Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Causes of seizures can include:

• Abnormal levels of sodium or glucose in the blood
• Brain infection, including meningitis
• Brain injury that occurs to the baby during labor or childbirth
• Brain problems that occur before birth (congenital brain defects)
• Brain tumor(rare)
• Choking
• Drug abuse
• Electric shock
• Epilepsy
• Fever(particularly in young children)
• Head injury
• Heart disease
• Heat illness (see heat intolerance)
• High fever
• Illicit drugs, such as angel dust (PCP), cocaine, amphetamines
• Kidney or liver failure
• Low blood sugar
• Phenylketonuria (PKU), which can cause seizures in infants
• Poisoning
• Stroke
• Toxemia of pregnancy
• Uremia related to kidney failure
• Very high blood pressure (malignant hypertension)
• Venomous bites and stings (see snake bite)
• Use of illegal street drugs, such as cocaine or amphetamines
• Withdrawal from alcohol after drinking a lot on most days
• Withdrawal from certain drugs, including some painkillers and sleeping pills
• Withdrawal from benzodiazepines (such as Valium)

Sometimes no cause can be identified. This is called idiopathic seizures. They usually are seen in children and young adults but can occur at any age. There may be a family history of epilepsy or seizures.

If seizures repeatedly continue after the underlying problem is treated, the condition is called epilepsy.

Home Care

Most seizures stop by themselves. However, the patient can be hurt or injured during a seizure.

When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.

Cushion the person's head.

Loosen tight clothing, especially around the person's neck.

Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.

Look for a medical I.D. bracelet with seizure instructions.

Stay with the person until he or she recovers, or until you have professional medical help.

If a baby or child has a seizure during a high fever, cool the child slowly with tepid water. Do not place the child in a cold bath. You can give the child acetaminophen (Tylenol) once he or she is awake, especially if the child has had fever convulsions before.

For information on how to help someone who is having a seizure, see: Seizure first aid

Call your health care provider if

Call 911 or your local emergency number if:

• This is the first time the person has had a seizure.
• A seizure lasts more than 2 to 5 minutes.
• The person does not awaken or have normal behavior after a seizure.
• Another seizure starts soon after a seizure ends.
• The person had a seizure in water.
• The person is pregnant, injured, or has Diabetes.
• The person does not have a medical ID bracelet (instructions explaining what to do).
• There is anything different about this seizure compared to the person's usual seizures.

Report all seizures to the person's health care provider. The doctor may need to adjust or change the person's medications.

What to expect at your health care provider's office

A person who has had a new or severe seizure is usually seen in a hospital emergency room. The health care provider will try to diagnose the type of seizure based on the symptoms.

Tests will be done to rule out other medical conditions that cause seizures or similar symptoms. This may include fainting, transient ischemic attack (TIA) or stroke, panic attacks, migraine headaches, sleep disturbances, and others.

Tests may include:

• Blood tests
• CT scan of the head or MRI of the head
• EEG (usually not in the emergency room)
• Lumbar puncture(spinal tap)

Further testing is needed if you have:

• A new seizure without an obvious cause
• Epilepsy (to make sure the person is taking the right amount of medicine)

A single seizure due to an obvious trigger (such as use of a certain drug) is treated by eliminating or avoiding that trigger.

Prevention

There is no specific way to prevent all seizures. However, the following tips may help control some of them:

• Always take your medications as your doctor instructed. Family members should observe and record any seizure information to make sure the person gets proper treatment.
• Get plenty of quality sleep, reduce stress, exercise, and eat a healthy diet. Poor health habits can make you more likely to have more seizures.

You might help lower your risk of seizures if you:

• Use helmets to prevent head injury. This will lessen the likelihood of a brain injury that leads to seizures.
• Avoid illegal street drugs.

You should not drive if you have uncontrolled seizures. Every U.S. state has a different law detailing which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

References

Duvivier EH, Pollack CV Jr. Seizures. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 100.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1991-2007.

Rubin DH, Kornblau DH, Conway EE Jr, Caplen SM. Neurologic Disorders. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 173.

Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG. 2009 May;116(6):758-67.

Reviewed By

Review Date: 01/04/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Having a brain seizure can be a terrifying experience. If you have a seizure, there was a problem with too much uncoordinated electrical activity in your brain.

In general, a seizure is when too many of your brain cells become excited at the same time. There are two different types of seizures, generalized and partial. With a generalized seizure, your brain has abnormal electrical activity on both sides of your brain. Partial seizures happen when electrical activity surges in one part of your brain.

Seizures can happen for many reasons:

It may be from high levels of salt or sugar in your blood; brain injury from a stroke or head injury; brain problems you are born with or perhaps a brain tumor.

Dementia, such as Alzheimer's disease, high fever or illnesses or infections that hurt your brain. Illegal drug use or withdrawal from alcohol or drug use can cause seizures as well.

So, what are the signs that someone is having a seizure?

Some people with seizures may have simple staring spells, while others have violent, uncontrollable shaking and loss of consciousness. Some people will see flashing lights, others may hallucinate. Some people may have strange sensations, such as tingling, smelling an odor that isn't really there, or emotional changes.

Most people who have a seizure for the first time will go to the emergency room. The doctor will do tests to rule out medical causes, such as a stroke. You may have blood tests, CT or MRI scans of your head, or a spinal tap.

Treatment depends on the cause of your seizure. For example, if a seizure was caused by fever, treatment will focus on bringing the fever down.

Your doctor may send you home with some medicines to help you avoid having more seizures if there is reason to think you are at continued risk of seizures. You should get plenty of sleep and try to keep as regular a schedule as possible, and try to avoid too much stress.

Most people with seizures can have a very active lifestyle. Plan ahead for the possible dangers of a certain activity. Avoid any activity where loss of consciousness would be dangerous until it is clear that seizures are unlikely to occur again.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.