There are several different types of seizures, with varying
symptoms that can be categorized as follows:
Partial seizures:
- Usually brief (often less than 3 minutes)
- Abnormal muscle movement
- Repetitive movements-lip smacking, picking at clothes,
unnecessary swallowing
- Changes in mood or emotion
- Nausea
- Sweating
- Flushed face
General seizures:
- Absence seizure (usually in children)
- Typically less than 10 seconds
- Unresponsiveness
- Upward rolling of eyes
- Rapid eye blinking
- May occur several times during the course of the day
- Tonic-Clonic (generalized) seizure-most common
- Typically lasts between 30 seconds and 5 minutes
- Loss of consciousness
- Eye deviation
- Clenched jaw
- Frothing at mouth
- Lip or tongue biting may occur
- Urinary and fecal incontinence
- Stiffness of muscles and limbs, followed by spasms and
shaking
- Atonic seizure
- Typically lasts less than 15 seconds
- Sudden loss of muscle control-individuals will
collapse/fall
- Brief loss of consciousness
- Myoclonic seizures
- Sudden muscle spasms
- Head nodding
- Twitching of arms and/or legs
- Individuals may fall
Seizure patients would be asked about their passed and
current medical conditions:
- History:
- Family history of seizures
- Previous head trauma
- Previous brain infections (e.g. meningitis, encephalitis)
- Brain tumor
- Life style (sleep deprivation, illicit drugs, alcohol
abuse/withdrawal)
- Medication use-although not common, some prescribe medications
may occasionally be a trigger for seizures
- Physical exam might include:
- Vital signs (especially temperature to assess for
infection)
- Neurological exam-checks for changes in speech, vision,
sensation, strength and coordination. Detection of abnormalities
might help signify abnormalities within the brain
INVESTIGATIONS:
Blood test:
- Check for sodium, potassium, calcium, magnesium, glucose
- Blood cultures might be obtained if infection is suspected
- Drug and toxin screen
Urine:
- Routine analysis
- Infections
- Drug and toxin screen
Computed Tomography (CT) Scan:
- This device uses x-rays. Patients will lie on a table with the
head placed inside of the scanner (resembles a large donut).
Computer analysis of x-ray images produces detailed images of the
brain can be obtained in this fashion. The scanning time is usually
very rapid (less than 1 minute)
- In special circumstances a dye might be injected into the veins
just before the scan. This can sometimes help to identify areas of
infection (abscesses), inflammation, tumors etc.
Magnetic Resonance Imaging (MRI):
- This does not use x-rays. Instead MRI uses magnetic fields over
the body. The device looks like a long cylindrical tube. Patients
will lie on a table that slides into the hollow tube. Computer
analysis of magnetic fields within the machine can generate images
of the internal structures of the body's organs, including the
brain
- MRI of the brain will show the normal structures, plus any
area(s) of brain injury caused by the inflammation, tumors,
previous stroke etc. Patients must lie still inside a MRI machine
for about 30-60 min
- In some circumstances a dye might be injected into the veins
just before the scan to help improve detection of abnormalities.
Patients who complain of claustrophobia or discomfort may be given
a mild sedative to help relax prior to MRI scanning
Electroencephalography (EEG):
- This test is used to try to detect abnormal electrical activity
within the brain that might suggest that that patient is at risk of
recurrent seizures. During an EEG, tiny patches with wire
connections are attached in different areas on the scalp. These
detect the small electrical signals from the brain, which can be
displayed on a screen, or printed, allowing the physician (usually
a neurologist) to examine the electrical activity of the patient's
brain
- In some circumstances, the EEG may be completed after a period
of "sleep deprivation". The patient is asked to stay at home and
avoid sleeping the night before the test. These sleep-deprived EEGs
are usually done in the morning after the patient has stayed awake
all night. Most EEGs may take less than 90 min to set up and
complete. However, in special scenarios patients may require
prolonged EEGs for few hours
- Note: however, a normal EEG does not imply
that the person does not have seizure disorder, as the abnormal
electrical brain activity triggering the seizure might only occur
intermittently, such that in between episodes the patient and the
EEG recordings are relatively normal
Cerebrospinal fluid (CSF) analysis:
Lumbar puncture/Spinal tap
- This procedure is not routinely used in the assessment of a
seizure patient but may be used in some circumstances, e.g.
suspected brain infection
- The purpose is to extract a small amount of fluid called
cerebrospinal fluid (CSF) from the patient's spine in the low back
(lumbar) area and send for analysis. During the procedure the
physician will clean and drape the lumbar area. A local anesthetic
is administered over the skin where the needle is to be placed.
Since the spinal cord does not extend down into the lower lumbar
region there is little or no chance of causing injury to the spinal
cord
- The extracted CSF is sent to the laboratory for analysis and is
checked for protein, glucose, white cells and infectious organisms
such as bacteria or viruses. In some circumstances CSF can be used
to check for cancer cells (if required)
TREATMENT:
Epilepsy is generally treated with medications depending on seizure
types. Anti-seizure drugs are designed to prevent and minimize the
occurrence of seizures.
Some commonly used anti-seizure (anti-convulsant) medications shown
in alphabetical order with trade/generic name
include:
Many of these medications have side effects such as:
- Rash
- Drowsiness
- Blurred vision
- Insomnia
- Memory impairment
- Nausea
- Extreme thirst
- Swelling of the tongue
- Gum thickening
- Increase facial hair
- Weight gain or loss
- Tremors
- Suicidal thoughts
- Change in liver function
- Decrease white blood cells
- Osteoporosis
- Potential fetal deformities during pregnancy
Note: However, while there are potential side
effects from using these medications, they tend to occur at a low
frequency and in addition the effects of untreated epilepsy needs
to be considered, i.e. potential brain injury from prolonged
seizure, physical injury from falls, and sometimes even death.
Consequently, the treating physician will assess the side effect
risks versus the benefits in seizure prevention (risk versus
benefit ratio), before recommending treatment. If the patient has
other medical conditions or medications these are taken into
account when prescribing an anti-epileptic drug.
Neurosurgical treatment:
- Considered in special circumstances where the epileptic
condition is resistant to the medications used and if the seizures
are being generated form a clearly defined small part of the brain
that is not controlling a vital function (e.g. speech)
- Many patients with epilepsy may have a good or improved
outcome
- Some patients may become seizure free completely just by
avoiding potential triggers (sleep deprivation or drug use etc)
while others may require anti-epileptic drugs
- Some individuals may only partially respond to medications and
show reduce seizure severity and/or frequency
Some potential strategies that may help improve outcome and/or
reduce potential harm include:
- Epileptic patients should consider carrying/wearing a medical
identification card/bracelet
- Learn to recognize and avoid potential triggers (if known):
- Avoid sleep deprivation
- Certain types of video games
- Avoid excess alcohol consumption as it may low seizure
threshold, ie makes it easier to have a seizure
- Patients using antiepileptic medications should adhere to
prescribed regimen since missing doses, or irregular use of
medication could potentially reduce the protection from the
medication and allow seizure recurrence
- Avoid adjusting medication(s) dose or schedule without
consulting a healthcare professional as this might reduce efficacy
of the drug or increase the drug concentration in the blood to a
toxic level
- Patient using multiple medication should be careful not to
mix-up medications and doses
- Some anti-seizure medications require intermittent blood tests
to check levels. Patients should be aware of their medications and
need for blood tests monitoring depending on the agents used
- Appreciate the importance of seizure precautions:
- Avoid driving and use of heavy machinery until seizures brought
under good control
- Avoid solo use of bathtubs/hot-tubs
- Avoid heights (e.g. climbing, working on roofs etc - unless
seizures are under control; use of a harness/tether would be
advised)
- Caution with use of stoves/ovens
- Unaccompanied use of balconies in high rise buildings should be
avoided
- Individuals close to the patient should be made aware of how to
deal with episodes:
- Support and protect the patient's head
- Turn the patient on the side
- Loosening constricting clothing
- Ease the person to floor and push away any object that can
cause harm (e.g. glass tables, furniture)
- Alert emergency services
- Relapse is more likely in patients who have had any of the
following:
- A seizure disorder since childhood
- Need for more than 1 drug to be seizure-free
- Abnormal EEG
- Abnormal brain CT or MRI
- Poor compliance with prescribed medication
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