Seizures – Symptoms, causes, and Diagnosis

Hey! Quick question- What unites Albert Einstein, Teddy Roosevelt, Danny Glover and Susan Boyle?

Apart from the fact that they positively impacted millions with their craft, all of these people are epileptics and suffered from seizures.

A seizure is an abnormal, excessive or synchronous firing of the electrical circuits in a part of or in the entirety of the brain.

Epileptics are people who are more prone to seizures than the general population.

Since time immemorial, it have been identified as one of the most unpredictable, terror-inflicting and difficult-to-deal-with maladies of all.

However, with advances in modern science and medicine, we are understanding the mechanisms behind the different types of seizures and developing novel ways to treat and prevent them.  

Symptoms of Seizures

The symptoms of a seizure vary depending on the type of seizure and the parts of the brain that are involved. Nevertheless, there are some common symptoms-

• Before the onset of a focal (partial) seizure a strange sensation called an “aura” may be experienced. 
• There is temporary confusion.
• A strange feeling in the stomach as if you’re on a roller coaster or fairground ride.
• A sensation of Deja vu or a strange feeling of reliving the same experience in the past.
• Unusual tastes or smells without any overt stimuli.
• Emotional derangement- feelings of intense joy or fear.
• Tingling sensation in the limbs.
• A blank expression and empty stare on the patient’s face and the feeling that the person “is elsewhere mentally”.
• Sudden rapid eye movements.
• Drooling or frothing at the mouth.
• Twitching of body parts.
• Inadvertent swallowing, mouth opening and closing, lip-smacking etc.
• Uncontrolled jerking and spasming of body parts.
• Loss of muscle tone
• Sudden collapse
• Loss of consciousness

What are the Causes of Seizures

Our Brains have cells in them known as nerves or neurons. These neurons communicate with each other through electrical signals. Chemicals known as neurotransmitters(such as GABA) help to carry these signals.

The brain ideally functions in a balance between excitatory and inhibitory stages. When this balance is deranged there is an abnormal, excessive or synchronous firing of the electrical circuits in a part of or in the entirety of the brain leading to a seizure. Depending on the areas of the brain involved seizures are classified into different types.

This derangement may be caused due to many reasons-

• Cerebral injury due to trauma or concussion
• Loss of blood supply to the brain(cerebral hypoxia)
• Aneurysms
• Brain tumours
• Stroke
• Drug or alcohol withdrawal
• Severe infections such as meningitis and encephalitis
• Severe hypoglycemia or hyperglycemia
• Prolonged high fever, especially in children
• Structural defects in the brains
• Syndromic conditions
• Electrolyte imbalances, especially sodium and calcium
• Certain toxins such as heavy metals and carbon monoxide
• Autoimmune disorders
• Mental disorders like Alzheimer’s Disease and certain forms of Dementia

There are certain conditions that may make seizures more likely to occur. These are known as seizure trigger factors-

• Sleep deprivation
• Missed doses of anti-epileptic drugs in treated patients
• Alcohol (particularly withdrawal)
• Recreational drug misuse
• Physical and mental exhaustion
• Flickering lights, including TV and computer screens (generalised epilepsy syndromes only)
• Intercurrent infections and metabolic disturbances
• Uncommon: loud noises, music, reading, hot baths

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Focal Seizures

Focal seizures are also known as partial seizures. Here, excessive activity is limited to only a small portion of the brain. Focal seizures are associated with auras.

There are two types of Focal Seizures-

• Simple Focal Seizures– The precise manifestations depend on the region of the brain involved. Usually, the aura itself is the seizure and awareness is not lost.
• Complex Focal Seizures- They are characterised by a complex medley of symptoms such as aura, amnesia, abnormal behaviour, uncontrolled movements and loss of awareness.

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Generalized seizures

Generalized seizures involve all the areas of the brain from the time they start. There are various subtypes of generalized seizures all of which have their own set of symptoms.

1. 1. Generalized tonic-clonic seizures- This was previously known as grand mal epilepsy. It is characterised by an aura followed by an epileptic cry, There is a loss of consciousness and the person falls to the ground like a log. Muscles become stiff and rigid- tonic phase, followed by jerking around of the limbs and other parts- clonic phase. After this, there is a period of relaxation and post-seizure automatism. The patient regains consciousness in a dazed state.
   2. Absence seizures- Previously known as petit mal epilepsy, they involve a sudden onset of staring, unresponsiveness and momentary loss of consciousness. 
   3. Myoclonic Seizures- They involve momentary single or multiple sudden, brief shock-like contractions.

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How to Diagnose Seizures?

While clinical symptoms are sufficient to diagnose this disease, a bevvy of other tests are available to clinicians to make better and more precise calls on the type and severity.

• Neurological examinations– they are performed to evaluate behavior,  consciousness and motor function

• Blood Panel- to rule out infections and electrolyte imbalances.

• Lumbar Puncture- a spinal tap is performed to ascertain if there are any infectious agents in the cerebrospinal fluid.

• EEG- an electroencephalogram needs to be performed to visualize the electrical activity in the brain.

• Other tests- such as MRIs, CT scans. PET scans etc may be needed for more granular examination.

What are the Complications due to Seizures?

There may be several complications due to a seizure

• Injury- This happens due to sudden falling down after the loss of consciousness and may even be fatal.

• Airway blockage- caused by inadvertent blocking of the airway by the tongue.

• Status Epilepticus– This is the most serious complication of a seizure and needs emergency care.

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Treatment for Seizures

An isolated case of seizure does not need active treatment as the chances of it occurring again are usually slim to none.

For diagnosed epileptics

• Antiepileptic medications are prescribed by the doctor and are generally quite helpful in controlling and preventing the occurrence of this disease.
• Brain surgery may be needed if the seizures are not controlled even after medication.

• Dietary Changes- There is mounting evidence that diets such as the ketogenic diet may help combat the symptoms of seizures.

• Avoidance of trigger factors- is perhaps the single best thing for epileptics following an evaluation of the specific trigger factors applicable to them.

Conclusion

Seizures are caused due to abnormal and excessive electrical discharge in the brain. While the symptoms may seem scary, they are definitely manageable and with the right choices and a little bit of extra care, they won’t be getting in between you and a normal and happy life!

Seizures Related FAQs

Here are the answers to some frequently asked questions