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.
- The electrical activity is caused by complex chemical changes that occur in nerve cells.
- Brain cells either excite or inhibit (stop) other brain cells from sending messages. Usually there is a balance of cells that excite and those that can stop these messages. However, when a seizure occurs, there may be too much or too little activity, causing an imbalance between exciting and stopping activity. The chemical changes can lead to surges of electrical activity that cause seizures.
- Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders that can affect the brain. Some seizures can hardly be noticed, while others are totally disabling.
Major Types of Seizures
Seizures are classified into two groups.
- Generalized seizures: affect both sides of the brain.
- Absence seizures: sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space.
- Tonic-clonic seizures: also called grand mal seizures, can make a person
- Cry out.
- Lose consciousness.
- Fall to the ground.
- Have muscle jerks or spasms.
The person may feel tired after a tonic-clonic seizure.
- Focal seizures: are located in just one area of the brain. These seizures are also called partial seizures.
- Simple focal seizures: affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell.
- Complex focal seizures: can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes.
- Secondary generalized seizures: begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure.
Seizures may last as long as a few minutes.
Nerve cells (neurons) in the brain create, send and receive electrical impulses, which allow the brain’s nerve cells to communicate. Anything that disrupts these communication pathways can lead to a seizure. Some types of seizure disorders may be caused by genetic mutations.
The most common cause of seizures is epilepsy. But not every person who has a seizure has epilepsy. Sometimes seizures may be caused or triggered by:
- High fever, which can be associated with an infection such as meningitis
- Lack of sleep
- Flashing lights, moving patterns or other visual stimulants
- Low blood sodium (hyponatremia), which can happen with diuretic therapy
- Medications, such as certain pain relievers, antidepressants or smoking cessation therapies, that lower the seizure threshold
- Head trauma that causes an area of bleeding in the brain
- Abnormalities of the blood vessels in the brain
- Autoimmune disorders, including systemic lupus erythematosus and multiple sclerosis
- Brain tumor
- Use of illegal or recreational drugs, such as amphetamines or cocaine
- Alcohol misuse, during times of withdrawal or extreme intoxication
- COVID-19 virus infection
The primary goal of epilepsy therapy is to prevent seizures as much as possible and minimize side effects.
When seizures are related to an identifiable illness or condition – such as overuse of alcohol or a severe chemical imbalance in the blood – the seizures usually go away when the problem is corrected. When no medical cause for seizures can be found and seizures continue to occur, antiepileptic medications are prescribed. Treatment of epilepsy can be complex. If a single medication doesn’t fully control seizures, the next step is usually referral to a neurologist.
Status epilepticus is a life-threatening medical emergency. If not adequately treated, this condition can cause both brain damage and failure of other vital organs. Treatment includes administering antiepileptic medications intravenously (into a vein) until the seizures are controlled.
Antiepileptic medications can cause a variety of side effects, and side effects are more likely to occur with higher doses. Side effects include gastrointestinal upset, elevation of liver enzymes, low white blood cell counts with higher risk of infection, weight gain, drowsiness, confusion and memory problems, dizziness and balance problems, tremor, and double vision.
When medication fails to control a person’s seizures, surgery may be considered. The decision to do surgery depends on many factors, including the frequency and severity of seizures, the patient’s risk of brain damage or injury from frequent seizures, the effect on quality of life, the patient’s overall health, and the likelihood that surgery will control the seizures.
Whether people who have a single, isolated seizure should be treated is controversial. Generally, treatment is recommended for patients who have abnormalities that show up in a neurological examination, brain scan or EEG. These abnormalities increase the chance that the person will have more seizures. Even for people who do not have these abnormalities, there is some evidence that treatment can reduce the risk of more seizures. This possible benefit needs to be balanced against the risk of side effects from medication.
How do you help someone who is having a seizure?
Clear the area around a person who’s having a seizure to prevent possible injury. If possible, place them on their side and provide cushioning for their head.
Stay with the person, and call 911 as soon as possible if any of these apply:
- The seizure lasts longer than three minutes.
- They don’t wake up after the seizure
- They experience repeat seizures.
- The seizure occurs in someone who is pregnant.
- The seizure occurs in someone who has never had a seizure.
It’s important to remain calm. While there’s no way to stop a seizure once it’s begun, you can provide help. Here’s what the American Academy of Neurology recommends:
- As soon as you start noticing the symptoms of a seizure, keep track of time. Most seizures last between one to two minutes. If the person has epilepsy and the seizure lasts longer than three minutes, call 911.
- If the person having the seizure is standing, you can prevent them from falling or injuring themselves by holding them in a hug or gently guiding them to the floor.
- Make sure they’re away from furniture or other objects that could fall on them or cause injury.
- If the person having the seizures is on the ground, try to position them on their side so that saliva or vomit leaks out of their mouth instead of down their windpipe.
- Don’t put anything into the person’s mouth.
- Don’t try to hold them down while they’re having a seizure.
Once a seizure is over, here’s what to do:
- Check the person for injuries.
- If you couldn’t turn the person onto their side during their seizure, do so when the seizure is over.
- Use your finger to clear their mouth of saliva or vomit if they’re having trouble breathing, and loosen any tight clothing around their neck and wrists.
- Stay with them until they’re fully awake and alert.
- Provide them with a safe, comfortable area to rest.
- Don’t offer them anything to eat or drink until they’re fully conscious and aware of their surroundings.
- Ask them where they are, who they are, and what day it is. It may take several minutes to become fully alert and be able to answer your questions.
preventive measures are not known, but few precautions will help trigger episodes which includes:
- Eat a healthy and nutritious diet
- Have a regular exercise regimen
- Learn to manage stress effectively
- Get adequate rest
- Avoid tobacco and alcohol use
- Wear seatbelts and helmets when riding vehicles
- Pregnant women must follow proper prenatal care for the fetus to develop normally
Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:
- Temporary confusion
- A staring spell
- Uncontrollable jerking movements of the arms and legs
- Loss of consciousness or awareness
- Psychic symptoms such as fear, anxiety or deja vu
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.
Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.