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Seizures

A. JABBAR DENTAL CLINIC

Sadia Khan

Overview

Seizures are temporary abnormalities in behaviors, muscle tone or movements, states of awareness, or sensations due to excessive neuronal activity in the brain. 
&nbsp;

Anyone can have seizures, though certain age groups and medical conditions make some people more prone to them. 11% of people in the US have had at least 1 episode during their lives.

Recurring seizures are known as <a href="https://merisehat.pk/disease/epilepsy">epilepsy</a>. Epilepsy is even less common than other types of seizures. Only 1-3% of people in the US have had epilepsy during their life.<a href="#accordion">[5]</a>

Studies have established that both the incidence and prevalence of epilepsy in children are high in underdeveloped countries, especially in rural areas. Some population-based studies show that focal seizures are slightly more common than generalized seizures in children.<a href="#accordion">[6]</a> 
&nbsp;

In the context of Asian countries, it is important to consider the specific epidemiological and clinical aspects of seizures in these regions. For instance, studies have highlighted the incidence of recurrent febrile seizures in South Indian districts and their strong association with a history of perinatal complications.<a href="#accordion">[3]</a>

Also, in the context of infectious diseases, the relationship between Zika virus infection and seizures has been investigated. Reports indicate neurological complications in infected individuals, particularly in Southeast Asia, with seizure being a likely manifestation.<a href="#accordion">[4]</a> 
&nbsp;

Seizures can be broadly categorized into:<a href="#accordion">[5]</a> 
&nbsp;

<ul>
	<li>Provoked Seizures -&nbsp;Caused by other conditions, like high fever, hypoglycemia, and drug withdrawal; account for 25-30% of all cases</li>
	<li>Unprovoked Seizures -&nbsp;Spontaneous and not caused by a medical condition of an individual; also include seizures that occur a week after an acute injury like stroke or brain hemorrhage 
	&nbsp;</li>
</ul>

According to the International League Against Epilepsy (2017), there are 3 major types of seizures:<a href="#accordion">[7]</a> 
&nbsp;

<ul>
	<li>
	Focal Onset Seizures
	</li>
</ul>

Also known as partial seizures, these originate in one area of the brain. However, they can spread and cause generalized seizures.

They are further divided into focal onset impaired awareness and focal onset aware seizures.

<ul>
	<li>
	Generalized Onset Seizures
	</li>
</ul>

These seizures affect both sides of the brain. They are further divided into absence seizures, tonic seizures, atonic seizures, clonic seizures, myoclonic seizures, and tonic-clonic seizures.

<ul>
	<li>
	Unknown Onset Seizures
	</li>
</ul>

Some seizures may not have a clear onset pattern, making their classification more challenging. 
&nbsp;

Sign and Symptoms

The signs and symptoms of seizures can vary widely from mild to severe, depending on the type of the seizure. Common characteristic symptoms and signs associated with seizures include:

<ul>
	<li>Sudden loss of consciousness or awareness</li>
	<li>A staring spell</li>
	<li>Involuntary or uncontrolled muscle movements</li>
	<li>Cognitive or emotional changes, including anxiety and feelings of deja vu</li>
	<li>Temporary <a href="https://merisehat.pk/disease/confusion">confusion</a> or disorientation 
	&nbsp;</li>
</ul>

Causes

Seizures can be caused by a variety of factors, including:<a href="#accordion">[8]</a>

<ul>
	<li>Epilepsy</li>
	<li>A high fever</li>
	<li>A traumatic brain injury</li>
	<li>Infections such as encephalitis or meningitis</li>
	<li>Certain medicines, such as antidepressants 
	&nbsp;</li>
</ul>

<h5>Stages Of Seizures</h5>

An episode may have the following stages:<a href="#accordion">[8]</a>

<ul>
	<li>Prodrome or the beginning phase</li>
	<li>Ictal or the middle phase</li>
	<li>Postictal or the end phase 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of seizures involves a thorough evaluation of the patient&#39;s medical history, physical examination, and diagnostic tests.

Functional imaging techniques, such as long-term video EEG monitoring, are essential for diagnosing psychogenic nonepileptic seizures and differentiating them from epileptic seizures.<a href="#accordion">[1]</a>

The doctor may also do a neurological exam and order blood tests and a lumbar puncture to determine the cause of the seizure and the patient&rsquo;s probability of having another episode in the future. 
&nbsp;

Treatment

The treatment of seizures aims to reduce the frequency of seizures and improve the patient&#39;s quality of life. Available options include medication, surgical interventions, and lifestyle management.

Anticonvulsant medications, such as phenytoin, carbamazepine, and valproate, are commonly used to prevent seizures and stabilize electrical activity in the brain.<a href="#accordion">[9]</a>

Moreover, surgical interventions, such as lobectomy, and electrical stimulation, such as deep brain stimulation, may be considered to reduce seizure frequency and severity and provide relief.

Lifestyle and home remedies, such as taking medicine correctly, getting enough sleep, being physically active, not smoking, and wearing a medical alert bracelet or seizure detection device, also help take control and ensure personal safety during a seizure. 
&nbsp;

Seizures can lead to various complications, especially if left uncontrolled or untreated.<a href="#accordion">[2]</a>

<ul>
	<li>Physical Injuries: Seizures can result in falls and injuries, such as fractures or head trauma.</li>
	<li>Accidents: It&rsquo;s possible to lose control of a vehicle while driving or accidentally drown while bathing or swimming due to loss of awareness or movement.</li>
	<li>Status Epilepticus: This is a life-threatening condition that occurs due to prolonged (lasting more than 5 minutes) or recurrent (not enough time between episodes to recover) seizures. It may cause brain damage or death.</li>
	<li>Cognitive Impairment: Chronic seizures may impact cognitive function and lead to memory problems or learning difficulties.</li>
	<li>Emotional And Psychological Impact: Seizures can affect emotional well-being and lead to anxiety, depression, or social stigma. 
	&nbsp;</li>
</ul>

The following may trigger seizures:

<ul>
	<li>Age; children and the elderly are more affected</li>
	<li>A family history of seizures</li>
	<li>Genetic predisposition to neurological conditions</li>
	<li>Lifestyle, including lack of sleep, low blood sodium, drug abuse</li>
	<li>Pregnancy and hormonal changes 
	&nbsp;</li>
</ul>

The following measures can reduce the chances of having a seizure:

<ul>
	<li>Eat a balanced diet and maintain a healthy weight</li>
	<li>Wear safety equipment whenever necessary</li>
	<li>Get vaccinated and ensure timely treatment of infections, especially eye and ear infections</li>
	<li>Manage chronic conditions, like diabetes</li>
	<li>Not misuse prescription or recreational drugs</li>
	<li>Avoid known seizure triggers, like flashing lights and stress 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Seizures are temporary abnormalities in behaviors, muscle tone or movements, states of awareness, or sensations due to excessive neuronal activity in the brain.</li>
	<li>The main types of seizures include focal, generalized, and unknown onset seizures.</li>
	<li>Common signs and symptoms of seizures include loss of consciousness, involuntary muscle movements, and altered mental status.</li>
	<li>Common causes of seizures include epilepsy, dangerously high fever, traumatic brain injury, infections, and certain medicines.</li>
	<li>Diagnosis of seizures involves a comprehensive evaluation, including long-term video EEG monitoring, blood tests, and a lumbar puncture.</li>
	<li>Treatment options for seizures include anticonvulsant medications, surgical interventions, and lifestyle management.</li>
	<li>Complications of seizures may include physical injuries, accidents, status epilepticus, cognitive impairment, and emotional and psychological impact.</li>
	<li>Common risk factors for seizures include age, family history, genetic predisposition to neurological conditions, and pregnancy and hormonal changes.</li>
	<li>Preventive measures for reducing the risk of seizures include wearing safety equipment whenever necessary, managing chronic conditions, not misusing prescription or recreational drugs, and avoiding known triggers.</li>
</ul>

[1] Gedzelman, E. and LaRoche, S. (2014). Long-term video eeg monitoring for diagnosis of&amp;nbsp;psychogenic nonepileptic seizures. Neuropsychiatric Disease and Treatment, 1979.

[2] Shih, J., Fountain, N., Herman, S., Bagić, A., Lado, F., Arnold, S., … & Labiner, D. (2017). Indications and methodology for video‐electroencephalographic studies in the epilepsy monitoring unit. Epilepsia, 59(1), 27-36.

[3] Hackett, R., Hackett, L., & Bhakta, P. (1997). Febrile seizures in a south indian district: incidence and associations. Developmental Medicine &Amp; Child Neurology, 39(6), 380-384.

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