Seizures  

What is a seizure?

The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally communicate with each other through electrical activity.

A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.

What are the different types of seizures?

There are several different types of seizures, including the following:

partial seizures
Partial seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. In about one-third of people with partial seizures, the person may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities, or changes in the sense of smell. Two types of partial seizures include the following:

simple partial seizures
The seizures typically last less than one minute. The person may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the person's sight may be altered. The person's muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as the fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The person may also experience sweating, nausea, or become pale.
 

complex partial seizures
This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, the person may complain of being tired or sleepy after the seizure. This is called the postictal period.

generalized seizures
Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include the following:

absence seizures (formerly known as petit mal seizures)
These seizures are characterized by an altered state of consciousness and staring episodes. Typically, the person's posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the person may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures are uncommon before the age of 5 and occur more often in girls.

atonic
With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his/her head. During the seizure, the person is limp and unresponsive.

generalized tonic-clonic seizures (GTC or formerly known as grand mal seizures)
This seizure is characterized by five distinct phases that occur. The body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake), followed by a clonic period (contraction and relaxation of the muscles) and the postictal period. During the postictal period, the person may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.

myoclonic seizures
This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.

infantile spasms
This rare type of seizure disorder occurs in infants from before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when he/she is trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications.

febrile seizures
This type of seizure is associated with fever. These seizures are more commonly seen in children between 6 months and 6 years of age, and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called "simple," and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called "complex" and there may be long-term neurological changes in the child.

What causes a seizure?

A person may experience one or many seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:

in newborns and infants:

birth trauma, congenital (present at birth) problems, fever,metabolic or chemical imbalances in the body

in children, adolescents, and adults:

alcohol or drugs, head trauma, infection, unknown reasons

Other possible causes of seizures may include the following:

brain tumor, neurological problems, drug withdrawal, medications

What are the symptoms of a seizure?

The person may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs of seizures. Symptoms or warning signs may include:

staring, jerking movements of the arms and legs, stiffening of the body, loss of consciousness, breathing problems or breathing stops, loss of bowel or bladder control, falling suddenly for no apparent reason, not responding to noise or words for brief periods, appearing confused or in a haze, sleepiness and irritable upon waking in the morning, nodding the head or periods of rapid eye blinking and staring During the seizure, the person's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.

The symptoms of a seizure may resemble other problems or medical conditions. Always consult your physician for a diagnosis.

How are seizures diagnosed?

The full extent of the seizure may not be completely understood immediately after onset of symptoms, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the person and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up.

Diagnostic tests may include:

blood tests

electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

Treatment of a seizure:

Specific treatment for a seizure will be determined by your physician based on:

your age, overall health, and medical history

type of the seizure

frequency of the seizures

your tolerance for specific medications, procedures, or therapies

expectations for the course of the condition

your opinion or preference The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the normal activities of daily living (ADLs). The major goals of seizure management include the following:

proper identification of the type of seizure

using medication specific to the type of seizure

using the least amount of medication to achieve adequate control

maintaining appropriate medication levels

Treatment may include:

medications

There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the patient, side effects, the cost of the medication, and the adherence with the use of the medication.

Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the person's rectum). If the person is in the hospital with seizures, medication by injection or intravenous (IV) may be used.

It is important to take your medication on time and as prescribed by your physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for the most effective seizure control.

All medications can have side effects, although some people may not experience side effects. Discuss your medication's side effects with your physician.

While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:

blood work
Frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired level. This level is called the "therapeutic level" and is where the medication works most efficiently. Blood work may also be done to monitor the effects of medications on body organs.

urine tests
These tests are performed to see how the person's body is responding to the medication.

electroencephalogram (EEG)
An EEG is a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain.

vagus nerve stimulation (VNS)
Some people, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently only used for persons over the age of 12 who have partial seizures that are not controlled by other methods.

VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the person feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure.

There are some side effects that may occur with the use of VNS. These may include, but are not limited to, the following:

hoarseness

pain or discomfort in the throat

change in voice

surgery

Another treatment option for seizures is surgery. Surgery may be considered in a person who:

has seizures that are unable to be controlled with medications.

has seizures that always start in one area of the brain.

has a seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory, or vision.

Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain.

A person may be awake during the surgery. The brain itself does not feel pain. With the person awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.

Surgery is not an option for everyone with seizures. Discuss this treatment option with your physician for more information.

More information regarding the person with seizures or epilepsy:

Make sure you or your child (if age appropriate) understand the type of seizure that is occurring and the type of medication(s) that are needed.

Know the dose, time, and side effects of all medications.

Consult your physician before taking other medications. Medications for seizures can interact with many other medications, causing the medications to work improperly and/or causing side effects

Young women of childbearing age who are on seizure medications need to be informed that seizure medications are harmful to a fetus, and the medication may also decrease the effectiveness of oral contraceptives.

Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle.

If a person has good control over the seizures, only minimal restrictions need to be placed on activities, in most cases.

Specific follow-up will be determined by your physician.

Medications for seizures may not be needed for the person's entire life. Some persons may be taken off their medications if they have been seizure-free for one to two years. This will be determined by your physician.

Mechanical aids can make life monumentally easier for people with cerebral palsy. They are things like silverware, wheelchairs, communication aids, writing aids and more that have been adapted in one way or another for people who would otherwise not be able to use them.

Many patients with cerebral palsy have such high muscle tone that they do not have full, if any, use of their hands. Silverware has been created to give these people more independence in their everyday lives. By adding grips, using special molds to create handles or by affixing straps or other modifications to the silverware, people who would not have been able to hold a fork on their own are now able to eat by themselves.

Writing aids, such as pens or pencils, are other objects that many people with cerebral palsy have trouble manipulating, since frequently they have difficulties with small objects. Much like adapted silverware, pens and pencils have been adapted with added grips and handles so people with cerebral palsy can have far more success using them.

Wheelchairs are essential for many people with cerebral palsy, but they are not always equipped for a person who cannot either roll the wheels by themselves in a manual chair, or they do not have the coordination to operate a motorized wheelchair with a joystick. Wheelchairs have also been adapted for these people, so that they do not have to have a person with them to operate their wheelchair. While most controls are hand-operated in wheelchairs, these chairs have been designed so that the controls lie behind the head. While there are more than one version of such a wheelchair, a common adaptation functions so that by simply pushing her or her head back against the headrest (where the controls are located) the chair will move forward, and can turn left or right depending on which direction he or she moves their head. Even reversing can be easily accomplished by activating the reverse switch, also located on the headrest.

Communication aids are quite helpful for those whose speech patterns make it hard to conduct any form of in-depth conversation. For these people, it maybe easier to use a communication aid to talk with others. Communication aids vary greatly, and can range from a poster with pictures of things the person might want to a magnetic alphabet board so he or she can spell out what they are trying to convey.

With the fairly recent leaps in technological advancement, computers have made a monumental change in many of the lives of people with cerebral palsy. Not only can they be used as a communication aid by reading aloud typed words on the screen, they can be adapted in such a way that the patient would be able to do most anything they wanted, even design websites. Many of these computers have touch screens, but special mouses and pointers fitted to one’s forehead if they are unable to operate a computer mouse. There are special keyboards with extra-large keys, and keyboard and special software created for people who use only one hand, or even one finger. There is software for people who have little or no control over their movement that helps them to dial and speak on the phone, or to be able to just type the first few letters in a word and have the computer “predict” what the word will be.

All of these things and more have helped people with cerebral palsy to overcome their particular limitations and be able to accomplish everyday things that perhaps they would not have been able to with out the help of personalized mechanical aids.

March of Dimes – Medical References – Cerebral Palsy
Professionals & Researchers

Cerebral Palsy – eCureMe.com