Evaluation of a First-Time Seizure
What is epilepsy?
Epilepsy is a brain condition that causes a person to have seizures. It is one of the most common disorders of the nervous system. It affects people of all ages, races, and ethnic backgrounds.
The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal brain signals. Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or drug withdrawal, or a brain concussion. But when a person has 2 or more seizures with no known cause, this is diagnosed as epilepsy.
There are different types of seizures. The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The 2 main categories of epileptic seizures are focal (partial) seizure and generalized seizure.
Focal (partial) seizures
Focal seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. Before a focal seizure, you may have an aura, or signs that a seizure is about to occur. This is more common with a complex focal seizure. The most common aura involves feelings, such as deja vu, impending doom, fear, or euphoria. Or you may have visual changes, hearing abnormalities, or changes in your sense of smell. The 2 types of focal seizures include:
Simple focal seizure
The symptoms depend on which area of the brain is affected. If the abnormal electrical brain function is in the part of the brain involved with vision (occipital lobe), your sight may be altered. More often, muscles are affected. The seizure activity is limited to an isolated muscle group. For example, it may only include the fingers, or larger muscles in the arms and legs. You may also have sweating, nausea, or become pale. You don’t lose consciousness in this type of seizure.
Complex focal seizure
This type of seizure often occurs in the area of the brain that controls emotion and memory function (temporal lobe). You will likely lose consciousness. This may not mean you pass out. You may just stop being aware of what's going on around you. You may look awake, but have a variety of unusual behaviors. These may range from gagging, lip smacking, running, screaming, crying, or laughing. You may be tired or sleepy after the seizure. This is called the postictal period.
A generalized seizure occurs in both sides of the brain. You will lose consciousness and be tired after the seizure (postictal state). Types of generalized seizures include:
This is also called petit mal seizure. This seizure causes a brief changed state of consciousness and staring. You will likely maintain your posture. Your mouth or face may twitch or your eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, you may not recall what just occurred. You may go on with your activities as though nothing happened. These seizures may occur several times a day.
This is also called a drop attack. With an atonic seizure, you have a sudden loss of muscle tone and may fall from a standing position or suddenly drop your head. During the seizure, you will be limp and unresponsive.
Generalized tonic-clonic seizure (GTC)
This is also called grand mal seizure. The classic form of this kind of seizure has 5 distinct phases. Your body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake). This is followed by contraction and relaxation of the muscles (clonic period) and the postictal period. During the postictal period, you may be sleepy. You may have problems with vision or speech, and may have a bad headache, fatigue, or body aches. Not all of these phases occur in everyone with this type of seizure.
This type of seizure causes quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters. This means that they may occur several times a day, or for several days in a row.
What causes a seizure?
A seizure can be caused by many things. These can include:
An imbalance of nerve-signaling brain chemicals (neurotransmitters)
Brain damage from illness or injury
Epilepsy may be caused by a combination of these. In most cases, the cause of epilepsy can’t be found.
What are the symptoms of a seizure?
Your symptoms depend on the type of seizure. General symptoms or warning signs of a seizure can include:
Jerking movements of the arms and legs
Stiffening of the body
Loss of consciousness
Breathing problems or stopping breathing
Loss of bowel or bladder control
Falling suddenly for no apparent reason, especially when associated with loss of consciousness
Not responding to noise or words for brief periods
Appearing confused or in a haze
Nodding your head rhythmically, when associated with loss of awareness or loss of consciousness
Periods of rapid eye blinking and staring
During the seizure, your lips may become tinted blue and your breathing may not be normal. After the seizure, you may be sleepy or confused.
The symptoms of a seizure may be like those of other health conditions. Make sure to talk with your healthcare provider for a diagnosis.
How are seizures diagnosed?
Your healthcare provider will ask about your symptoms and your health history. You’ll be asked about other factors that may have caused your seizure, such as:
Drug or alcohol use
A recent injury to the head
High fever or infection
You may also have:
A neurological exam
Blood tests to check for problems in blood sugar and other factors
Imaging tests of the brain, such as an MRI or CT scan
Electroencephalogram, to test your brain's electrical activity
Lumbar puncture (spinal tap), to measure the pressure in the brain and spinal canal and test the cerebral spinal fluid for infection or other problems
How are seizures treated?
The goal of treatment is to control, stop, or reduce how often seizures occur. Treatment is most often done with medicine. There are many types of medicines used to treat epilepsy. Your healthcare provider will need to identify the type of seizure you are having. Medicines are selected based on the type of seizure, age of the person, side effects, cost, and ease of use. Medicines used at home are usually taken by mouth as capsules, tablets, sprinkles, or syrup. Some medicines can be given into the rectum. If you are in the hospital with seizures, medicine may be given by injection or intravenously by vein (IV).
It is important to take your medicine on time and as prescribed by your doctor. People’s bodies react to medicine differently so your schedule and dosage may need to be adjusted for the best seizure control. All medicines can have side effects. Talk with your healthcare provider about possible side effects. While you are taking medicine, you may need tests to see how well the medicine is working. You may have:
Blood tests. You may need blood tests often to check the level of medicine in your body. Based on this level, your healthcare provider may change the dose of your medicine. You may also have blood tests to check the effects of the medicine on your other organs.
Urine tests. Your urine may be tested to see how your body is reacting to the medicine.
Electroencephalogram (EEG). An EEG is a procedure that records the brain's electrical activity. This is done by attaching electrodes to your scalp. This test is done to see how medicine is helping the electrical problems in your brain.
If medicine doesn’t work well enough for you, your healthcare provider may advise other types of treatment. You may have:
Vagus nerve stimulation (VNS)
This treatment sends small pulses of energy to the brain from one of the vagus nerves. This is a pair of large nerves in the neck. If you have partial seizures that are not controlled well with medicine, VNS may be an option. VNS 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 one of the vagus nerves. The battery is then programmed to send energy impulses every few minutes to the brain. When you feel a seizure coming on, you may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure. VNS can have side effects such as hoarse voice, pain in the throat, or change in voice.
Surgery may be done to remove the part of the brain where the seizures are occurring. Or the surgery helps to stop the spread of the bad electrical currents through the brain. Surgery may be an option if your seizures are hard to control and always start in one part of the brain that doesn’t affect speech, memory, or vision. Surgery for epilepsy seizures is very complex. It is done by a specialized surgical team. You may be awake during the surgery. The brain itself does not feel pain. If you are awake and able to follow commands, the surgeons are better able to check areas of your brain during the procedure. Surgery is not an option for everyone with seizures.
Living with epilepsy
If you have epilepsy, you can manage your health. Make sure to:
Take your medicine exactly as directed
Get enough sleep, as lack of sleep can trigger a seizure
Avoid anything that may trigger a seizure
Have tests as often as needed
See your healthcare provider regularly
When should I call my healthcare provider?
Call your healthcare provider if:
Your symptoms get worse or do not get better
You have side effects from medicine
Key points about epilepsy and seizures
A seizure occurs when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal signals
There are many types of seizures. Each can cause different kinds of symptoms. These range from slight body movements to loss of consciousness and convulsions.
Epilepsy is when you have 2 or more seizures with no known cause.
Epilepsy is treated with medicine. In some cases, it may be treated with VNS or surgery.
It’s important to avoid anything that triggers seizures. This includes lack of sleep.