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Definition

A seizure happens when there are certain types of abnormal electrical activity in the brain. During a seizure, you may:

  • Lose consciousness
  • Stare into space
  • Have convulsions (abnormal jerking of the muscles)
  • Experience abnormalities of sensation or emotion

If you have two or more seizures that are not due to an illness or other trigger, then it is considered a seizure disorder. This condition is also known as epilepsy. Seizure disorders may be classified by the part of the brain they affect and the kinds of symptoms they cause. One way to categorize into two important groups is:

  • Generalized seizure disorder—onset is throughout the brain, not from a single focal location
  • Partial seizure disorder (focal seizure)—begins within certain areas of the brain
Brain Cells (Neurons)
IMAGE
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Causes

Seizures are caused by abnormal brain function. For many people, it is not known what causes the malfunction. Some known causes include:

  • In newborns:
    • Congenital brain abnormalities (present at birth)
    • Birth injuries that deprive the brain of oxygen
    • Metabolic disorders
    • Maternal drug use
    • Infection
  • In infants and children:
  • In children and adults:
  • In elderly:

Risk Factors

Factors that may increase your chance of developing seizures or a seizure disorder include:

If you already have a seizure disorder, the following factors can increase your chance of having a seizure:

  • Sleep deprivation
  • Alcohol
  • Hormonal changes (such as those that occur at points during the menstrual cycle)
  • Stress
  • Flashing lights, especially strobe lights
  • Use of certain medicines
  • Missing doses of anti-epileptic medicines

Symptoms

There are many kinds of seizure disorders with a variety of symptoms, such as:

  • Aura—a sensation at the start of a seizure, may involve the perception of an odd smell or sound, visual symptoms, or unusual stomach sensations
  • Staring
  • Loss of consciousness
  • Repeated jerking of a single limb
  • Generalized convulsion with uncontrollable jerking of muscles throughout the body
  • Hand rubbing
  • Lip smacking
  • Picking at clothing
  • Perception of an odor, sound, or taste
  • Loss of bladder or bowel control
  • Postictal state—a state of drowsiness, alteration in responsiveness, and/or confusion that commonly occurs after a generalized tonic-clonic seizure; may last minutes, hours, or days

Symptoms of generalized seizure disorders include:

  • Generalized tonic-clonic seizures—loss of consciousness, stiffening, uncontrollable jerking of muscles throughout the body
  • Absence seizures—staring, eye blinking, or eye rolling

Symptoms of partial seizure disorder include:

  • Complex partial or temporal lobe seizures:
    • May lose contact with reality, stop purposeful activity, and begin a series of automatic gestures (eg, lip smacking, hand-wringing, or picking at clothing)
    • May appear as a brief moment of confusion or loss of attentiveness
    • May have a perception of unusual sights, sounds, or smells
  • Simple partial seizures:
    • Does not involve a loss of contact with reality or a loss of consciousness
    • Single area of the body may move uncontrollably (eg, leg or arm shaking)
    • May include the perception of an odor, sound, or taste, or an unrelated emotion

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a neurologist. These doctors specialize in the nervous system and brain.

Tests may include the following:

  • Blood tests—to look for abnormal levels of different substances in the blood
  • Electroencephalogram (EEG)—a test that uses sensors to evaluate electrical brain activity
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head (used in some cases)
  • Lumbar puncture —a test of the cerebrospinal fluid (CSF) from the lower back; may be done to look for infection or bleeding
  • Magnetoencephalography (MEG)—an imaging device that measures the brain's magnetic fields
  • Positron emission tomography (PET)—an imaging test that shows activity in the brain
  • Single photon emission computed tomography (SPECT)—an imaging test that shows blood flow in the brain

Treatment

The goals of treatment are to:

  • Treat the underlying cause (if known)
  • Prevent seizures—may be done through medicine, surgery, or special therapies
  • Avoid factors that stimulate seizure activity

Anti-epileptic Medication

There are wide varieties of medicines that may be used. Some of these include:

  • Phenytoin
  • Diazepam
  • Lorazepam
  • Carbamazepine
  • Valproic acid
  • Levetiracetam
  • Gabapentin
  • Phenobarbital
  • Ethosuximide
  • Clonazepam
  • Primidone
  • Oxcarbazepine
  • Lamotrigine
  • Topiramate
  • Felbamate
  • Tiagabine
  • Zonisamide
  • Pregabalin
  • Lacosamide
  • Adrenocorticotropic hormone (ACTH)
  • Vigabatrin (approved for use in infants)

These drugs may be given alone or in combination. Each of these drugs may have particular side effects and interactions. Talk to your doctor about which medicine is right for you.

Talk to your doctor if you are or plan to become pregnant.

Surgery

If medicine does not work or the side effects are too severe, you may need surgery. Surgery involves the removal of the seizure focus. This is the area of the brain that has been identified as starting the seizure. Surgery is only an option for people who have very localized areas of the brain involved.

Vagus Nerve Stimulation (VNS)

A device is implanted in the chest. It will provide intermittent electrical stimulation to the vagus nerve. It is not clear how this works. Somehow it prevents or decreases the frequency of seizures. You may still require medicine. The dosage may be less.

Ketogenic Diet

This is a very strict diet. It is high in fat and low in carbohydrates and proteins. This diet keeps the body’s chemical balance in ketosis. Ketosis decreases the frequency of seizures. The reason is unknown. Following a ketogenic diet is most successful in children. It is less successful in adults.

Modification of Activity

If you have a seizure disorder, you can take the following steps to try to decrease the chance of a seizure:

  • Get enough sleep.
  • Avoid excessive alcohol intake. Alcohol can make seizures more likely.
  • Avoid hyperventilating.
  • Avoid places where flashing or strobe lights are in use.
  • Wear a medical alert bracelet. That way, if you have a seizure, people around you will understand what is happening. They will be able to take appropriate steps to be helpful.
  • Consider keeping a seizure log. Record things that were happening around the time of a seizure. This will help to identify a seizure trigger.
  • Take your seizure medicines according to the prescription.

Prevention

There are no known ways to prevent every type of seizure disorder. You can take steps to prevent brain injuries that could lead to seizures:

  • Always wear a helmet when using bikes, rollerblades, skateboards, or scooters.
  • Wear protective headgear when playing contact sports.
  • Dive in safe depths of water.
  • Always wear a seatbelt.
  • Avoid using street drugs.
  • If your baby or child has a high fever, get treatment right away.
  • Get prenatal care. If you have high blood pressure during pregnancy, get proper treatment.
  • If you have a chronic condition, get proper care.

If you have a very severe seizure disorder, some changes may be needed to prevent serious injuries, such as:

  • Depending on your condition, avoid driving.
  • Do not swim or bathe alone.
  • Do not work on ladders or ledges.
  • Avoid or modify athletic activities.

Talk to your doctor about these kinds of issues.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 12/2013 -
  • Update Date: 06/10/2014 -
  • Epilepsy Foundation

    http://www.efa.org

  • National Institute of Neurological Disorders and Stroke

    http://www.ninds.nih.gov

  • Center for Epilepsy and Seizure Education

    http://epilepsy.cc

  • Epilepsy Ontario

    http://www.epilepsyontario.org

  • Antiepileptic drugs (AEDs) for seizure disorders. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 29, 2012. Accessed August 31, 2012.

  • Cecil RL, Goldman L, Ausiello DA. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: WB Saunders Company; 2004.

  • Epilepsy in Adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 9, 2012. Accessed August 31, 2012.

  • FDA approves new drug to treat severe form of epilepsy. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116980.htm. Accessed August 31, 2012.

  • FDA approves Potiga to treat seizures in adults. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm258834.htm. Accessed August 31, 2012.

  • Fisher RS, Van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy: Definition proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46:470–472.

  • 12/20/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine.

  • 5/14/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500-506.

  • 11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Sabril approved by FDA to treat spasms in infants and epileptic seizures. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm179855.htm. Updated August 21, 2009. Accessed October 8, 2009.

  • 5/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Quet F, Guerchet M, Pion SD, Ngoungou EB, Nicoletti A, Preux PM. Meta-analysis of the association between cysticercosis and epilepsy in Africa. Epilepsia. 2010 ;51(5):830-837.

  • 6/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Veiby G, Engelsen BA, et al. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol. 2013;70(11):1367-1374.