An 

epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous
neuronal activity in the brain.[5] Outward effects vary from uncontrolled shaking movements involving much of the body
with loss of consciousness (tonic-clonic seizure), to shaking movements involving only part of the body with variable levels
of consciousness (focal seizure), to a subtle momentary loss of awareness (absence seizure).[3] Most of the time these
episodes last less than two minutes and it takes some time to return to normal.[4][7] Loss of bladder control may occur.[3]
Seizures may be provoked and unprovoked.[5] Provoked seizures are due to a temporary event such as low blood
sugar, alcohol withdrawal, abusing alcohol together with prescription medication, low blood sodium, fever, brain infection,
or concussion.[3][5] Unprovoked seizures occur without a known or fixable cause such that ongoing seizures are likely.[4][3][5]
[6]
 Unprovoked seizures may be exacerbated by stress or sleep deprivation.[3] Epilepsy describes brain disease in which there
has been at least one unprovoked seizure and where there is a high risk of additional seizures in the future.[5] Conditions that
look like epileptic seizures but are not include: fainting, nonepileptic psychogenic seizure and tremor.[3]
A seizure that lasts for more than a brief period is a medical emergency.[9] Any seizure lasting longer than five minutes
should be treated as status epilepticus.[7] A first seizure generally does not require long-term treatment with anti-seizure
medications unless a specific problem is found on electroencephalogram (EEG) or brain imaging.[6] Typically it is safe to
complete the work-up following a single seizure as an outpatient.[3] In many, with what appears to be a first seizure, other
minor seizures have previously occurred.[10]
Up to 10% of people have at least one epileptic seizure.[4][8] Provoked seizures occur in about 3.5 per 10,000 people a year
while unprovoked seizures occur in about 4.2 per 10,000 people a year.[4] After one seizure, the chance of experiencing a
second is about 50%.[11] Epilepsy affects about 1% of the population at any given time[8] with about 4% of the population
affected at some point in time.[6] Many places require people to stop driving until they have not had a seizure for a specific
period.[4]

Contents

 1Signs and symptoms

o 1.1Focal seizures
o 1.2Generalized seizures
o 1.3Duration
o 1.4Postictal
 2Causes
o 2.1Metabolic
o 2.2Structural
o 2.3Medications
o 2.4Infections
o 2.5Stress
o 2.6Other
 3Mechanism
 4Diagnosis
o 4.1Classification
o 4.2Physical examination
o 4.3Tests
o 4.4Differential diagnosis
 5Prevention
 6Management
o 6.1Medication
o 6.2Other
 7Prognosis
 8Epidemiology
 9History
 10Society and culture
o 10.1Economics
o 10.2Driving
 11Research
 12References
 13External links

Signs and symptoms[edit]

See also: Seizure types
The signs and symptoms of seizures vary depending on the type.[12] The most common and stereotypical type of seizure
is convulsive (60%), typically called a tonic-clonic seizure.[13] Two-thirds of these begin as focal seizures prior to developing
into tonic-clonic seizures.[13] The remaining 40% of seizures are non-convulsive, an example of which is absence seizure.
[14]
 When EEG monitoring shows evidence of a seizure, but no symptoms are present, it is referred to as a subclinical
seizure.[15]

Focal seizures[edit]
Focal seizures often begin with certain experiences, known as an aura.[12] These may include sensory (including visual,
auditory, etc), cognitive, autonomic, olfactory or motor phenomena.[16]
In a complex partial seizure a person may appear confused or dazed and cannot respond to questions or direction.[16]
Jerking activity may start in a specific muscle group and spread to surrounding muscle groups—known as a Jacksonian
march.[17] Unusual activities that are not consciously created may occur.[17] These are known as automatisms and include
simple activities like smacking of the lips or more complex activities such as attempts to pick something up.[17]

Generalized seizures[edit]
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.[18] They
all involve a loss of consciousness and typically happen without warning.[19]

 Tonic-clonic seizures present with a contraction of the limbs followed by their extension, along with arching of the back
for 10–30 seconds.[19] A cry may be heard due to contraction of the chest muscles.[19] The limbs then begin to shake in
unison.[19] After the shaking has stopped it may take 10–30 minutes for the person to return to normal.[19]
 Tonic seizures produce constant contractions of the muscles.[19] The person may turn blue if breathing is impaired.[19]
 Clonic seizures involve shaking of the limbs in unison.[19]
 Myoclonic seizures involve spasms of muscles in either a few areas or generalized through the body.[19]
 Absence seizures can be subtle, with only a slight turn of the head or eye blinking.[16] The person often does not fall over
and may return to normal right after the seizure ends, though there may also be a period of post-ictal disorientation.[16]
 Atonic seizures involve the loss of muscle activity for greater than one second.[17] This typically occurs bilaterally (on
both sides of the body).[17]

Duration[edit]
A seizure can last from a few seconds to more than five minutes, at which point it is known as status epilepticus.[20] Most
tonic-clonic seizures last less than two or three minutes.[20] Absence seizures are usually around 10 seconds in duration.[14]

Postictal[edit]
After the active portion of a seizure, there is typically a period of confusion called the postictal period before a normal level of
consciousness returns.[12] This usually lasts 3 to 15 minutes[21] but may last for hours.[22] Other common symptoms include:
feeling tired, headache, difficulty speaking, and abnormal behavior.[22] Psychosis after a seizure is relatively common,
occurring in between 6 and 10% of people.[23] Often people do not remember what occurred during this time.[22]

Causes[edit]
Main article: Causes of seizures
Seizures have a number of causes. Of those who have a seizure, about 25% have epilepsy.[24] A number of conditions are
associated with seizures but are not epilepsy including: most febrile seizures and those that occur around an acute infection,
stroke, or toxicity.[25] These seizures are known as "acute symptomatic" or "provoked" seizures and are part of the seizure-
related disorders.[25] In many the cause is unknown.
Different causes of seizures are common in certain age groups.
 Seizures in babies are most commonly caused by hypoxic ischemic encephalopathy, central nervous system (CNS)
infections, trauma, congenital CNS abnormalities, and metabolic disorders.
 The most frequent cause of seizures in children is febrile seizures, which happen in 2–5% of children between the ages
of six months and five years.[26]
 During childhood, well-defined epilepsy syndromes are generally seen.
 In adolescence and young adulthood, non-compliance with the medication regimen and sleep deprivation are potential
triggers.
 Pregnancy and labor and childbirth, and the post-partum, or post-natal period (after birth) can be at-risk times,
especially if there are certain complications like pre-eclampsia.
 During adulthood, the likely causes are alcohol related, strokes, trauma, CNS infections, and brain tumors.[27]
 In older adults, cerebrovascular disease is a very common cause. Other causes are CNS tumors, head trauma, and
other degenerative diseases that are common in the older age group, such as dementia.[28]

Metabolic[edit]
Dehydration can trigger epileptic seizures if it is severe enough.[29] A number of disorders including: low blood sugar, low
blood sodium, hyperosmolar nonketotic hyperglycemia, high blood sodium, low blood calcium and high blood urea levels
may cause seizures.[19] As may hepatic encephalopathy and the genetic disorder porphyria.