Hypotension 

is low blood pressure.[1] Blood pressure is the force of blood pushing against the
walls of the arteries as the heart pumps out blood.[2] Blood pressure is indicated by two numbers,
the systolic blood pressure (the top number) and the diastolic blood pressure (the bottom number),
which are the maximum and minimum blood pressures, respectively.[3] A systolic blood pressure of
less than 90 millimeters of mercury (mmHg) or diastolic of less than 60 mmHg is generally
considered to be hypotension.[4][5] Different numbers apply to children.[6] However, in practice, blood
pressure is considered too low only if noticeable symptoms are present.[7]
Hypotension is the opposite of hypertension, which is high blood pressure.[2] It is best understood as
a physiological state rather than a disease.[2] Severely low blood pressure can deprive the brain and
other vital organs of oxygen and nutrients, leading to a life-threatening condition called shock.
[3]
 Shock is classified based on the underlying cause, including hypovolemic shock, cardiogenic
shock, distributive shock, and obstructive shock.[8]
Hypotension can be caused by excessive exercise, excessive heat, low blood
volume (hypovolemia),[9] hormonal changes,[10] widening of blood vessels,[11] anemia,[12] a lack
of vitamin B12 and folic acid,[7][13] anaphylaxis,[7] heart problems,[14] or endocrine problems.[15] Some
medications can also lead to hypotension.[16] There are also syndromes that can cause hypotension
in patients including orthostatic hypotension,[17] vasovagal syncope,[18] and other rarer conditions.[19][20]
An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally
excessive or synchronous neuronal activity in the brain.[6] 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.[5][8] Loss of bladder
control may occur.[3]
Seizures may be provoked and unprovoked.[6] 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][6] Unprovoked seizures occur without a known or
fixable cause such that ongoing seizures are likely.[5][3][6][7] 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.
[6]
 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.[10] Any seizure lasting longer
than five minutes should be treated as status epilepticus.[8] 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.[7] 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.[11]
Up to 10% of people have at least one epileptic seizure.[5][9] 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.[5] After
one seizure, the chance of experiencing a second is about 50%.[12] Epilepsy affects about 1% of the
population at any given time[9] with about 4% of the population affected at some point in time.[7] Many
places require people to stop driving until they have not had a seizure for a specific period.[5]

Focal seizures[edit]
Focal seizures often begin with certain experiences, known as an aura.[13] These may include
sensory (including visual, auditory, etc.), cognitive, autonomic, olfactory or motor phenomena.[17]
In a complex partial seizure a person may appear confused or dazed and cannot respond to
questions or direction.[17]
Jerking activity may start in a specific muscle group and spread to surrounding muscle groups—
known as a Jacksonian march.[18] Unusual activities that are not consciously created may occur.
[18]
 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.[18]

Generalized seizures[edit]
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and
atonic seizures.[19] They all involve a loss of consciousness and typically happen without warning.[20]

 Tonic-clonic seizures present with a contraction of the limbs followed by their extension, along
with arching of the back for 10–30 seconds.[20] A cry may be heard due to contraction of the chest
muscles.[20] The limbs then begin to shake in unison.[20] After the shaking has stopped it may take
10–30 minutes for the person to return to normal.[20]
 Tonic seizures produce constant contractions of the muscles.[20] The person may turn blue if
breathing is impaired.[20]
 Clonic seizures involve shaking of the limbs in unison.[20]
 Myoclonic seizures involve spasms of muscles in either a few areas or generalized through the
body.[20]
 Absence seizures can be subtle, with only a slight turn of the head or eye blinking.[17] 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.[17]
 Atonic seizures involve the loss of muscle activity for greater than one second.[18] This typically
occurs bilaterally (on both sides of the body).[18]
Duration[edit]
A seizure can last from a few seconds to more than five minutes, at which point it is known as status
epilepticus.[21] Most tonic-clonic seizures last less than two or three minutes.[21] Absence seizures are
usually around 10 seconds in duration.[15]

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.[13] This usually lasts 3 to 15
minutes[22] but may last for hours.[23] Other common symptoms include: feeling tired, headache,
difficulty speaking, and abnormal behavior.[23] Psychosis after a seizure is relatively common,
occurring in between 6 and 10% of people.[24] Often people do not remember what occurred during
this time.[23]

Causes[edit]
Main article: Causes of seizures
Seizures have a number of causes. Of those who have a seizure, about 25% have epilepsy.[25] 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.[26] These seizures are
known as "acute symptomatic" or "provoked" seizures and are part of the seizure-related disorders.
[26]
 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.[27]
 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.[28]
 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.[29]
Metabolic[edit]
Dehydration can trigger epileptic seizures if it is severe enough.[30] 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.[20] As may hepatic
encephalopathy and the genetic disorder porphyria.[20]

Structural[edit]
 Cavernoma or cavernous malformation is a treatable medical condition that can cause seizures,
headaches, and brain hemorrhages.
 Arteriovenous malformation (AVM) is a treatable medical condition that can cause seizures,
headaches, and brain hemorrhages.
 Space-occupying lesions in the brain (abscesses, tumours). In people with brain tumours, the
frequency of epilepsy depends on the location of the tumor in the cortical region.[31]
Medications[edit]
Both medication and drug overdoses can result in seizures,[20] as may certain medication and drug
withdrawal.[20] Common drugs involved include: antidepressants, antipsychotics, cocaine, insulin, and
the local anaesthetic lidocaine.[20] Difficulties with withdrawal seizures commonly occurs after
prolonged alcohol or sedative use, a condition known as delirium tremens.[20]

Infections[edit]
 Infection with the pork tapeworm, which can cause neurocysticercosis, is the cause of up to half
of epilepsy cases in areas of the world where the parasite is common.[32]
 Parasitic infections such as cerebral malaria. In Nigeria this is one of the most common causes
of seizures among children under five years of age.[33]
 Infection, such as encephalitis or meningitis[34]
Stress[edit]
Stress can induce seizures in people with epilepsy, and is a risk factor for developing epilepsy.
Severity, duration, and time at which stress occurs during development all contribute to frequency
and susceptibility to developing epilepsy. It is one of the most frequently self-reported triggers in
patients with epilepsy.[35][36]
Stress exposure results in hormone release that mediates its effects in the brain. These hormones
act on both excitatory and inhibitory neural synapses, resulting in hyper-excitability of neurons in the
brain. The hippocampus is known to be a region that is highly sensitive to stress and prone to
seizures. This is where mediators of stress interact with their target receptors to produce effects.[37]
Other[edit]
Seizures may occur as a result of high blood pressure, known as hypertensive encephalopathy, or in
pregnancy as eclampsia when accompanied by either seizures or a decreased level of
consciousness.[20] Very high body temperatures may also be a cause.[20] Typically this requires a
temperature greater than 42 °C (107.6 °F).[20]

 Head injury may cause non-epileptic post-traumatic seizures or post-traumatic epilepsy

 About 3.5 to 5.5% of people with celiac disease also have seizures.[38]
 Seizures in a person with a shunt may indicate failure
 Hemorrhagic stroke can occasionally present with seizures, embolic strokes generally do not
(though epilepsy is a common later complication); cerebral venous sinus thrombosis, a rare type
of stroke, is more likely to be accompanied by seizures than other types of stroke
 Multiple sclerosis may cause seizures
 Electroconvulsive therapy (ECT) deliberately sets out to induce a seizure for the treatment of
major depression.
 Reflex seizure induced by a specific stimulus or trigger (extrinsic or intrinsic stimuli)

Mechanism[edit]
Normally, brain electrical activity is non-synchronous.[17] In epileptic seizures, due to problems within
the brain,[39] a group of neurons begin firing in an abnormal, excessive,[14] and synchronized manner.
[17]
 This results in a wave of depolarization known as a paroxysmal depolarizing shift.[40]
Normally after an excitatory neuron fires it becomes more resistant to firing for a period of time.
[17]
 This is due in part from the effect of inhibitory neurons, electrical changes within the excitatory
neuron, and the negative effects of adenosine.[17] In epilepsy the resistance of excitatory neurons to
fire during this period is decreased.[17] This may occur due to changes in ion channels or inhibitory
neurons not functioning properly.[17] Forty-one ion-channel genes and over 1,600 ion-channel
mutations have been implicated in the development of epileptic seizure.[41] These ion channel
mutations tend to confer a depolarized resting state to neurons resulting in pathological hyper-
excitability.[42] This long-lasting depolarization in individual neurons is due to an influx of Ca2+ from
outside of the cell and leads to extended opening of Na+ channels and repetitive action potentials.
[43]
 The following hyperpolarization is facilitated by γ-aminobutyric acid (GABA) receptors
or potassium (K+) channels, depending on the type of cell.[43] Equally important in epileptic neuronal
hyper-excitability, is the reduction in the activity of inhibitory GABAergic neurons, an effect known as
disinhibition. Disinhibition may result from inhibitory neuron loss, dysregulation of axonal sprouting
from the inhibitory neurons in regions of neuronal damage, or abnormal GABAergic signaling within
the inhibitory neuron.[44] Neuronal hyper-excitability results in a specific area from which seizures may
develop, known as a "seizure focus".[17] Following an injury to the brain, another mechanism of
epilepsy may be the up regulation of excitatory circuits or down regulation of inhibitory circuits.[17]
[45]
 These secondary epilepsies occur through processes known as epileptogenesis.[17][45] Failure of
the blood–brain barrier may also be a causal mechanism.[46] While blood-brain barrier disruption
alone does appear to cause epileptogenesis, it has been correlated to increased seizure activity.
[47]
 Furthermore, it has been implicated in chronic epileptic conditions through experiments inducing
barrier permeability with chemical compounds.[47] Disruption may lead to fluid leaking out of the blood
vessels into the area between cells and driving epileptic seizures.[48] Preliminary findings of blood
proteins in the brain after a seizure support this theory.[47]
Focal seizures begin in one hemisphere of the brain while generalized seizures begin in both
hemispheres.[19] Some types of seizures may change brain structure, while others appear to have
little effect.[49] Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy
but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.[49]
Seizure activity may be propagated through the brain's endogenous electrical fields.[50] Proposed
mechanisms that may cause the spread and recruitment of neurons include an increase in K+ from
outside the cell,[51] and increase of Ca2+ in the presynaptic terminals.[43] These mechanisms blunt
hyperpolarization and depolarizes nearby neurons, as well as increasing neurotransmitter release.[43]