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A seizure disorder includes any condition in which there are repeated episodes of seizures of any type. In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction.
Many people have unusual sensations just before a seizure starts. Some seizures cause uncontrollable shaking and loss of consciousness, but more often, people simply stop moving or become unaware of what is happening. Doctors suspect the diagnosis based on symptoms, but imaging of the brain, blood tests, and electroencephalography (to record the brain's electrical activity) are usually needed to identify the cause. If needed, drugs can usually prevent seizures.
Normal brain function requires an orderly, organized, coordinated discharge of electrical impulses. Electrical impulses enable the brain to communicate with the spinal cord, nerves, and muscles as well as within itself. Seizures may result when the brain's electrical activity is disrupted. There are two basic types of seizures:
Epileptic: These seizures have no apparent cause (or trigger) and occur repeatedly. These seizures are called a “seizure disorder” or “epilepsy.” Nonepileptic: These seizures are triggered (provoked) by a disorder or another condition that irritates the brain. In children, a fever can trigger a nonepileptic seizure.
Certain mental disorders can cause symptoms that resemble seizures, called psychogenic nonepileptic seizures. Causes Which causes are most common depend on when seizures start:
Before age 2: High fevers or temporary metabolic abnormalities, such as abnormal blood levels of sugar (glucose), calcium, magnesium, vitamin B6, or sodium, can trigger one or more seizures. Seizures do not occur once the fever or abnormality resolves. If the seizures recur without such triggers, the cause is likely to be an injury during birth, a birth defect, or a hereditary metabolic abnormality or brain disorder. 2 to 14 years: Often, the cause is unknown. After age 25: A head injury, stroke, or tumor may damage the brain, causing a seizure. Alcohol withdrawal (caused by suddenly stopping drinking) is a common cause of seizures. However, in about half of people in this age group, the cause is unknown.
Seizures with no identifiable cause are called idiopathic. Causes of Seizures Cause
High fever Brain infections
Heatstroke Infections Abscess AIDS Malaria Meningitis Rabies Syphilis Tetanus Toxoplasmosis Viral encephalitis
High blood levels of sugar or sodium Kidney or liver failure Low blood levels of sugar, calcium, magnesium, or sodium Underactive parathyroid gland Vitamin B6 deficiency (in newborns)
Inadequate oxygen supply to the brain
Abnormal heart rhythms Carbon monoxide poisoning Near drowning Near suffocation Stroke Vasculitis
Structural damage to the brain
Brain tumor (noncancerous or cancerous) Head injury Hydrocephalus Intracranial hemorrhage Stroke
Abnormalities present or occurring at birth
Birth defect Hereditary metabolic disorders, such as Tay-Sachs disease or phenylketonuria Injury during birth
Fluid accumulation in the brain (cerebral edema) Prescription drugs*
Eclampsia Hypertensive encephalopathy BuspironeSOME TRADE NAMES BUSPAR
(used to treat anxiety disorders) Camphor CeftazidimeSOME TRADE NAMES FORTAZ TAZICEF (an antibiotic) Chlorpromazine (used to treat schizophrenia) CiprofloxacinSOME TRADE NAMES CILOXAN CIPRO (an antibiotic) ChloroquineSOME TRADE NAMES ARALEN (used to treat malaria) CyclosporineSOME TRADE NAMES NEORAL SANDIMMUNE (used to prevent and treat rejection of organ transplants) Imipenem (an antibiotic) IndomethacinSOME TRADE NAMES INDOCIN (used to relieve pain and reduce inflammation) Meperidine (used to relieve pain) PhenytoinSOME TRADE NAMES DILANTIN
TheophyllineSOME TRADE NAMES THEOLAIR (used to treat asthma and other airway disorders) Tricyclic antidepressants (overdose)
Recreational drugs Withdrawal of a drug after heavy use Exposure to toxins
Amphetamines Cocaine (overdose) Alcohol General anesthetics (used during surgery) Sedatives, including sleep aids Lead Strychnine
Symptoms In about 20% of people who have a seizure disorder, seizures are preceded by unusual sensations (called aura), such as the following:
Abnormal smells or tastes
Butterflies in the stomach A feeling of déjà vu An intense feeling that a seizure is about to begin
Almost all seizures are relatively brief, lasting from a few seconds to a few minutes. Most seizures last 1 to 2 minutes. When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue. These after-effects are called the postictal state. In some people, one side of the body is weak, and the weakness lasts longer than the seizure (a disorder called Todd's paralysis). Most people who have a seizure disorder look and behave normally between seizures. Other possible symptoms include numbness or tingling in a specific body part, brief episodes of unresponsiveness, loss of consciousness, confusion, and loss of muscle or bladder control. Symptoms also vary depending on whether the seizure is partial or generalized. About 70% of people have only one type of seizure. The rest have two or more types. Diagnosis Doctors diagnose a seizure disorder when people have at least two unprovoked seizures that occur at different times. The diagnosis is based on symptoms and the observations of eyewitnesses. Symptoms that suggest a seizure include loss of consciousness, muscle spasms that shake the body, loss of bladder control, sudden confusion, and inability to pay attention. However, seizures cause such symptoms much less often than most people think. A brief loss of consciousness is more likely to be fainting (syncope) than a seizure. Seizures that last only 1 or 2 minutes can seem to go on forever. Doctors also need to know what people experienced before the episode: whether they had a premonition or warning that something unusual was about to happen and whether anything, such as certain sounds or flashing lights, seemed to trigger the episode. Doctors ask whether people have had a disorder that can cause seizures (such as a brain infection) or a head injury. Doctors also ask about which drugs (including alcohol) people are taking or have recently stopped. A thorough physical examination is done. It may provide clues to the cause of the symptoms. Computed tomography (CT) is usually done promptly to check for bleeding, tumors, and other structural damage to brain tissue (for example, by a stroke). If results are
negative, magnetic resonance imaging (MRI) is usually done later. It provides detailed images of abnormalities and can detect most neurologic disorders. If doctors suspect a brain infection such as meningitis or encephalitis, a spinal tap (lumbar puncture) is usually done. Electroencephalography (EEG) can help confirm the diagnosis. EEG is a painless, safe procedure that records electrical activity in the brain. Doctors examine the recording (electroencephalogram) for evidence of abnormal electrical discharges. Because the recording time is limited, EEG can miss abnormalities, and results may be normal, even in people who have a seizure disorder. EEG is sometimes scheduled after people have been deprived of sleep for 18 to 24 hours because lack of sleep makes abnormal discharges more likely to occur. Treatment If the cause can be identified and eliminated, no additional treatment is necessary. For example, if a low blood sugar (glucose) level (hypoglycemia) caused the seizure, glucose is given, and the disorder causing the low level is treated. Other treatable causes include an infection, certain tumors, and an abnormal sodium level. If people have a seizure disorder, general measures plus drugs are usually sufficient. If drugs are ineffective, surgery may be recommended. General Measures: Exercise is recommended and social activities are encouraged. However, people who have a seizure disorder may have to make some adjustments. For example, they should eliminate or limit their consumption of alcoholic beverages and should not use recreational drugs. They should refrain from activities in which a sudden loss of consciousness could result in serious injury. For example, they should not bathe in a bathtub, climb, swim, or operate power tools. After seizures are controlled (typically for at least 6 months), they can do these activities if adequate precautions are taken. For example, they should swim only when lifeguards are present. In most states, laws prohibit people with a seizure disorder from driving until they have been free of seizures for at least 6 months to 1 year. Anticonvulsants: These drugs reduce the risk of having another seizure. Usually, they are prescribed only for people who have had more than one seizure, unless the cause has been identified and completely eliminated. They are usually not prescribed when people have had only one generalized seizure. Most anticonvulsants are taken by mouth.
Anticonvulsants can completely prevent generalized seizures in about one third of people who have them and greatly reduce the frequency of seizures in another third. Almost two thirds of people who respond to anticonvulsants can eventually stop taking them without having a relapse. However, anticonvulsants are ineffective in about 10 to 20% of people with a seizure disorder. These people are referred to a seizure center and evaluated for surgery. Emergency Treatment: Emergency treatment is required for status epilepticus and seizures that last more than 5 minutes. Large doses of one or more anticonvulsants are given intravenously as quickly as possible. Measures to prevent injuries are taken during the prolonged seizure. People are monitored closely to make sure breathing is adequate. If it is not, a tube is inserted to help with breathing—a procedure called intubation. If seizures persist, a general anesthetic is given to stop them. Surgery: If people continue to have seizures while taking two or more anticonvulsants or if they cannot tolerate side effects of the anticonvulsants, brain surgery may be done. These people are tested at specialized epilepsy centers to determine whether surgery can help. Tests may include the following:
Functional MRI: To determine which areas in the brain are causing seizures Single-photon emission CT (SPECT): To check for areas with decreased blood flow around the time of a seizure, which may indicate which areas in the brain are causing seizures EEG combined with magnets used for imaging (magnetic source imaging): Also to help determine which areas in the brain are causing seizures
Stimulation of the Vagus Nerve: Electrical stimulation of the 10th cranial nerve (vagus nerve) can reduce the number of partial seizures by more than one half in some people. This treatment is used when seizures continue despite use of anticonvulsants and when surgery is not a possibility.
The vagus nerve is thought to have indirect connections to areas of the brain often involved in causing seizures. A device that looks like a heart pacemaker (vagus nerve stimulator) is implanted under the left collarbone and is connected to the vagus nerve in the neck with a wire that runs under the skin. The device causes a small bulge under the skin. The operation is done on an outpatient basis and takes about 1 to 2 hours.
SOURCE: http://www.merckmanuals.com/home/brain_spinal_cord_and_nerve_disorders/seizure_disorder s/seizure_disorders.html
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