Seizure

Seizures vary from mild to life-threatening and have many causes. They can occur once, such as when a child has a fever, or repeatedly, such as in epilepsy. At Atrium Health Floyd and Harbin Clinic, our neurologists work with you to determine the seizure type and underlying cause. They provide expert care to reduce or stop seizures.

What are seizures?

During a seizure, nerve cells (neurons) in the brain send out the wrong signals. Those signals can cause uncontrollable muscle spasms and shaking or less noticeable symptoms, such as changes in sensation, emotions and behavior.

Epilepsy is a neurological disorder that increases a person's risk of seizures. However, not all seizures are a sign of epilepsy.

In general, seizures are more common in children and young adults, but they can occur at any age. Seizures and epilepsy can also run in families.

Causes of seizures

Seizures happen when there is a sudden disruption in the brain's electrical activity. This disorganized brain activity may be caused by a medical condition or injury. Often, doctors are unable to determine the cause (idiopathic seizures).

When the underlying cause is specific and temporary, the seizures are called provoked (nonepileptic). Unprovoked (epileptic) seizures occur randomly and repeatedly. The causes of nonepileptic and epileptic seizures vary widely and often overlap.

Causes of nonepileptic seizures may include:

• Abnormal blood levels of sodium, glucose and other electrolytes
• Brain infection, including meningitis
• Brain injury
• Brain tumor
• Drug abuse
• Electric shock
• Fever (particularly in young children)
• Heart disease
• Heat illness
• Stroke and transient ischemic attack (TIA)
• Toxic substances, including poisons and venomous bites and stings
• Toxin buildup in the body due to liver or kidney failure
• Very high blood pressure (malignant hypertension)
• Withdrawal from alcohol, drugs and certain medicines

Common causes of epileptic seizures may include:

• Abnormal blood vessels in the brain
• Brain infection
• Brain injury
• Brain problems that are present at birth (congenital brain anomaly)
• Brain tumor
• Dementia, such as Alzheimer's disease
• Metabolic disorders present at birth (such as phenylketonuria)
• Stroke or transient ischemic attack (TIA)

Seizure symptoms

Symptoms vary widely, depending on which part of the brain is affected. They usually start suddenly and may include:

• Changes in feelings or sensations
• Drooling
• Falling to the floor
• Loss of bladder or bowel control (incontinence)
• Loss of consciousness
• Staring
• Uncontrollable muscle spasms and shaking
• Unusual behaviors, such as lip smacking or fidgeting

Some people have warning signs (aura) before a seizure, such as:

• Changes in sense of touch, taste, smell or sight
• Emotional changes, such as fear or anxiety
• Nausea, headache or dizziness

Seizure types

Seizures fall into two main groups:

Focal seizures: These seizures affect just one part of your brain. You may or may not lose awareness and remember what happened.

Generalized seizures: These seizures are a result of abnormal activity on both sides of the brain. There are several types of generalized seizures, each with characteristic symptoms. For example, absence seizures involve blank staring. Tonic-clonic seizures cause convulsions, rigid muscles and loss of consciousness. In some cases, a generalized seizure starts as a focal seizure.

Seizure diagnosis

Your doctor will determine the type of seizure based on the symptoms you experience and other tests, such as:

• Physical exam
• Neurological exam
• Blood tests
• Brain imaging tests, such as CT, MRI or positron emission tomography (PET) scans
• Electroencephalogram (EEG)
• Lumbar puncture (spinal tap)

Seizure prevention

Seizure prevention centers around avoiding the many causes. Eating a healthy diet, wearing a helmet during sports and avoiding alcohol and illegal drugs can reduce your risk.

If you have epilepsy, understanding what may trigger a seizure is important. Common triggers include lack of sleep, stress, flashing lights or certain foods or medications. Tracking and identifying what happens before a seizure will help you avoid those situations in the future.

Seizure treatment

When possible, your doctor will treat the underlying condition that’s causing the seizures. Other treatments that can help reduce seizure activity include:

• Antiseizure medications
• Dietary changes
• Implantation of a brain stimulation device to disrupt seizure signals
• Surgery

Some people with epilepsy require lifelong care. Others are able to reduce or stop their antiseizure medicines after having no seizures for several years. Certain types of childhood epilepsy may go away or improve with age, usually in the late teens or 20s.

When taking antiseizure medications, always take them on time and as directed. Don’t stop taking medicines without talking to your doctor first. Also, let your doctor know if you plan to become pregnant, as some medications increase the risk of birth anomalies.

What to do during a seizure

Most seizures last from a few seconds to several minutes and stop on their own. A seizure lasting longer than 5 minutes or having many seizures without waking up between them is a medical emergency. Call 911.

During a seizure, the main goal is to protect the person from injury:

• Lay them on the ground and clear the area of furniture or other sharp objects.
• Place a cushion under their head.
• Loosen tight clothing, especially around the neck.
• Turn them on their side to prevent inhalation of vomit into the lungs.
• Look for a medical ID bracelet with seizure instructions.
• Stay with them until they recover, or until medical help arrives.

In addition, you should NOT:

• Hold them down or try to make them stop convulsing
• Move them, unless they are in danger
• Place anything between their teeth
• Give them anything by mouth until they are fully awake
• Start CPR, unless the seizure has stopped and they are unresponsive and not breathing

If a child has a seizure due to a high fever, don’t place them in a cold bath. Cool the child slowly with lukewarm water. Once the child is awake, you can give them acetaminophen to reduce the fever.