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  Seizure Disorder

Seizure Disorder is sudden brief alterations in how the brain functions. Seizure disorder is commonly referred to as Epilepsy. Epilepsy affects one percent of the United States population. In 50% of all cases, no specific cause can be determined. Some causes of epilepsy are head injury, genetic, infectious illnesses, tumors, and lead poisoning.

Seizure Disorder Neurological disorder
Seizure Disorder


A seizure occurs when electrical impulses are fired by nerves at rates up to four times higher than the normal level. This causes an electrical storm of the brain. Repeated patterns of electrical storms are what define epilepsy.

Categories and symptoms

Symptoms of seizures are based on their categories. Two main categories of seizures are partial and generalized. A partial seizure is divided into two sub categories, simple partial and complex partial. Partial seizures originate in a specific area of the brain.

A simple partial seizure has these symptoms

 patient remains conscious
 weakness
 numbness
 atypical smells/tastes
 twitching of muscles/limbs
 head turning
 paralysis
 vision impairments
 vertigo

When symptoms spread for a localized place to other parts of the body, it is called Jacksonian epilepsy.

Complex partial seizures begin in the temporal lobe and have these symptoms:

 impaired consciousness
 impaired ability to interact with environment
 automatic repetitive behavior (automatisms)
o lip smacking,
o circle walking
o sitting and standing
 unusual thought like déjà vu
 uncontrollable laughing, fear
 visual hallucinations
 olfactory (smell/taste) hallucinations

Generalized seizures involve a larger part of the brain – often both sides from the beginning of the seizure. Generalized seizures are divided into subtypes known as tonic-clonic, absence, and myoclonic.

A tonic-clonic seizure is also known as a grand mal. The symptoms of this seizure involve specific movements of the arms, legs and face with loss of consciousness. An individual may call out or cry shortly before losing consciousness. Before a grand mal seizure, an individual may experience an aura or unusual feeling the is a premonition of the seizure. When an individual has a grand mal seizure their body may fall suddenly, head and body jerks, drool and incontinence mal also occur. Once the jerking ends, a patient may stay unconscious for a while. Grand mal seizures can last up to twenty minutes. When individuals regain consciousness they may feel weak, confused and go back to sleep for a long time.

Absence seizures are also known as petit mal. These seizure present will with symptoms of loss of conscious without motor behavior. There usually is no aura or warning before the onset. The loss of consciousness is extremely brief, about five to ten seconds with the individual returning to normal behavior. The individual usually does not note the seizure and appears as if daydreaming or staring off into space.

Myoclonic seizures present with the symptoms of a brief jerking movement that typically occurs on both sides of the body. The motor activity can be severe or hardly noticeable. Most myoclonic seizures begin before the age of five. There are different syndromes that are defined by their myoclonic seizure presentation:

West syndrome symptoms are infantile spasms, impairment or stoppage of psychomotor development and hypsarrythmia – an abnormality of the electroencephalogram. (EEG) The infantile spasms involve the individual getting into a folded or jack-knife position. Children with West syndrome also have neurological complications. The seizures, unfortunately do not respond well to a majority of anticonvulsant medications.

Lennox-Gastaut syndrome has the symptoms of minor motor seizures. The seizures can include atypical petit mal seizures, atonic seizures and myoclonic seizures. The atypical petit mal seizures may present with brief unconsciousness, staring and in cycles that are not in typical petit mal seizures. Atonic seizures may occur with sudden loss of muscle tone.

Status Epilepticus is extensive seizures or seizure activity that lasts over twenty minutes. This is a medial emergency with poor outcome. If not treated aggressively, it can be fatal. Status epilepticus is caused by stroke, infection, trauma, certain medications, brain tumor, drug overdose or cardiac arrest.

Diagnosis

After the first seizure, an individual needs to have a complete evaluation. The evaluation should include a detailed clinical history with details of birth, childhood, family history and current medications. Drug and alcohol use should be noted, if present.

Seizure subtypes should be determined. Information that needs to be examined about the patient includes time of day of the seizure, state of consciousness of the patient prior to seizure, and determines if any seizure triggers are involved, such as sleep deprivation, dehydration, fevers or flickering light.

Diagnostic testing for seizures includes CT scan, magnetic resonance imaging, and electroencephalography or EEG. Urinalysis and complete blood count with drug screening or toxin screen are also performed on an individual.

A CAT scan will check for brain tumor, stroke, hemorrhage, trauma or infection. This test is limited because it does not provide detail of certain structures such as the temporal lobes, a common site for seizures.

An MRI will provide excellent detail of the brain. This test can check for abnormalities in the brain, lesions, small strokes and trauma. A contrast agent that is injected into a vein will provide an even better picture of the brain.

An EEG is also known as a brain wave. This test reads the electrical activity of the brain. There is no image produced but a graph of electrical activity can identify a dysfunction in the brain. An EEG is usually recorded for about 45 minutes. Environmental factors and behaviors can be performed while testing, such as strobe light, sleep, hyperventilating, and sleep deprivation. Activity during a seizure can be noted on the graph, the activity is called an epileptiform. Sometimes an EEG is performed with video monitoring to record activity that is motor and electrical.

Treatment

Treatment of seizure disorders involves the use of anticonvulsants. Anticonvulsants act indifferent ways in the body and therefore some drugs may be more useful for certain seizure types.

Treatment also depends on the underlying etymology of the seizures, such as tumor, stroke or head injury.

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