Seizure Disorder

04/09/2023 1

Seizure DisorderAn overview

Sushant Satyal

04/09/2023 Sushant Satyal

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Contents

Introduction Some Definitions Brain Activity During Seizure Types of Seizure Percentage of various types of seizures all

over the world Common Symptoms Seizure have a beginning, middle and end


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Contd….

Causes and examples Drugs used to treat Seizure Home Care What to expect at Your Office Visit Precautions Conclusion


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Introduction

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.


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Contd….

Classified as involving parts of the brain

Involving a small part of the brain: Focal

Involving the whole part of the brain:

Generalized

Focal Seizures can be simple or complex

Also classified in terms of body affected


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Contd….

Whole body affected : Generalized

Small part or side of the body affected: Focal

Symptom may vary depending on what parts of brain are involved.

Some Seizures may hard to notice as they consist of staring spells

May cause loss of awareness and shaking of body


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Some Definitions

A sudden, involuntary, time-limited alteration in behavior, motor activity, autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain.

Seizure (medicine), sudden attack or spasm, as in epilepsy or a similar disorder. Seizures differ with the type of condition and may consist of loss of consciousness, convulsive jerking of parts of the body, emotional explosions, or periods of mental confusion.


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Brain Activity During Seizure An electroencephalogram (an EEG) is a

recording of the brain's electrical activity. The procedure is simple and painless. About 20 small adhesive electrodes are placed on the scalp, and the brain's activity is recorded under normal conditions. Then the person is exposed to various stimuli, such as bright or flashing lights, to try to provoke a seizure. During a seizure, electrical activity in the brain accelerates, producing a jagged wave pattern. Such recordings of brain waves help identify a seizure disorder. Different types of seizures have different wave patterns.


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Types of Seizure

A. Primary generalized seizure: Begins with a widespread electrical discharge Involves both sides of the brain at once Hereditary factors are important

B. Partial Seizure: Begins with an electrical discharge in one limited

area of the brain Related to head injury, brain infection, stroke, or

tumor


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Contd….

Types of Primary generalized seizure

1. Absence seizures:

▪ Brief episodes of staring

▪ Absence seizures are considered complex

absence seizures

▪ Include a change in muscle activity


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Contd….

▪ Most common movement are eye blinks

▪ Complex absence seizures are often more

than 10 seconds long

▪ Usually begin between ages 4 and 14

▪ no warning before a seizure, and the person is

completely alert immediately afterward


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Contd….

▪ Other movements include slight tasting

movements of the mouth, hand movements

such as rubbing the fingers together ,etc

▪ Children who get them usually have normal

development and intelligence

▪ 70% of cases, absence seizures stop by age

18


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Contd….

2. Atypical absence seizure:

▪ Atypical (a-TIP-i-kul) means unusual or not

typical

▪ Person will stare but often is somewhat

responsive

▪ Eye blinking or slight jerking movements of the

lips may occur


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Contd….

▪ Hard to distinguish from the person's usual

behavior, especially in those with cognitive

impairment

▪ Generally begins at the age of 6

▪ Most of the children affected have below-

average intelligence


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Contd….

▪ Other types of seizures that are difficult to control

▪ Seizures usually continue till adulthood

▪ Daydreaming and inattentiveness can mimic these

seizures

▪ Diagnosis can be difficult if the behavior during

seizures is similar to the child's usual behavior


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Contd….

3. Monoclonic seizures:

▪ Very brief jerks, last only for 2 to 3 sec

▪ seizures usually cause abnormal movements on

both sides of the body at the same time

▪ Myo" means muscle and "clonus" (KLOH-nus)

means rapidly alternating contraction and

relaxation


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Contd….

▪ Seizures usually begin in childhood, but the

seizures can occur at any age

▪ Seizures occur in reflex epilepsies, triggered by

flashing lights or other things in the environment

▪ Syndromes usually can be diagnosed on the basis

of the medical history and often EEG patterns


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Contd….

4. Atonic Seizures:

▪ Atonic" (a-TON-ik) means "without tone

▪ In an atonic seizure, muscles suddenly lose strength

▪ Eyelids may droop, the head may nod, and the

person may drop things and often falls to the ground

▪ Also known as "drop attacks" or "drop seizures


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Contd….

▪ The person usually remains conscious

▪ Another name for this type of seizure is “akinetic”

▪ (A-kin-ET-ik), which means "without movement“

▪ Seizures often begin in childhood

▪ Often last into adulthood

▪ People with atonic seizures are injured when they fall


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Contd….

▪ Seizures may cause people to fall when they're

standing often have tonic seizures rather than

atonic seizures

▪ Syndromes usually can be diagnosed on the

basis of the medical history and often EEG

patterns


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Contd….

5. Tonic Seizures:

▪ Usually last less than 20 sec

▪ In such seizures, the tone is greatly increased

and the body, arms, or legs make sudden

stiffening movements

▪ Consciousness is usually preserved

▪ Seizures most often occur during sleep


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Contd….

▪ Usually involve all or most of the brain,

affecting both sides of the body

▪ Common in people who have the epilepsy

syndrome called Lennox-Gastaut syndrome

▪ Seizures in Lennox-Gastaut syndrome may

become more difficult to control over time


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Contd….

6. Clonic seizures:

▪ Seizures consist of rhythmic jerking

movements of the arms and legs

▪ Length vary according to the case

▪ Clonus" (KLOH-nus) means rapidly alternating

contraction and relaxation of a muscle


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Contd….

▪ Movements cannot be stopped by restraining

or repositioning the arms or legs

▪ These seizures are rarely found

▪ Common are tonic-clonic seizures, in which

the jerking is preceded by stiffening (the

"tonic" part)


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Contd….

▪ Sometimes tonic-clonic seizures start with

jerking alone

▪ These are called clonic-tonic-clonic seizures

▪ Occur at various ages, including in newborns

▪ Brief and infrequent clonic seizures in infants

usually disappear within very short period


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Contd….

▪ Occasionally "jitteriness" in a young infant can be

mistaken for a clonic seizure

▪ Children with neurological impairments with

repetitive movements that could be mistaken for

clonic seizures

▪ The EEG pattern will change during a seizure, so

video-EEG is very useful for diagnosis


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Contd….

7. Tonic-clonic seizures:

▪ Normally last for 2 to 3 min

▪ More than 5 min calls for immediate medical

help

▪ Seizure that lasts more than 30 minutes

indicate convulsion

▪ Person loses consciousness and falls to the

floor


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Contd….

▪ Tongue or cheek may be bitten, so bloody

saliva may come from the mouth

▪ Person may turn a bit blue in the face

▪ After the tonic phase comes the clonic phase

▪ Arms and usually the legs begin to jerk rapidly

and rhythmically


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Contd….

▪ Bending and relaxing at the elbows, hips, and

knees

▪ After a few minutes, the jerking slows and stops

▪ Bladder or bowel control sometimes is lost as the

body relaxes

▪ Consciousness returns slowly, and the person may

be drowsy, confused, agitated, or depressed


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Contd….

▪ They affect both children and adults

▪ Children who have had a single tonic-clonic

seizure, the risk that they will have more seizures

▪ Some children will outgrow their epilepsy

▪ Tonic-clonic seizures can be controlled by seizure

medicines


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Contd….

▪ Patients who are seizure-free for a year or two

while taking seizure medicine will stay seizure-free

▪ Medicine can be stopped gradually

▪ Patients with no epilepsy wave in EEG can stay

free with any medication

▪ People who faint sometimes may develop tonic or

clonic seizure


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Contd….

Types of Partial seizures

1. Simple partial seizures:

▪ Different from person to person, depending on the

part of the brain where they begin

▪ One thing they all have in common is that the person

remains alert and can remember what happens

▪ Usually last for less than 2 min


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Contd….

▪ Doctors often divide simple partial seizures into categories depending on the type of symptoms the person experiences

i. Motor seizuresii. Sensory seizuresiii. Autonomic seizuresiv. Psychic seizures

▪ Anyone can get these seizures

▪ People who have had a head injury, brain

infection, stroke, or brain tumor likely to get them


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Contd…..

▪ These seizures often can be controlled by seizure

medicines

▪ Medical disorders such as, stomach disorders or a

pinched nerve can cause some similar symptoms

▪ Some symptoms (such as déja vu) are

experienced by almost everyone at some time


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Contd….

2. Complex Partial Seizures:

▪ Usually last between 30 seconds and 2 minutes

▪ Afterward, the person may be tired or confused

for about 15 minutes and may not be fully normal

for hours

▪ Seizures usually start in a small area of the

temporal lobe or frontal lobe of the brain


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Contd….

▪ Quickly involve other areas of the brain that

affect alertness and awareness

▪ These seizures (usually ones beginning in the

temporal lobe) start with a simple partial

seizure

▪ Also called an aura, this warning seizure often

includes an odd feeling in the stomach


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Contd…..

▪ Person loses awareness and stares blankly

▪ Most people move their mouth, pick at the air or

their clothing, or perform other purposeless actions

▪ These movements are called "automatisms"

▪ Less often, people may repeat words or phrases,

laugh, scream, or cry


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Contd….

▪ Some people do things during these seizures that

can be dangerous or embarrassing

▪ People need to take precautions in advance

▪ Complex partial seizures starting in the frontal lobe

tend to be shorter than the ones from the temporal

lobe

▪ Some complex partial seizures turn into secondarily

generalized seizures


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Contd…..

▪ people who have had a head injury, brain

infection, stroke, or brain tumor are more likely to

get seizures

▪ If medication is not effective, some can be

eliminated by epilepsy surgery

▪ Complex partial seizures sometimes resemble

daydreaming or absence sezuires


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Contd…..

3. Secondarily generalized seizures:

▪ Start in one limited area of the brain

▪ Can also spread throughout the brain becoming

generalized

▪ Convulsive phase of these seizures usually lasts

no more than a few minutes

▪ Preceding partial seizure is usually not very long


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Contd….

▪ Happen when a burst of electrical activity in a

limited area (the partial seizure) spreads

throughout the brain

▪ Seizures occur in more than 30% of people

with partial epilepsy

▪ Can affect people of all ages who have partial

seizures

▪ Seizures of this kind can be controlled with

medication


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Contd….

▪ Seizures of this kind can be controlled with

medication

▪ If not controlled with medication, surgery is

another option

▪ Easily diagnosed through EEG or MRI tests


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Percentage of various types of seizures all over the world

34%

20%17%

15%

7%7%

Simple partialOther generalizedPartial unknownAbsenceMyoclonicUnclassified


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Common Symptoms

Change in consciousness, so that you can't

remember some period of time

Change in emotion, like unexplainable fear,

panic, joy, or laughter

Change in sensation of the skin, usually

spreading over the arm, leg, or trunk


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Contd….

Changes in vision, including flashing lights, or (rarely)

hallucinations (seeing things that aren't there)

Loss of muscle control and falling, often very

suddenly

Muscle movement such as twitching that might

spread up an arm or leg


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Contd….

Muscle movement such as twitching that

might spread up an arm or leg

Muscle tension/tightening that causes

twisting of the body, head, arms or leg

Tasting a bitter or metallic flavor


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Seizure have a beginning, middle and end

Beginning State: This stage can be said as warning or aura Sometimes an individual may not be aware of such

aura In middle stage this aura is followed by other

symptoms It may be considered as simple partial seizure

Middle State: People have aura in beginning, the aura may convert

into convulsion For those who don’t have aura, the seizure may

continue as complex partial seizure


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Contd….

End state:

This state represents a transition from seizure

back to normal state

Also referred as the “Post-ictal period”

Signifies recovery period of brain

May last from a second to minutes to hours


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Contd….

If a person has a convulsion, the level of

awareness gradually improves during the post-

ictal period, much like a person waking up from

anesthesia after an operation


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Contd….

Early seizure symptoms: Sensory/ thoughts

▪ Déjà vu ▪ Jamais vu ▪ Smell▪ Sound▪ Taste▪ Visual loss or blurring▪ Racing thoughts▪ Stomach feelings ▪ Strange feelings ▪ Tingling feeling

Emotional▪ Fear/Panic▪ Pleasant feeling

Physical ▪ Dizziness▪ Headache ▪ Lightheadedness▪ Nausea ▪ Numbness

No Warnings▪ Sometimes seizures come

with no warnings


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Contd…..

Middle Seizure Symptoms : Sensory/ thoughts▪ Black out▪ Confusion▪ Deafness/Sounds ▪ Electric Shock Feeling ▪ Loss of consciousness ▪ Smell▪ Spacing out ▪ Out of body experience▪ Visual loss or blurring

Emotional:▪ Fear/Panic

Physical:▪ Chewing

movements ▪ Convulsion ▪ Eyes rolling up ▪ Falling down ▪ Foot stomping ▪ Hand waving ▪ Inability to move


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Contd….

• Incontinence▪ Staring▪ Stiffening ▪ Swallowing ▪ Sweating ▪ Teeth clenching/grind▪ Tongue biting▪ Tremors▪ Twitching movement▪ Breathing difficulty▪ Heart racing


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Contd….

Post-ical state: Thought▪ Memory loss▪ Writing Difficulty

Emotional▪ Confusion▪ Depression and

Sadness▪ Fear▪ Frustration▪ Shame/

Embarrassment

Physical▪ Bruising ▪ Difficulty talking▪ Injuries▪ Sleeping ▪ Exhaustion▪ Headache ▪ Nausea ▪ Pain▪ Thirst ▪ Weakness▪ Urge to

urinate/defecate


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Causes and examples

Causes Examples

High fever •Heatstroke•Infections

Brain infections •Abscess•AIDS•Malaria•Meningitis•Rabies•Syphilis•Tetanus•Toxoplasmosis•Viral encephalitis


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Contd…..

Causes Examples

Metabolic disorders •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•Vasculiti


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Contd….Causes Examples

Structural damage to the brain •Brain tumor•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

luid accumulation in the brain (cerebral edema)

•Eclampsia•Hypertensive encephalopathy


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Drugs used to treat Seizure

Drug Use Possible side-effects

Acetazolamide Absence seizures when other anticonvulsants are ineffective

Kidney stones and chemical imbalance in blood

Carbamazepine Generalized seizuresPartial seizures

A low white blood cell count (granulocytopenia), production of too few blood cells (aplastic anemia, which can be fatal disorder), a low platelet count (thrombocytopenia), digestive upset, inability to articulate words, lethargy, dizziness, and visual disturbances


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Contd….

Drugs Uses Possible side-effects

Clonazepam Atonic seizures Atypical absence seizuresInfantile spasmsMyo clonic seizures

Drowsiness, abnormal behavior, loss of coordination, and lost effectiveness of the drug after 1 to 6 months

Divalproex Absence seizuresFebrile seizuresGeneralized tonic-clonic seizuresInfantile spasmsJuvenile myoclonic epilepsyMyoclonic seizures

Nausea, vomiting, abdominal pain, diarrhea, temporary drowsiness, dizziness, shaking (tremor), reversible hair loss, weight gain, and liver damage


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Contd…..


Ethosuximide Absence seizures Nausea, lethargy, dizziness, a low white blood cell count and a low red blood cell count

Felbamate Atypical absence seizures, Partial seizures

Headache, fatigue, liver failure, and, rarely, aplastic anemia (which can be fatal)

Fosphenytoin Status Epilepticus Loss of coordination, drowsiness, headache, rash, and tingling sensations


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Contd….


Gabapentin Partial seizures Drowsiness, dizziness, weight gain, and headacheIn children, aggressive behavior, mood swings, and hyperactivity

Lamotrigine Generalized seizuresPartial seizures

Nausea, vomiting, indigestion, headache, drowsiness, dizziness, insomnia, fatigue, loss of coordination, double vision, tremor, rash, and abnormal menstrual periods


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Contd….


Levetiracetam Juvenile myoclonic epilepsyMyoclonic seizuresPartial seizures

Dizziness, weakness, fatigue, loss of coordination, changes in mood and behavior, and increased risk of infection

Oxcarbazepine Partial seizures Headache, abdominal pain, double vision, drowsiness, dizziness, fatigue, nausea, low sodium levels in the blood, and a low white blood cell count


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Contd….


Topiramate Atypical absence seizuresPartial seizuresPrimarily generalized tonic-clonic seizures

Confusion, reduced concentration, difficulty finding words, fatigue, loss of appetite and weight, numbness or tingling, reduced sweating, and kidney stones

Valproate Absence seizuresFebrile seizuresGeneralized tonic-clonic seizuresInfantile spasmsJuvenile myoclonic epilepsy

Nausea, vomiting, abdominal pain, diarrhea, weight gain, reversible hair loss, temporary drowsiness, shaking (tremor), and, rarely, liver damage


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Home Care

Stay with the person until recovery or you have

professional medical help

Monitor pulse ,rate of breathing, and blood pressure

Do not give the person anything by mouth until

convulsions have stopped and the person is fully

awake and alert


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Contd….

Do not move the person unless he or she is

in danger or near something hazardous

Do not place anything including your

fingers between the person’s teeth. You can

break person’s teeth, if you do so.


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What to expect at Your Office Visit

The doctor will perform a physical examination and ask questions to help understand the cause of the seizures, such as:

Are there any risk factors ( such as recent

head injury)?

Did it occur or start on one side of the body?

Did the person remain awake and aware

during seizure?

How long the seizure last?


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Contd….

How often do the seizures happen?

Was there any aura of the seizures?

Were there any other symptoms present

(visual changes, abnormal smells)?


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Contd….

The following tests may be performed:

Blood tests Ct scan or MRI of the brain EEG Lumbar puncture


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People with uncontrolled seizures should not drive.

Drinking should be avoided

Medicines should be taken regularly

Avoid activities such as climbing to high places, biking,

and swimming

Use of sharp instruments such as knife should be

avoided

Precautions


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Conclusion

Seizure is life threatening disease

No specific way to prevent seizures

But it is curable if instruction are followed

Good habits may help to control seizures


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Contd….

Sleep deprivation, and poor diet must be

avoided

Good sleep habits, stress reduction, proper

exercise, and sound nutrition may help

Use helmets to avoid head injury

Have faith in yourself, and seizure is

curable!!


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Thank You!!

Health & Medicine

Seizure Disorder