Seizures

Seizure symptoms and causes

Overview

A seizure is a sudden, uncontrolled burst of electrical activity in the brain. This activity can lead to changes in behavior, movements, feelings, and levels of consciousness. While epilepsy is diagnosed when a person experiences two or more seizures without a known cause, not all seizures are caused by epilepsy.

There are many types of seizures, each with unique symptoms. These types vary in how much they affect daily life, as well as by where they start in the brain and how far they spread. Most seizures last from 30 seconds to two minutes, but a seizure lasting longer than five minutes is a medical emergency and requires immediate intervention.

Seizures can be caused by conditions such as stroke, head injury, or infections like meningitis. However, the cause is often unknown. Medication can control most seizures, although side effects may occur, so it is essential to work closely with a healthcare provider to balance treatment and quality of life.

Symptoms

Seizure symptoms can vary widely depending on the type and severity. They may include:

• Brief periods of confusion
• A blank staring spell
• Uncontrolled jerking movements of the arms and legs
• Loss of awareness or consciousness
• Emotional changes, such as fear, anxiety, or déjà vu

Most seizures fall into two main categories: focal seizures and generalized seizures. These classifications are based on how and where the abnormal brain activity begins. If the origin of the seizure cannot be determined, it may be classified as an unknown onset seizure.

Focal Seizures

Focal seizures, also known as partial seizures, are caused by electrical disturbances in a specific area of the brain. They can occur with or without loss of awareness.

Focal Seizures with Impaired Awareness

These seizures involve a change in consciousness, making the person feel as if they are in a dreamlike state. The person may stare into space and repeat certain movements, such as hand rubbing or lip smacking. They may not respond to their surroundings and often don’t remember the seizure afterward.

Focal Seizures without Impaired Awareness

In these seizures, awareness is not lost, but other symptoms like sudden emotional shifts (anger, joy, or sadness), sensory changes, or nausea may occur. Symptoms might include jerking of a specific body part, dizziness, or seeing flashing lights. People experiencing these seizures may have trouble speaking but remain aware.

Generalized Seizures

Generalized seizures affect the entire brain from the onset. Common types include:

• Absence seizures: Often occurring in children, these seizures involve brief periods of staring or slight body movements like eye blinking. They usually last only 5–10 seconds but can occur frequently throughout the day.
• Tonic seizures: These cause muscle stiffness, primarily in the back, arms, and legs, which may lead to sudden falls.
• Atonic seizures: Known as “drop seizures,” these result in a sudden loss of muscle control, often causing a collapse.
• Clonic seizures: Characterized by rhythmic jerking of muscles, particularly in the neck, face, and arms.
• Myoclonic seizures: These involve brief jerks or twitches in the arms or legs without loss of consciousness.
• Tonic-clonic seizures: Previously known as grand mal seizures, these are the most common generalized seizures, leading to loss of consciousness, body stiffness, and shaking. They may cause a person to bite their tongue or lose bladder control.

Stages of a Seizure

Seizures generally have three stages: the beginning, middle, and end phases. These stages are also called prodrome, ictal, and postictal phases.

Prodrome

The prodrome, or early warning stage, may occur hours or days before a seizure. Some people experience changes in behavior or emotions, a feeling that something is not right, or an aura. An aura, often the first symptom of a seizure, may include sensations like déjà vu, unusual smells or tastes, or an overwhelming sense of fear or joy.

Ictal Phase

This phase is the seizure itself, beginning with the first symptom and ending when the seizure stops. Symptoms depend on the type of seizure and can range from minor muscle movements to full-body convulsions.

Postictal Phase

After a seizure, recovery begins in the postictal phase, which can last minutes or hours. People may feel tired, confused, or weak. Other symptoms may include memory issues, nausea, headache, and mood changes. Recovery time varies based on the seizure type and area of the brain affected.

When to See a Doctor

Seek medical help immediately if:

• The seizure lasts longer than five minutes
• Breathing does not resume after the seizure ends
• A second seizure follows immediately
• The person has a high fever
• The person is pregnant, diabetic, or injured during the seizure

For a first-time seizure, see a healthcare professional as soon as possible.

Causes

Seizures result from abnormal electrical activity in the brain’s neurons. Various factors can disrupt neuron communication, including:

• High fever: Common in young children, these are called febrile seizures.
• Infections: Brain infections like meningitis or encephalitis can lead to seizures.
• Sleep deprivation
• Low blood sodium: Often due to diuretics, which increase urination.
• Medications: Some medicines for pain, depression, or smoking cessation may trigger seizures.
• Brain injuries: Traumatic events, such as head trauma or stroke, can cause bleeding and seizures.
• Substance misuse: Alcohol and certain drugs can both cause and exacerbate seizures.

Risk Factors

Several factors increase the risk of seizures, including:

• Head trauma
• Brain conditions: Cognitive impairment, tumors, and Alzheimer’s disease can increase risk.
• Family history: Genetic factors may play a role in seizure susceptibility.
• Substance use: Excessive alcohol or recreational drug use also raises seizure risk.

Complications

Seizures can lead to serious complications, which may include:

• Falls: Seizures can cause falls, leading to potential head injuries or broken bones.
• Drowning: Seizures in water pose a risk of drowning, requiring extra caution around pools or bathtubs.
• Car accidents: Loss of awareness during a seizure may prevent safe driving, increasing accident risk.
• Pregnancy complications: Seizures during pregnancy can pose risks to both mother and child.
• Mental health issues: Living with seizures can contribute to anxiety, depression, and other mental health challenges.
• Sudden Unexpected Death in Epilepsy (SUDEP): Rarely, poorly managed seizures can lead to sudden death, particularly in severe epilepsy cases.

Prevention

Preventing seizures involves managing triggers, such as avoiding sleep deprivation, reducing stress, and staying away from alcohol or recreational drugs. People prone to seizures should avoid flashing lights when possible and adopt a healthy lifestyle.

Diagnosis

A healthcare provider may conduct several tests to diagnose seizures, including:

• Neurological exam: Tests motor skills, behavior, and brain function.
• Blood tests: Blood samples reveal sugar, electrolyte levels, and infection indicators.
• Spinal tap: Collects spinal fluid to check for brain infections.
• EEG: Measures brain’s electrical activity to identify abnormal patterns.
• MRI or CT scans: Imaging tests show structural

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