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Seizures and Epilepsy - Causes
A seizure is caused by a sudden increase in the electrical activity in one portion of the brain. The seizure can stay in that one area giving rise to specific and focal symptoms, or it may spread (generalization) to the entire brain resulting in a loss of consciousness and body shaking. This sudden discharge of electrical activity can be secondary to a wide variety of causes--ranging from epilepsy to head injury. Epilepsy refers to a seizure disorder of unknown cause, usually presenting in childhood. Approximately 4 million people in the U.S. have some form of epilepsy. Studies have estimated that there may be as many as 100,000 new cases reported every year. Patients with epilepsy have a mortality rate that is 2-3 times higher than that of the general population (see complications of seizures below).
THE CAUSES FOR SEIZURE
1. FEBRILE SEIZURES (secondary to fever in children)
2. STROKE
3. HEAD INJURY
4. METABOLIC DERANGEMENTS (low oxygen in the blood stream, body salt or electrolyte abnormality, low blood sugar)
5. ALCOHOL WITHDRAWAL OR DRUG WITHDRAWAL
6. EPILEPSY
7. PREECLAMPSIA (untreated)
8. DRUG TOXICITY, DRUG SIDE EFFECT, OR POISONING SEIZURE COMPLICATIONS
1. TONGUE BITING AND DENTAL INJURY
2. ASPIRATION PNEUMONIA
3. BONE FRACTURE (fractured collarbone is common)
4. BRAIN DAMAGE (from prolonged seizures, or from low oxygen due to interference with normal breathing during the seizure)
5. RESPIRATORY ARREST (breathing stops secondary to a blocked airway)
6. TRAUMA (further injury as the result of a seizure) Common symptoms of a seizure vary widely according to the type of seizure. Symptoms may range from prolonged staring with petit-mal seizure to complete loss of consciousness, including generalized shaking. Seizures may be focal, or generalized. A focal seizure will involve involuntary jerking, shaking, or some repetitive movement in one extremity (or the face) only. The generalized, or grand-mal seizure, is typified by loss of consciousness, tongue biting, loss of bladder control, and shaking of ALL the extremities. This is followed by a period of sluggish responsiveness, slow deep breathing, and confusion. This is known as the "postictal state" and may last anywhere from 15 minutes to several hours. Evaluation will include history and physical examination. Controlling an ongoing seizure will be given priority. Patients with a "first time" seizure will commonly have a more extensive evaluation then the patient with known epilepsy. In some cases, CT-scanning or MRI scanning of the head is useful exclude tumor, or brain injury. Blood tests (blood counts, blood chemistry) are important when looking for a metabolic derangement that might be responsible for the seizure. Bone and extremity x-rays will be done where indicated, if injury (sustained during the seizure) is suspected. EEG or an electroencephalogram is often diagnostic for seizure disorder. Epileptics on anticonvulsant medications may have their blood levels checked to make sure their dosage is adequate. Treatment priority is based on controlling the active seizure. Intravenous medications are frequently given to abort the seizure. The decision to hospitalize the patient will be based on the underlying cause of the seizure as well as the number and duration of seizures experienced. Patients with known epilepsy and no history for injury will often have their medication (e.g. Dilantin, carbamazepine, valproic acid, phenobarbital) levels optimized, and be safely discharged to family or friends. The Neurologist is the expert in the evaluation of this problem.
FIRST AID FOR SEIZURES
1. Make sure the convulsing patient has a clear and open airway. Take careful notice of any food or vomit in the airway. With the head and neck extended slightly into the "sniffing position", the airway can be kept clear.
2. Do not place anything into the patients mouth. Patients who are having a seizure DO NOT "swallow their tongue." Attempting to grab the tongue, or place objects into the mouth will result in injury to yourself and/or the patient. Pay close attention to their breathing in the event that it discontinues. Many times, head and neck repositioning will assist in opening the airway and establish patient breathing.
4. Left side laying down is the best position.
5. Try to keep the seizing patient away from objects that may injure them. Notify emergency medical personnel IMMEDIATELY.
Hope this article will provide you information about seizures and epilepsy.
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