โรคลมชัก - Seizures

Seizures

Seizures are uncontrolled disturbances of electricity in the brain. Your movements, feelings or behaviour may be changed unconsciously when seizures occur.

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Seizures 

Seizures are uncontrolled disturbances of electricity in the brain. Your movements, feelings or behaviour may be changed unconsciously when seizures occur. There are several types of seizures with ranges of severity and the area of seizures in the brain. Seizures normally last from 30 second to 2 minutes. If the seizures last for more than 5 minutes, an emergency medical help is required. People may experience seizures after a stroke, a close head injury or an infection. Commonly, it can be controlled with medication.

Symptoms

Signs and symptoms of seizures differ from the types and the severity of the disease. People with seizures may experience:

  • Loss of consciousness and awareness
  • Uncontrollable jerking movements of the arms and legs
  • Temporary confusion
  • A staring spell

There are two types of seizures: focal and generalized seizures that are classified by the area of the abnormal electrical activity and how they begin in the brain. However, the reason why this abnormal electrical activity occurs is still unknown.

 Focal seizures

This type of seizure occurs when abnormal electrical activity affects one area of the brain. People with focal seizures may or may not lose their consciousness.

  • Focal seizures with loss of consciousness
    People with this kind of focal seizures will not respond normally as usual. They may perform repetitive movements such as walking in circles, hand rubbing, chewing or swallowing.
  • Focal seizures without loss of consciousness
    These types of focal seizures will not cause unconsciousness. However, people with this kind of seizures may experience:
    • the changes of sensation including smell, look, taste, feel and sound
    • jerking of a body part such as arm and lef
    • tingling
    • dizziness
    • flashing lights

Symptoms of focal seizures might be similar with other neurological disorders such as migraine, narcolepsy or mental illness.

Generalized seizures

This type of seizures occurs when abnormal electrical activity affects all areas of the brain. Generalized seizures can be categorized into several kinds including:

  • Absence seizures
    This kind of generalized seizures is often found in children. It may cause some loss of awareness and some body movement such as lip smacking or eye blinking.
  • Tonic seizures
    This normally causes stiff muscles including back, arms and legs which may lead to falling.
  • Atonic seizures
    Atonic seizures can cause loss of muscle control and lead to sudden collapse and falling.
  • Clonic seizures
    This kind of generalized seizures often cause repeated, jerking and rhythmic movements especially of the neck, face and arms.
  • Myoclonic seizures
    People with myoclonic often experience sudden jerks or twitches of arms and legs.
  • Tonic-clonic seizures
    Tonic-clonic seizures may cause the most difficulty of people with the disease. They may experience the loss of consciousness, stiffening and shaking body, biting tongue or loss of bladder control.

When to see the doctor

See the doctor immediately if:

    • You experience the seizure for the first time.
    • The seizure lasts for more than 5 minutes.
    • Consciousness or breathing abnormally after the seizures stop.
    • The next seizure comes right after the first one.
    • You have a high degree of fever.
    • You have heat exhaustion.
    • You are pregnant.
    • You have diabetes.
    • You have been injured after the seizures.

Causes

The electrical impulses are created, sent and received by nerve cells in the brain. The seizures occur when something disrupts the communication pathways of these electrical impulses.

            Epilepsy is the most common cause of the seizures. However, other causes of the disease may include:

    • high fever relating to an infection
    • Lack of sleep
    • Hyponatremia or low blood sodium
    • some medications such as some pain reliever and antidepressants
    • head trauma
    • stroke
    • brain tumor
    • illegal drugs such as cocaine and amphetamines
    • alcohol abuse
    • COVID-19 infection

Complications

 The seizures may cause several harmful complications such as:

  • falling
  • drowning
  • car accidents
  • pregnancy complications
  • emotional health issues

Diagnosis

             The doctor may conduct some tests to examine the cause of your seizures which may include:

    • A neurological exam To look for a problem with the brain and nervous system.
    • Blood test To check for signs of infections, genetic conditions, sugar level in blood or electrolyte imbalances
    • Lumbar puncture To suspects an infection that may cause the seizures
    • An electroencephalogram (EEG) To investigate the activity of the brain and predict the tendency of the return of the seizures and whether the seizure is caused by epilepsy
    • Computerized tomography (CT) To reveal abnormalities that may occur in the brain
    • Magnetic resonance imaging (MRI) To detect lesions or abnormalities that may cause the seizures
    • Positron emission tomography (PET) To inspect the active areas of the brain and to detect the abnormality
    • Single-photon emission computerized tomography (SPECT) To monitor the blood flow activity in the brain that may happen during the seizures

Treatment

The doctor may decide to start the treatment with people who have experienced seizures several times. The treatment may include:

  • Anti-seizure medication
  • Surgery and other therapies
    • Surgery To stop the occurrence of the seizures by removing the area of the brain where the seizure begins
    • Vagus nerve stimulation A device will be implanted underneath the skin of the chest to send signals to the brain.
    • Responsive neurostimulation Electrodes will be implanted on the surface of the brain or within brain tissue to stop the seizures.
    • Deep brain stimulation To control the amount of stimulation produced
    • Dietary therapy  The doctor may recommend dietary therapy to improve seizure control.

Pregnancy and seizures

Women with seizures who are planning for pregnancy are recommended to consult the doctor since some medications for treating seizures may increase the risk of birth defects. The doctor may change the dosage of the medication before or during the pregnancy.

Preparing for the appointment

Before your appointment, you may prepare yourself including:

    • Information record about the seizure
    • Be aware of restrictions prior the appointment
    • A list of key personal information
    • A list of medications that you are taking
    • Questions that you want to ask the doctor

During the consulting, the doctor may ask some questions including information such as:

    • episode of the seizure
    • detail of the seizure you have experienced
    • your feelings before the seizure
    • the symptoms you have experienced
    • duration of the seizure
    • history of family member involved with a seizure disorder or epilepsy
    • your travelling record especially to outside the country

Published: 25 Oct 2020

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