Seizures

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are involved. Many, if not all, types of seizures cause loss of awareness and some cause twitching or shaking of the body.

Fever-induced

A febrile seizure is a convulsion in a child triggered by a fever. These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause. 

Alternative Names 
Seizure - fever induced 

Causes 
About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families. 

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness 

Febrile seizures are usually triggered by fevers from:

  • Ear infections
  • Roseola infantum (a condition with fever and rash caused by several different viruses)
  • Upper respiratory infections caused by a virus
  • Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down.

A child is likely to have more than one febrile seizure if:

  • There is a family history of febrile seizures
  • The first seizure happened before age 12 months
  • The seizure occurred with a fever below 102 degrees Fahrenheit

Symptoms 
A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body. 

Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine. 

The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue. 

Finally, the contraction is broken by brief moments of relaxation. The child's body begins to jerk rhythmically. The child does not respond to the parent's voice. 

A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness. 

Febrile seizures are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure. 

Exams and Tests 
The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis. 

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap). 

To avoid having to undergo a seizure workup:

  • The child must be developmentally normal.
  • The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child's body, and not confined to one part of the body.
  • The seizure must not have lasted longer than 15 minutes.
  • The child must not have had more than one febrile seizure in 24 hours.
  • The child must have a normal neurologic exam performed by a health care provider.

Treatment

  • During the seizure, leave your child on the floor.
  • You may want to slide a blanket under the child if the floor is hard.
  • Move him only if he is in a dangerous location.
  • Remove objects that may injure him.
  • Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
  • If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.
  • Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down:

  • Insert an acetaminophen suppository (if you have some) into the child's rectum.
  • Do NOT try to give anything by mouth.
  • Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
  • After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.
  • After the seizure, the most important step is to identify the cause of the fever.

Outlook (Prognosis) 
The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties. 

A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures. 

Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy. 

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime. 

Most children outgrow febrile seizures by age 5. 

Possible Complications

  • Biting oneself
  • Breathing fluid into the lungs
  • Complications if a serious infection, such as meningitis, caused the fever
  • Injury from falling down or bumping into objects
  • Injury from long or complicated seizures
  • Seizures not caused by fever
  • Side effects of medications used to treat and prevent seizures (if prescribed)

When to Contact a Medical Professional

  • Children should see a doctor as soon as possible after their first febrile seizure.
  • If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital.
  • If the seizure ends quickly, drive the child to an emergency room when it is over.
  • Take your child to the doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.

Call or see the health care provider if other symptoms occur before or after the seizure, such as:

  • Abnormal movements
  • Agitation
  • Confusion
  • Drowsiness
  • Nausea
  • Problems with coordination
  • Rash
  • Sedation
  • Tremors
  • It is normal for children to sleep or be briefly drowsy or confused right after a seizure.

Prevention 
Because febrile seizures can be the first sign of illness, it is often not possible to prevent them. A febrile seizure does not mean that your child is not getting the proper care. 

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. However, no medication is completely effective in preventing febrile seizures.

Grand Mal

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. Such seizures usually involve muscle rigidity, violent muscle contractions, and loss of consciousness. 

Generalized tonic-clonic seizures are the type of seizure that most people associate with the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a single episode, or as part of a repeated, chronic condition (epilepsy). 

Symptoms 
Many patients have an aura (a sensory warning sign) before the seizure. This can include vision, taste, smell, or sensory changes, hallucinations, or dizziness. 

The seizure itself involves:

  • Loss of consciousness or fainting, usually lasting between 30 seconds and 5 minutes
  • General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20 seconds
  • Violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for 1 -2 minutes
  • Biting the cheek or tongue, clenched teeth or jaw
  • Incontinence (loss of urine or stool control)
  • Stopped breathing or difficulty breathing during seizure
  • Blue skin color
  • Almost all people lose consciousness, and most people have both tonic and clonic muscle activity.

After the seizure, the person usually has:

  • Normal breathing
  • Sleepiness that lasts for 1 hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion, temporary and mild
  • Weakness of one side of the body for a few minutes to a few hours following seizure (This is called Todd's paralysis.)

Partial (focal)

All seizures are caused by abnormal electrical disturbances in the brain. Partial (focal) seizures occur when this electrical activity remains in a limited area of the brain. The seizures may sometimes turn into generalized seizures, which affect the whole brain. This is called secondary generalization. 

Partial seizures can be further characterized as: 

Simple -- not affecting awareness or memory 
Complex -- affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior

Patients with focal seizures can have any of the symptoms below, depending on where in the brain the seizure starts. 

Patients with simple focal seizures do not lose consciousness and will be aware of and remember the events that occur at the time. 

Patients with complex partial seizures will have abnormal consciousness and may or may not remember any or all of the symptoms or events surrounding the seizure. Symptoms that may occur include the following:

  • Abnormal muscle contraction
  • Muscle contraction/relaxation (clonic activity) -- common
  • Affects one side of the body (leg, part of the face, or other area)
  • Abnormal head movements
  • Forced turning of the head
  • Complex, repetitive movements (such as picking at clothes) -- these are called automatisms and include:
  • Abnormal mouth movements
  • Lip smacking
  • Behaviors that seem to be a habit
  • Chewing/swallowing without cause
  • Forced turning of the eyes

Abnormal sensations

  • Numbness, tingling, crawling sensation (like ants crawling on the skin)
  • May occur in only one part of the body, or may spread
  • May occur with or without motor symptoms
  • Hallucinations
  • Abdominal pain or discomfort
  • Nausea
  • Sweating
  • Flushed face
  • Dilated pupils
  • Rapid heart rate/pulse

Other symptoms:

  • Blackout spells -- periods of time lost from memory
  • Changes in vision
  • Sensation of deja vu
  • Changes in mood or emotion

Petit mal

A petit mal seizure is the term commonly given to a staring spell, most commonly called an "absence seizure." It is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain. 

Petit mal seizures occur most commonly in people under age 20, usually in children ages 6 to 12. They can occur as the only type of seizure but can also happen along with other types of seizures such as generalized tonic-clonic seizures (also called grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures). 

Symptoms 
Most petit mal seizures last only a few seconds. Most commonly they involve staring episodes or "absence spells." 

The person may stop walking or talking in mid-sentence, and start again a few seconds later. The person usually does not fall. The person is usually wide awake and thinking clearly immediately after the seizure. 

"Spells" can be uncommon or occur up to hundreds of times in one day. They may occur for weeks to months before they are noticed, and may interfere with school function and learning. The seizures may sometimes be mistaken for a lack of attention or other misbehavior. Unexplained difficulties in school and learning difficulties may be the first indication of petit mal seizures. 

Symptoms of typical petit mal seizures may include:

  • Muscle activity changes
  • No movement
  • Hand fumbling (especially with longer spells)
  • Fluttering eyelids
  • Lip smacking (especially with longer spells)
  • Chewing (especially with longer spells)
  • Consciousness changes
  • Staring episodes (unintentional)
  • Lack of awareness of surroundings
  • Sudden halt in conscious activity (movement, talking, etc.)
  • May be provoked by hyperventilation or flashing lights, in some cases
  • Abrupt beginning of seizure
  • Each seizure lasts no more than a few seconds
  • Full recovery of consciousness, no confusion
  • No memory of seizure

Atypical petit mal seizures begin slower, last longer, and may have more noticeable muscle activity than typical petit mal seizures. There is usually no memory of the seizure. Symptoms may include:

  • Unintentional staring
  • Lack of awareness of surroundings
  • Sudden stop of conscious activity (movement, talking, etc.)
  • Hand fumbling
  • Fluttering eyelids
  • May be provoked by hyperventilation, in some cases
  • May have slower, gradual beginning of seizure
  • Each lasts only seconds to minutes
  • Recovery may be slower
  • May have short period of confusion or bizarre behavior
  • No memory of seizure
  • May change into a different type of seizure (such as a grand mal or atonic seizure)

Reactive

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. 

Considerations 
There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are involved. Many, if not all, types of seizures cause loss of awareness and some cause twitching or shaking of the body. 

However, some seizures may be hard to notice because they consist of staring spells that can easily go unnoticed. Occasionally, seizures can cause temporary changes in sensation or vision. 

Symptoms of seizures come on suddenly, over just seconds to a minute, and may include:

  • 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
  • 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 or down an arm or leg
  • Muscle tension/tightening that causes twisting of the body, head, arms, or legs
  • Tasting a bitter or metallic flavor

Symptoms may stop after a few minutes, or continue for 15 minutes. They rarely continue longer. 

Shaking of the entire body when it occurs should last a few minutes and stop within 5 minutes. 

Causes 
A seizure may be related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the repeated seizures do not happen again once the underlying problem is corrected, the person does not have epilepsy. 

In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be abnormally excited. 

In some people, a problem that is passed down through families (inherited) affects nerve cells in the brain, which leads to seizures. In these cases, the seizures happen spontaneously, without an immediate cause, and repeat over time. This is epilepsy. 

Idiopathic seizures are chronic seizures that occur without an identifiable cause. They usually begin between ages 5 and 20, but can occur at any age. The person can have a family history of epilepsy or seizures. 

Other more common causes of seizures include:

  • Tumors (such as brain tumor) or other structural brain lesions (such as bleeding in the brain)
  • Traumatic brain injury, stroke, or a transient ischemic attack (TIA)
  • Stopping alcohol after drinking heavily on most days
  • Illnesses that cause the brain to deteriorate
  • Dementia such as Alzheimer's disease
  • Problems that are present from before birth (congenital brain defects)
  • Injuries to the brain that occur during labor or at the time of birth
  • Low blood sugar or sodium levels in the blood
  • Kidney or liver failure
  • Use of cocaine, amphetamines, or certain other recreational drugs
  • Stopping certain drugs, such as barbiturates, painkillers (morphine, gabapentin) and sleeping pills, after taking them for a period of time
  • Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)
  • Phenylketonuria (PKU), which can cause seizures in infants

Home Care 
If someone who has never had a seizure before has one, call 911 or your local emergency number immediately. 

Persons with epilepsy should always wear a medical alert tag. 

Most seizures stop by themselves. However, a person having a generalized seizure may be injured; breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a generalized seizure, it is important to protect the person from injury. Turn the person on the side, so that any vomit leaves the body and does not enter the lungs. See: Seizure first aid 

After a generalized seizure, most people go into a deep sleep. Do not prevent the person from sleeping. The person will probably be disoriented, or possibly agitated for awhile after awakening. 

EMERGENCY FIRST AID 
 

  • Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the teeth. You can cause more damage than you can prevent. 
  • Do not try to hold the person down during the seizure. 
  • Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over. 
  • If the person having a seizure turns blue or stops breathing, try to position their head to prevent their tongue from blocking their airways. Breathing usually starts on its own once the seizure is over. 
  • CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
  • If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This is an emergency situation. Seek immediate medical help.

AFTER THE SEIZURE

Treat any injuries from bumps or falls. Record details of the seizure to report to the person's primary health care provider. You should note the following details:

  • How long it lasted
  • What body parts were affected
  • Type of movements or other symptoms
  • Possible causes
  • How the person behaved after the seizure

When to Contact a Medical Professional 
If this is the first time someone has ever had a seizure, or if this is an unusually long seizure in someone who has a seizure disorder, call 911 or your local emergency number immediately. These symptoms can be caused by life-threatening conditions, such as a stroke or meningitis. 

Report all seizures (even a mild one) to the health care provider. If the person is known to have epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or other instructions given. 

What to Expect at Your Office Visit 
Often, a person who has had a new or severe seizure will be seen in an emergency room, rather than a doctor's office. 

The health care provider will try to diagnose the type of seizure based on the symptoms. 

Other medical conditions that can cause a seizure or similar symptoms will be ruled out. Disorders that may cause similar symptoms include fainting, TIA or stroke, rage or panic attacks, migraine headaches, sleep disturbances, and conditions that cause loss of consciousness. 

The following tests may be done:

  • Blood tests
  • CT scan of the head or MRI of the head
  • EEG (usually not in the emergency room)
  • Lumbar puncture (also called a spinal tap)

The need for further tests or treatment depends on a number of factors. 

  1. A single seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating or avoiding that trigger. 
  2. A new seizure without an obvious trigger will require further testing and possible treatment. 
  3. A seizure in a person with known epilepsy will require tests to make sure the patient is taking the correct dose of their medicines. A possible change in medicines may be needed.

Prevention 
Instructions for taking any prescribed medications should be strictly followed. Family members should observe and record any seizure information to make sure the person gets proper treatment. 

Good health habits may help to control seizures. Because sleep deprivation, stress, and a poor diet can contribute to increased seizures, good sleep habits, stress reduction, proper exercise, and sound nutrition may help. 

There is no specific way to prevent all seizures. Use helmets when appropriate to prevent head injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid recreational drugs. People with epilepsy should take medication as directed and avoid excessive amounts of alcohol. 

People with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. People with uncontrolled seizures also should avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone. 

Secondary

A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. 

Considerations 
There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are involved. Many, if not all, types of seizures cause loss of awareness and some cause twitching or shaking of the body. 

However, some seizures may be hard to notice because they consist of staring spells that can easily go unnoticed. Occasionally, seizures can cause temporary changes in sensation or vision. 

Symptoms of seizures come on suddenly, over just seconds to a minute, and may include:

  • 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
  • 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 or down an arm or leg
  • Muscle tension/tightening that causes twisting of the body, head, arms, or legs
  • Tasting a bitter or metallic flavor

Symptoms may stop after a few minutes, or continue for 15 minutes. They rarely continue longer. 

Shaking of the entire body when it occurs should last a few minutes and stop within 5 minutes. 

Causes 
A seizure may be related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the repeated seizures do not happen again once the underlying problem is corrected, the person does not have epilepsy. 

In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be abnormally excited. 

In some people, a problem that is passed down through families (inherited) affects nerve cells in the brain, which leads to seizures. In these cases, the seizures happen spontaneously, without an immediate cause, and repeat over time. This is epilepsy. 

Idiopathic seizures are chronic seizures that occur without an identifiable cause. They usually begin between ages 5 and 20, but can occur at any age. The person can have a family history of epilepsy or seizures. 

Other more common causes of seizures include:

  • Tumors (such as brain tumor) or other structural brain lesions (such as bleeding in the brain)
  • Traumatic brain injury, stroke, or a transient ischemic attack (TIA)
  • Stopping alcohol after drinking heavily on most days
  • Illnesses that cause the brain to deteriorate
  • Dementia such as Alzheimer's disease
  • Problems that are present from before birth (congenital brain defects)
  • Injuries to the brain that occur during labor or at the time of birth
  • Low blood sugar or sodium levels in the blood
  • Kidney or liver failure
  • Use of cocaine, amphetamines, or certain other recreational drugs
  • Stopping certain drugs, such as barbiturates, painkillers (morphine, gabapentin) and sleeping pills, after taking them for a period of time
  • Infections (brain abscess, meningitis, encephalitis, neurosyphilis, or AIDS)
  • Phenylketonuria (PKU), which can cause seizures in infants

Home Care 
If someone who has never had a seizure before has one, call 911 or your local emergency number immediately. 

Persons with epilepsy should always wear a medical alert tag. 

Most seizures stop by themselves. However, a person having a generalized seizure may be injured; breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a generalized seizure, it is important to protect the person from injury. Turn the person on the side, so that any vomit leaves the body and does not enter the lungs. See: Seizure first aid 

After a generalized seizure, most people go into a deep sleep. Do not prevent the person from sleeping. The person will probably be disoriented, or possibly agitated for awhile after awakening. 

EMERGENCY FIRST AID

  • Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the teeth. You can cause more damage than you can prevent.
  • Do not try to hold the person down during the seizure.
  • Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
  • If the person having a seizure turns blue or stops breathing, try to position their head to prevent their tongue from blocking their airways. Breathing usually starts on its own once the seizure is over.
  • CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
  • If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This is an emergency situation. Seek immediate medical help.

AFTER THE SEIZURE 
Treat any injuries from bumps or falls. Record details of the seizure to report to the person's primary health care provider. You should note the following details:

  • How long it lasted
  • What body parts were affected
  • Type of movements or other symptoms
  • Possible causes
  • How the person behaved after the seizure

When to Contact a Medical Professional 
If this is the first time someone has ever had a seizure, or if this is an unusually long seizure in someone who has a seizure disorder, call 911 or your local emergency number immediately. These symptoms can be caused by life-threatening conditions, such as a stroke or meningitis. 

Report all seizures (even a mild one) to the health care provider. If the person is known to have epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or other instructions given. 

What to Expect at Your Office Visit 
Often, a person who has had a new or severe seizure will be seen in an emergency room, rather than a doctor's office. 

The health care provider will try to diagnose the type of seizure based on the symptoms. 

Other medical conditions that can cause a seizure or similar symptoms will be ruled out. Disorders that may cause similar symptoms include fainting, TIA or stroke, rage or panic attacks, migraine headaches, sleep disturbances, and conditions that cause loss of consciousness. 

The following tests may be done:

  • Blood tests
  • CT scan of the head or MRI of the head
  • EEG (usually not in the emergency room)
  • Lumbar puncture (also called a spinal tap)

The need for further tests or treatment depends on a number of factors.

  • A single seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating or avoiding that trigger.
  • A new seizure without an obvious trigger will require further testing and possible treatment.
  • A seizure in a person with known epilepsy will require tests to make sure the patient is taking the correct dose of their medicines. A possible change in medicines may be needed.

Prevention 
Instructions for taking any prescribed medications should be strictly followed. Family members should observe and record any seizure information to make sure the person gets proper treatment. 

Good health habits may help to control seizures. Because sleep deprivation, stress, and a poor diet can contribute to increased seizures, good sleep habits, stress reduction, proper exercise, and sound nutrition may help. 

There is no specific way to prevent all seizures. Use helmets when appropriate to prevent head injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid recreational drugs. People with epilepsy should take medication as directed and avoid excessive amounts of alcohol. 

People with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. People with uncontrolled seizures also should avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

Seizure Disorder

Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain. 

Sometimes a seizure is related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the seizure or seizures do not happen again once the underlying problem is corrected, the person does NOT have epilepsy. 

In other cases, permanent injury to or changes in brain tissue cause the brain to be abnormally excitable. In these cases, the seizures happen without an immediate cause. This is epilepsy. Epilepsy can affect people of any age. 

Epilepsy may be idiopathic, which means the cause cannot be identified. These seizures usually begin between ages 5 and 20, but they can happen at any age. People with this condition have no other neurological problems, but sometimes have a family history of seizures or epilepsy. 

Some other more common causes of epilepsy include:

  • Stroke or transient ischemic attack (TIA)
  • Illnesses that cause the brain to deteriorate
  • Dementia, such as Alzheimer's disease
  • Traumatic brain injury
  • Infections (including brain abscess, meningitis, encephalitis, neurosyphilis, and AIDS)
  • Problems that are present from before birth (congenital brain defects)
  • Injuries near the time of birth (in this case, seizures usually begin in infancy or early childhood)
  • Kidney failure or liver failure
  • Metabolic diseases that children may be born with (such as phenylketonuria)
  • Tumors or other structural brain lesions (such as hematomas or abnormal blood vessels)

Symptoms 
The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure. 

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure. 

Exams and Tests 
A physical examination (including a detailed neurologic examination) may be normal, or it may show abnormal brain function related to specific areas of the brain. 

People with epilepsy will often have abnormal electrical activity seen on an electroencephalograph (EEG). (An EEG is a reading of the electrical activity in the brain.) In some cases, the test may show the location in the brain where the seizures start. EEGs can often be normal after a seizure or between seizures, so it may be necessary to perform a longer test. 

Various blood tests and other tests looking for temporary and reversible causes of seizures, may include:

  • Blood chemistry
  • Blood sugar
  • CBC (complete blood count)
  • CSF (cerebrospinal fluid) analysis
  • Kidney function tests
  • Liver function tests
  • Tests for infectious diseases

Tests for the cause and location of the problem may include:

  • EEG
  • Head CT or MRI scan
  • Lumbar puncture (spinal tap)

Treatment 
For treatment of seizures, please see Seizures - first aid. 

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems. 

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth. 

The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time. 
Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels. 
It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage. 
You should not stop taking or change medications without talking to your doctor first.

Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

  • Certain prescribed medications
  • Emotional stress
  • Illness, especially infection
  • Lack of sleep
  • Pregnancy
  • Skipping doses of epilepsy medications
  • Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy." 

Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. 
Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.
Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. 

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs. 

Support Groups 
The stress caused by having seizures (or being a caretaker of someone with seizures) can often be helped by joining a support group. In these groups, members share common experiences and problems. See: Epilepsy - support group 

In addition to groups that meet face-to-face, there are many discussion groups and bulletin boards on the Internet where people with epilepsy can find support. 

Outlook (Prognosis) 
Some people with certain types of seizures may be able to reduce or completely stop their seizure medicines after having no seizures for several years. Certain types of childhood epilepsy goes away or improves with age -- usually in the late teens or 20s. 

For some people, epilepsy may be a lifelong condition. In these cases, the seizure drugs need to be continued. 

Death or permanent brain damage from seizures is rare. However, seizures that last for a long time or two or more seizures that occur close together (status epilepticus) may cause permanent harm. Death or brain damage are most often caused by prolonged lack of breathing, which causes brain tissue to die from lack of oxygen. There are some cases of sudden, unexplained death in patients with epilepsy. 

Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment. For this reason, people with epilepsy whose seizures are not under good control should not do these activities. 

People who have infrequent seizures may not have any severe restrictions on their lifestyle. 

Possible Complications

  • Difficulty learning
  • Inhaling fluid into the lungs, which can cause aspiration pneumonia
  • Injury from falls, bumps, or self-inflicted bites during a seizure
  • Injury from having a seizure while driving or operating machinery
  • Many epilepsy medications cause birth defects -- women wishing to become pregnant should alert their doctor in advance in order to adjust medications
  • Permanent brain damage (stroke or other damage)
  • Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
  • Side effects of medications

When to Contact a Medical Professional 
Call your local emergency number (such as 911) if this is the first time a person has had a seizure or if a seizure is occurring in someone without a medical ID bracelet (which has instructions explaining what to do). 

In the case of someone who has had seizures before, call 911 for any of these emergency situations:

  • This is a longer seizure than the person normally has, or an unusual number of seizures for the person
  • Repeated seizures over a few minutes
  • Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination. 

Prevention 
Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy. 

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy. 

Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone. 

Seizures in adults

You have epilepsy. People with epilepsy have seizures. A seizure is a sudden brief change in the electrical activity in your brain. It leads to brief unconsciousness and uncontrollable body movements. 

Below are some questions you may want to ask your doctor or nurse to help you take care of yourself if you have epilepsy. 

Questions

  • What safety measures do I need to take at home to prevent injuries when I have a seizure? 
  • Is it okay for me to drive? Where can I call to find more information about driving and epilepsy?
  • What should I discuss with my boss at work about my epilepsy? 
  • Are there work activities that I should avoid? 
  • Will I need to rest during the day? 
  • Will I need to take medicines during the work day?
  • Are there any sports activities that I should not do? Do I need to wear a helmet for any type of activities? 
  • Do I need to wear a medical alert bracelet? 
  • Who else should know about my epilepsy? 
  • Is it ever okay for me to be alone?
  • What do I need to know about my seizure medicines? 
  • What medicines am I taking? What are the side effects? 
  • Can I take antibiotics or other medicines also? How about acetaminophen (Tylenol), vitamins, herbal remedies? Will birth control pills still work if I am taking medicines for my seizures? 
  • How should I store the seizure medicines? 
  • What happens if I miss one or more doses? 
  • Can I ever stop taking a seizure medicine if there are side effects?
  • How often do I need to see the doctor? When do I need blood tests? 
  • What are the signs that my epilepsy is becoming worse? 
  • What should others with me do when I am having a seizure? After the seizure is over, what should they do? When should they call the doctor? When should we call 911? 

Seizures in children

Your child has epilepsy. People with epilepsy have seizures. A seizure is a sudden brief change in the electrical activity in your brain. It leads to brief unconsciousness and uncontrollable body movements. 

Below are some questions you may want to ask your doctor or nurse to help you take care of your child's epilepsy. 

Questions

  • What safety measures do I need to take at home to keep my child safe during a seizure? 
  • What should I discuss with my child's teachers about epilepsy? 
  • Will my child need to take medicines during the school day? 
  • Can my child participate in gym class and recess?
  • Are there any sports activities that my child should not do? Does my child need to wear a helmet for any type of activities? 
  • Does my child need to wear a medical alert bracelet? 
  • Who else should know about my child's epilepsy? 
  • Is it ever okay to leave my child alone?
  • What do we need to know about my child's seizure medicines? 
  • What medicines does my child take? What are the side effects? 
  • Can my child take antibiotics or other medicines also? How about acetaminophen (Tylenol), vitamins, or herbal remedies? 
  • How should I store the seizure medicines? 
  • What happens if my child misses one or more doses? 
  • Can my child ever stop taking a seizure medicine if there are side effects?
  • How often does my child need to see the doctor? When does my child need blood tests? 
  • Will I always be able to tell my child is having a seizure? 
  • What are the signs that my child's epilepsy is becoming worse? 
  • What should I do when my child is having a seizure? 
  • When should I call 911? 
  • After the seizure is over, what should I do? 
  • When should I call the doctor?

Tonic-clonic

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. Such seizures usually involve muscle rigidity, violent muscle contractions, and loss of consciousness. 

Generalized tonic-clonic seizures are the type of seizure that most people associate with the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a single episode, or as part of a repeated, chronic condition (epilepsy). 

Symptoms 
Many patients have an aura (a sensory warning sign) before the seizure. This can include vision, taste, smell, or sensory changes, hallucinations, or dizziness. 

The seizure itself involves:

  • Loss of consciousness or fainting, usually lasting between 30 seconds and 5 minutes
  • General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20 seconds
  • Violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for 1 -2 minutes
  • Biting the cheek or tongue, clenched teeth or jaw
  • Incontinence (loss of urine or stool control)
  • Stopped breathing or difficulty breathing during seizure
  • Blue skin color
  • Almost all people lose consciousness, and most people have both tonic and clonic muscle activity.

After the seizure, the person usually has:

  • Normal breathing
  • Sleepiness that lasts for 1 hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion, temporary and mild
  • Weakness of one side of the body for a few minutes to a few hours following seizure (This is called Todd's paralysis.)

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