Seizures occur when there is a sudden surge of abnormal electrical activity in the brain that usually affects how a person appears or acts for a short time.
Severe and repetitive seizures such as status epilepticus do kill brain cells (neurons). Isolated, brief seizures may also result in the death of specific brain cells in certain forms of epilepsy. This is why it is of utmost importance for people who have epilepsy to work with their doctors to keep their seizures under control.
There are 3 major groups of seizures:
- Generalized onset seizures
- Affect both sides of the brain at the same time
- Includes seizure types like tonic-clonic, absence, or atonic
- Focal onset seizures
- Focal seizures can start in one area or in one side of the brain
- Focal onset aware seizures occur when a person is awake and aware during a seizure (formerly called simple partial seizure)
- Focal onset impaired awareness seizures occur when a person is confused or awareness is affected during a focal seizure (formerly called a complex partial seizure)
- Unknown onset seizures
- Occur when the beginning of a seizure is not known, such as if it’s not witnessed by anyone
- An unknown onset seizure may later be diagnosed as a focal or generalized seizure
What Are Symptoms of Seizures?
A number of symptoms can occur during a seizure and may depend on the type of seizure.
Symptoms of generalized onset seizures include:
- Motor symptoms
- Tense or rigid muscles (tonic)
- Sustained rhythmical jerking movements (clonic)
- Muscle weakness or limpness (atonic)
- Brief muscle twitching (myoclonus)
- Epileptic spasms (body flexes and extends repeatedly)
- Non-motor symptoms (absence seizures)
- Staring spells
- Brief twitches that can affect a specific body part or just the eyelids
Symptoms of focal onset seizures include:
- Motor symptoms
- Jerking (clonic)
- Muscle weakness or limpness (atonic)
- Tense or rigid muscles (tonic)
- Brief muscle twitching (myoclonus)
- Epileptic spasms (body flexes and extends repeatedly)
- Repeated automatic movements (automatisms), such as clapping or rubbing of hands, lip smacking, chewing, or running
- Non-motor symptoms
- Changes in sensation
- Mood changes
- Changes in thinking or cognition
- Changes in autonomic functions (such as gastrointestinal sensations, waves of heat or cold, goosebumps, heart racing, etc.)
- Lack of movement (behavior arrest)
Symptoms of focal onset seizures include:
- Motor seizures: either tonic-clonic or epileptic spasms
- Non-motor seizures: behavior arrest
What Causes Seizures?
Causes of seizures can vary by age.
Causes of seizures in newborns include:
- Lack of oxygen during birth
- Low levels of blood sugar, blood calcium, blood magnesium or other electrolyte problems
- Malformations of the brain
- Problems with metabolism
- Intracranial bleeding
- Maternal drug use
Causes of seizures in infants and young children include:
- Infections
- Fever (febrile seizures)
- Brain tumor (rarely)
Causes of seizures in children and adults include:
- Congenital conditions
- Down's syndrome
- Tuberous sclerosis
- Neurofibromatosis
- Angelman's syndrome
- Genetics
- Head trauma
- Progressive brain disease (rare)
Causes of seizures in seniors include:
- Alzheimer's disease
- Stroke
- Trauma
Common triggers for seizures include:
- Alcohol or drug use
- Certain foods
- Certain medications
- Certain times of day or night
- Excess caffeine
- Fever or illness
- Flashing bright lights or patterns
- Lack of sleep
- Low blood sugar
- Menstrual cycle in women or other hormonal changes
- Poor diet
- Stress
How Are Seizures Diagnosed?
Along with a patient history and physical examination, tests used to diagnose the cause of seizures include:
- Electroencephalogram (EEG) checks for brain wave patterns consistent with seizure activity
- Blood tests to check for certain medical disorders
- Brain imaging to look for abnormal areas such as a tumor or infection
- X-ray of the brain
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Lumbar puncture (also called a spinal tap)
- Electrocardiogram (EKG) to check the heart
- Sleep testing
What Is the Treatment for Seizures?
The main treatment for seizures involves medicines called anti-epileptic drugs (AEDs), including:
- Brivaracetam
- Cannabidiol oral solution (Epidiolex)
- Carbamazepine (Carbatrol, Epitol, Tegretol, Tegretol XR)
- Cenobamate (Xcopri)
- Clobazam (Onfi, Sympazan)
- Clonazepam (Epitril, Klonopin, Rivotril)
- Diazepam nasal
- Diazepam rectal (Diastat)
- Divalproex sodium (Depacon, Depakote, Depakote ER, Epival)
- Eslicarbazepine Acetate (Aptiom)
- Ethosuximide (Zarontin)
- Ezogabine (Potiga)
- Felbamate (Felbatol)
- Fenfluramine
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra, Keppra XR, Roweepra)
- Lorazepam (Ativan)
- Midazolam nasal (Nayzilam)
- Oxcarbazepine (Oxtellar XR, Trileptal)
- Perampanel (Fycompa)
- Phenobarbital
- Phenytoin (Dilantin, Epanutin, Phenytek)
- Pregabalin (Lyrica)
- Primidone (Mysoline)
- Rufinamide (Banzel, Inovelon)
- Stiripentol (Diacomit)
- Tiagabine hydrochloride (Gabitril)
- Topiramate (Topamax, Qudexy XR, Trokendi XR)
- Valproic Acid (Convulex, Depakene, Depakine, Orfiril, Valporal, Valprosid)
- Vigabatrin (Sabril)
- Zonisamide (Zonegran)
Other treatments for seizures include:
- Diet therapy, including the ketogenic diet
- Epilepsy surgery
- Removal of a small part of the brain that's causing the seizures
- Implantation of a small electrical device inside the body to help control seizures
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https://pubmed.ncbi.nlm.nih.gov/25012371/
https://www.epilepsy.com/article/2014/3/meeting-news-do-seizures-damage-brain