Seizure

No wonder that the brain is one fascinating organ. It controls every tiny order and function in our bodies.

You might be surprised, but your brain contains billions of nerve cells arranged in specific patterns. Those nerve cells are responsible for the coordination of thought, behaviour, emotions, movements and sensations.

For the brain to send orders and receive messages from the rest of the body, there is a complicated network and system of nerves that connect the brain to the rest of the body so that communications occur in a split of a second.

If you want to know how fast and amazing your brain is, think about how fast you pull your hand back from a hot object.

It happens in less than a second.

Although all the parts of your brain work together, each part is responsible for a specific function. It controls everything, literally everything, from your heart rate to your mood.

Let's talk more about the brain structure

And let's start with the part you visualize when you think of brains in general, the cerebrum.

It is the largest part of the brain. The outermost layer of the cerebrum is the cerebral cortex, it is the grey matter of the brain.

The brain has deep wrinkles and folds that increase the surface area of the grey matter so that the brain can process more information.

The cerebrum is divided into two halves or hemispheres by a deep fissure in the middle. Each hemisphere is responsible for the opposite side of the body.

But the two hemispheres are not separated because they communicate with each other through a thick tract of nerves called the corpus callosum present at the base of the deep fissure.

Each hemisphere is divided into four lobes:

The frontal lobe. It controls thinking, planning, organizing, problem-solving, short-term memory and movement.
The parietal lobe. It is responsible for interpretations of sensory information such as taste, temperature and touch.
The occipital lobe. It processes images that are received from the eyes to link them with information and images stored in the memory.
The temporal lobe. It processes information received from different senses such as taste, smell and sound. It also plays a role in memory storage.

Another important part of the brain is the cerebellum. It is a wrinkled ball of tissue that lies behind and below the rest of the brain. It mainly works to combine sensory information from eyes, ears and muscles to help coordinate movements.

There is also the brainstem, which links the brain to the spinal cord. It has many vital functions that are essential for life such as heart rate, blood pressure and breathing. It is also very important for sleep.

You may have also heard about the limbic system. It is the system responsible for emotions and memories. It consists of deep structures within the brain. These structures come in pairs; each part is duplicated on the other side of the brain.

These parts are:

The thalamus. It is considered the gatekeeper of messages that pass between the spinal cord and the cerebral hemispheres.
The hypothalamus. It mainly controls emotions and the body's temperature. It also regulates crucial urges such as sleeping and eating.
The hippocampus. This part is responsible for saving memories. It sends memories to be saved in the right parts of the brain to be later recalled when necessary.

This is briefly the central nervous system, which consists mainly of the brain and spinal cord.

But the nervous system also has another division, which is the peripheral nervous system.

The peripheral nervous system is all the nerves in the body aside from the nerves in the brain and spinal cord. It is the communication network between the brain and the distant parts of the body. This extensive network of nerves makes communication between the brain and the extremities very fast. In a very short time, your brain can tell your hand muscles to contract to do a specific movement.

Grading down to a smaller level of structures, the main unit that forms the whole nervous system is the neuron or nerve cell.

Neurons have a cell body and an axon.

They also have two types of branches coming out of their cell bodies: dendrites and the axon.

Dendrites receive incoming messages from other nerve cells.

Axons carry signals that come out of the cell body to other neurons or muscle cells.

Neurons can provide lightning-fast communication because they are interconnected with each other. Neurons communicate with each other through electrical signals when they are stimulated.

When the neuron is stimulated, the impulse moves to the tip of the axon and causes the release of neurotransmitters: chemicals that act as messengers.

These neurotransmitters pass through the gap between the two neurons, also known as the synapse, and attach to receptors on the receiving cells. This mechanism repeats from neuron to neuron as the signals travel to their destination. This kind of communication allows us to think, move and feel.

But sometimes this electrical activity increases or decreases. Sometimes it is disturbed, which, consequently, leads to a number of diseases.

One of these diseases is seizures.

Have you ever heard about seizures?

When we watch movies and TV series, sometimes we see one of the characters suddenly fall and start doing abnormal movements and muscle twitches.

We recognize these abnormal movements and twitches as fits or seizures.

What is a Seizure?

Seizure

According to John Hopkins Medicine, a seizure is a burst of uncontrolled electrical activity between brain cells that causes temporary abnormality in muscle tone and movements (twitches, stiffness or limpness), behaviours, sensations or states of awareness.

It happens when there is a sudden uncontrolled disturbance in the brain electrical activity.

When someone has two or more seizures 24 hours apart that don't have an identifiable cause, it is generally considered to be epilepsy.

There are different types of seizures. These types of range in symptoms and severity.

Types of seizures are classified according to where they begin in the brain and how far they spread.

Most types last from about 30 seconds to two minutes. However, a seizure that lasts more than five minutes is considered a medical emergency.

Are Seizures common?

Seizures are more common than you think and they can happen due to many reasons. Seizures can occur after a stroke, a closed head injury or an infection such as meningitis or other brain infections. But mostly, in most cases, the cause of seizures is unknown.

Although most types of seizures can be controlled with medications, seizures have a significant effect on daily life.

As we mentioned, doctors usually classify seizures according to where they start on the brain and how they start.

So, they are either focal or generalized seizures. They can also be classified as unknown onset if it is not known how they began.

So, let's understand each type.

Focal seizures or partial seizures

These are the seizures that result from abnormal electrical activity in one area of the brain, and that's why they are also called partial seizures.

They occur either with or without loss of consciousness.

They usually occur due to any type of focal brain injury that leaves scar tangles.

Taking a good medical history and looking at the MRI of a focal seizures' patient will identify a cause such as old stroke, trauma, or meningitis.

Focal seizures with loss of consciousness.

Focal seizures can occur with an impaired level of consciousness or total loss of consciousness like being in a dream.

In this type, patients might look normal and awake, while in fact they stare into space and don't respond normally to any interaction. They might also perform repetitive movements such as hand rubbing, mouth movements, repeating certain words or walking in circles. Patients usually don't remember that seizures occurred or they don't even recognize they had seizures.

Focal seizures without loss of consciousness.

In this type, patients' emotions change. Patients suddenly feel angry, joyful or sad. Some people have nausea or unusual feelings that they can't describe. Sometimes the way things look, smell or taste also change but there is no loss of consciousness.

Some cases reported that they suffered from difficulty speaking, involuntary jerking of a body part such as an arm or a leg and some spontaneous sensory symptoms such as tingling, dizziness and seeing flashing lights.

Sometimes symptoms of focal seizures are confused with other neurological diseases such as migraine, narcolepsy or mental illnesses.

Generalized seizures

When seizures involve all areas of the brain, they are called generalized seizures.

There are different types of generalized seizures, including:

Absence seizures. This type was previously known as petit mal seizures. They occur mostly in children and when it happens, they stare into space or do subtle body movements such as eye blinking or lip-smacking. They don't last long, maybe from 5 to 10 seconds, but they may occur multiple times throughout the day. These seizures can occur in clusters, causing loss of consciousness.
Tonic seizures. Those are the seizures you usually see in movies. Some people, especially those with multiple brain injuries and intellectual disabilities may have tonic seizures. They cause stiffness of the muscles. They usually affect muscles of the back, arms and legs. They may cause loss of consciousness and recurrent falls to the ground, that's why they are also known as drop attacks.
Atonic seizures. They are also known as drop seizures. They cause loss of control over the muscles, which, consequently, causes sudden collapse, falling down or dropping of the head.
Clonic seizures. This type of seizure is associated with repeated rhythmic jerking movements of the muscles. They usually affect the neck, arms and face on, not only one side, but both sides of the body.
Myoclonic seizures. This type manifests as sudden brief jerks or twitches of the arms and legs but no loss of consciousness is manifested.
Tonic-clonic seizures. This is the most dramatic type of seizure. It may seem like a combination of both types of tonic and clonic seizures. It was previously known as grand mal seizures and it is quite severe that it causes a sudden loss of consciousness, body stiffening and shaking, loss of bladder control and sometimes tongue biting. It can last for several minutes which makes it scary.

Doctors need to confirm the diagnosis of seizures so that they can implement the most appropriate treatment options.

For that reason, there are some known symptoms that doctors agreed that they usually happen with many types of seizures, and they are:

Temporary confusion.
A staring spell.
Loss of consciousness or awareness.
Uncontrollable jerking movements of legs and arms
Cognitive/emotional symptoms such as anxiety, fear or Deja vu.

These symptoms can range from mild to severe and they vary according to the type of seizures, but as we stated, they are the most common symptoms of seizures.

So, if seizures usually resolve on their own or last for a few seconds, when should someone worry? When to call the doctor?

Some symptoms are red flags, once you witness them, call the doctor immediately. Those symptoms are:

Seizures that last more than five minutes.
A second seizure that follows the first one immediately.
Breathing or consciousness doesn't return after seizures have stopped.
If the patient is pregnant.
If the patient has diabetes.
If the patient has a fever.
If the patient injured themselves during seizures.

And, of course, if you or someone you know experiences seizures for the first time, you should contact your doctor.

As we mentioned before, anything that disrupts the communication pathways between nerve cells can cause seizures. However, some types of seizures are caused by genetic mutations.

But after all, the most common cause of seizures is epilepsy. But keep in mind that not everybody who has a seizure has epilepsy.

In many cases, seizures can be caused by:

Lack of sleep.
High fever. It can also be associated with infections such as meningitis.
Some visual stimulants such as flashing lights and moving patterns.
Head trauma that causes internal bleeding.
Brain tumor.
Stroke.
Abnormalities of the blood vessels of the brain.
Low blood sodium, hyponatremia, which happens sometimes during diuretic therapy.
Some medications such as certain types of pain relievers, antidepressants and smoking cessation therapies.
Autoimmune diseases, including multiple sclerosis and systemic lupus erythematosus.
Misuse of illegal drugs such as amphetamine and cocaine.
Alcohol misuse, extreme intoxication of alcohol or during withdrawal.
COVID-19 virus infection.

How can doctors confirm that a patient has seizures?

Doctor consult

When a patient has a seizure, the doctor will go through their symptoms to review them alongside the medical history of that patient.

Through symptoms and medical history, doctors can suspect seizures. However, some investigations and tests will be needed to identify the cause of seizures and evaluate how likely seizures attacks will occur.

Tests to diagnose seizures might include:

A neurological examination. The doctor will start by evaluating the patient's behaviour, motor abilities and mental functions to determine if there is a problem within the brain or the nervous system.
Blood tests. The doctor will need to check a blood sample for blood sugar levels and look for signs of infection, electrolyte imbalance and genetic conditions.
Lumbar puncture. Doctors ask for a sample of the cerebrospinal fluid to be checked when they suspect an infection.
An electroencephalogram (EEG). In this test, some electrodes are attached to the patient's scalp. These electrodes then record the electrical activity of the brain which appears as wavy lines on the EEG record. Those wavy lines may show specific patterns that tell doctors that seizures are likely to occur again. This test is also important because it will help the doctor to exclude other neurological conditions that mimic epilepsy as a reason for seizures. This test can be done in the outpatient clinic, overnight at home, or over a few nights in the hospital.
Magnetic resonance imaging (MRI). This test uses powerful magnets and radio waves to create a detailed view of the brain. This way, this test helps doctors to detect lesions and abnormalities in the brain that could lead to seizures.
Computerized tomography scan (CT scan). This test uses X-rays to get cross-sectional images of the brain. A CT scan is also used to detect lesions in the brain that might cause seizures such as tumors, internal bleedings and cysts.
Positron emission tomography. A PET scan uses a small amount of low-dose radioactive material that gets injected into a vein to visualize active areas in the brain and detect abnormalities.
Single-photon emission computerized tomography. This test creates a detailed 3D map of the blood flow activity in the brain during seizures.

How are seizures treated?

Treatment of seizures involves anti-seizure medications. But the point of the treatment is to choose the right type of anti-seizure medication.

There are many types of anti-seizure drugs. One of the most commonly used drugs and approved by the FDA is Epidiolex. It is, surprisingly, derived from marijuana and it was approved to treat certain types of seizures in children aged 2 and older.

The main target of choosing a specific anti-seizure medication is to pick the best one for the patient with the fewest side effects. In some cases, doctors use more than one medication.

But what are the possible side effects?

Side effects may include:

Weight gain.
Dizziness.
Fatigue.
Mood changes.
More serious side effects include damage to the liver or bone marrow.

It is not an easy job to find the right medication with the right dose. It can be so complex that patients have to try several types before they find one medication that controls their symptoms best.

Besides, other factors have to be taken into consideration when the doctor chooses the best medication for a patient. These factors include the frequency of seizures and the age of the patient.

Doctors will also go over the other medications that the patient takes to make sure that there will be no drug interaction.

Is surgery a treatment option?

If other treatment options aren't efficient, surgery can be an option.

The main target of surgery is to stop seizures from happening.

Surgery is the best treatment option for people who have seizures that always originate from the same place in the brain.

There are many types of seizures surgeries, including:

Lobectomy. Doctors locate the area of the brain where seizures start and remove it.
Multiple subpial transections. In this type of surgery, doctors make several cuts in areas of the brain to prevent seizures. It is usually done when the area of the brain where seizures originate can't be safely removed.
Corpus callosotomy. This surgery removes the links and neural connections between the right and left sides of the brain. It is done when seizures happen in one half of the brain and move to the other half. However, it is not quite effective because seizures can still occur on the side where they started.
Thermal ablation. It is a less invasive surgical option that focuses highly concentrated energy at a specific area in the brain where seizures begin to destroy the cells that cause seizures.
Hemispherectomy. This surgery removes half of the outer layer of the brain. It is an extreme type of surgery that's why it is only done when medications are not effective and seizures originate from only half of the brain.

What happens if seizures are left untreated? What are the complications of seizures?

Having seizures can lead to many complications, such as:

Falling. When patients fall during seizures, they can injure their head or break a bone.
Drowning. If a patient had seizures during swimming or having a bath, this patient is at risk of accidental drowning.
Car accidents. Seizures that cause loss of consciousness or control can be dangerous especially during driving a car.
Pregnancy complications. Seizures that happen during pregnancy pose dangers to both the mother and the baby.
Emotional health issues. People who have seizures usually have other psychological problems. It is mostly due to difficulties dealing with the condition.