SEIZURES

Outline:

• Definition• Classification• Signs and Symptoms• Causes• Treatment• First Aid

Definition of seizure:

• sudden surge of electrical activity in the brain

• usually affects how a person appears or acts for a short time

• Many things can occur during a seizure; whatever the brain and body can do normally can also occur.

Classification:

• 1) Focal (partial) seizures

Types of focal (partial) seizures are:

> Focal seizure

>Focal dyscognitive seizures

• 2) Generalised seizures• Absence

- Typical

- Atypical absence

- Absence with special features

- Myoclonic absence

- Eyelid Myoclonia• Tonic-Clonic• Clonic• Tonic• Atonic• Myoclonic

- Myoclonic

- Myoclonic atonic

- Myoclonic tonic

• 3) Unknown

 • a grouping of seizures that cannot be diagnosed as either a focal or generalized

seizure and are thus grouped as unknown

Anatomy and Physiology

• The pathways for information exchange between the brain and musculature can be divided into two general groups: the afferent

(sensory) and output or efferent (motor)

• A neuron or group of neurons in the brain can become hyperexcitable or irritable due to hypoxia, ischemia, hypoglycemia, or

electrolyte abnormalities. These affect the action potential and cause these nerve cells to discharge action potentials irregularly. If

this occurs, the corresponding muscle fascicles may begin to contract inappropriately, thus producing seizure-like activity.

• Depending on where the focus of this aberrant discharge is in a particular region of the brain, the corresponding motor or sensory

area will be affected, leading to either motor symptoms such as tonic-clonic contractions or sensory manifestations of seizure-like

activity, such as paresthesia, déjà vu, or hallucinations.

• The focus may spread and involve various areas of the brain, leading to chaotic, uninhibited discharge of electrical activity of

various neurons in the brain. The resultant motor and/or sensory activity manifested by and experienced by the patient is clinically

described as a seizure.

• Control of the seizure can be accomplished by suppressing the action potential via manipulation of sodium and potassium ion

permeabilities. This will render the axon refractory to the action potential, or block the neurotransmitter from binding to its receptor site.

Signs and Symptoms:

Some seizures occur with warning signs before the seizure takes place. This include:• Sudden feelings of fear and anxiousness• Feeling sick to your stomach• Dizziness• Changes in vision

Symptoms that indicate a seizure is in progress:• A blackout of time, followed by confusion• Uncontrollable muscle spasms• Drooling or frothing at the mouth• Sudden falling• Experiencing a strange taste in your mouth• Clenching teeth• Sudden, rapid eye movements• Making unusual noises, such as grunting• Losing control of bladder or bowel movement• Sudden mood changes

Symptoms occur suddenly and may include:• Changes in behavior such as picking at one’s clothing• Eye movements• Grunting and snorting• Shaking of the entire body• Temporary stop in breathing• Uncontrollable muscle spasms with twitching and jerking limbs

Generalized Seizures Symptoms

(Produced by the entire brain)

• “Grand Mal” or Generalized Tonic-Clonic Unconsciousness, convulsions, muscle rigidity• Absence Brief loss of consciousness

• Myoclonic Sporadic (isolated), jerking movements• Clonic Repetitive, jerking movements• Tonic Muscle stiffness, rigidity• Atonic Loss of muscle tone

Common symptoms before a seizure:

Awareness, Sensory, Emotional or Thought Changes:• Déjà vu • Jamais vu • Smells• Sounds• Tastes• Visuals loss or blurring• “Strange” feelings• Fear/panic • Pleasant feelings• Racing thoughts• Physical Changes:• Dizzy or lightheaded• Headache• Nausea or other stomach feelings • Numbness or tingling in part of the body

Common symptoms during a seizure:

Awareness, Sensory, Emotional or Thought Changes:• Loss of awareness • Confused, feeling spacey• Periods of forgetfulness or memory lapses• Distracted, daydreaming• Loss of consciousness, unconscious, or “pass out”• Unable to hear• Sounds may be strange or different• Unusual smells • Unusual tastes• Loss of vision or unable to see• Blurry vision• Flashing lights• Formed visual hallucinations • Numbness, tingling, or electric shock like feeling in body, arm or leg• Out of body sensations• Feeling detached• Body parts feels or looks different• Feeling of panic, fear, impending doom

Physical Changes:• Difficulty talking • Unable to swallow, drooling• Repeated blinking of eyes, eyes may move to one side or look upward, or staring• Lack of movement or muscle tone • Tremors, twitching or jerking movements • Rigid or tense muscles • Repeated non-purposeful movements, called automatisms, involve the face, arms or legs, such as• Lip smacking or chewing movements• repeated movements of hands, like wringing, playing with buttons or objects in hands, waving• dressing or undressing• walking or running• Repeated purposeful movements• Convulsion • Losing control of urine or stool unexpectedly• Sweating• Change in skin color • Pupils may dilate or appear larger than normal• Biting of tongue• Difficulty breathing• Heart Racing

Common symptoms after a seizure:• Awareness, Sensory, Emotional or Thought Changes:• Slow to respond or not able to respond right away• Sleepy• Confused• Memory loss• Difficulty talking or writing• Feeling fuzzy, lightheaded or dizzy• Feeling depressed, sad, upset• Scared• Anxious• Frustrated, embarrassed, ashamed• Physical Changes:• May have injuriesMay feel tired, exhausted or sleep for minutes or hours• Headache or other pain• Nausea or upset stomach• Thirsty• General weakness or weak in one part or side of the body• Urge to go to the bathroom or lose control of bowel or bladder

Causes:

• Abnormal level of sodium or glucose in the blood• Brain infections, including meningitis• Brain tumor• Drug abuse• Electric shock• Epilepsy• Heart disease• Heat illness• Poisoning• Stroke

First aid

If someone is having a seizure:

• Loosen clothing around the person's neck.

• Do not try to hold the person down or restrain them. This can result in injury.

• Do not insert any objects in the person's mouth. This can also cause injury.

• Remove sharp objects (glasses, furniture, and other objects) from around the person to prevent injury.

• After the seizure, it is helpful to lay the person on their side to maintain an open airway and prevent the person

from inhaling any secretions.

• If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.

• After a seizure, the person may be confused and should not be left alone.

• Bring the Patient to the hospital if:

• seizure lasts longer than 5 minutes or

• if another seizure begins soon after the first, or

• if the person cannot be awakened after the movements have stopped

Treatment• Carbamazepine (Carbatrol, Tegretol) is widely prescribed for trigeminal neuralgia, which causes searing facial pain

that feels like an electric shock.

*Carbamazepine: blocks voltage-activated sodium channels; produce less pronounced frequency-dependent block

• the use of the anticonvulsants gabapentin (Neurontin) or pregabalin (Lyrica) to help relieve pain caused by damaged

nerves.

*Gabapentin and pregabalin: act by binding to a2d proteins, which are believed to be accessory subunits of voltage-dependent calcium

channels that exist in four homologous forms; only types 1 and 2 bind them with high affinity

• Because these drugs have few side effects and are usually well tolerated, they are often the first medications to try for

neuropathic pain. You may experience side effects, such as drowsiness, dizziness, confusion or swelling in the feet

and legs. These side effects are limited by starting with a low dosage and slowly increasing it.

• Medications from other drug classes with distinct mechanisms of pain relief (such as antidepressants) may be used

in combination with anti-seizure class medications if anti-seizure medications fail to control your pain.