What is a Seizure/Convulsion?

It is a sudden change in behaviour, movements and consciousness that happens because of abnormal, excessive discharges from your brain cells called neurons. It is basically an electrical imbalance in your brain.

What is Epilepsy?

It is a condition when an individual has recurrent seizures due to a chronic condition. 

What Causes Epilepsy?

• In new-born babies (less than one month of age):

• Lack of oxygen supply to the baby during delivery or immediately after delivery.
• Brain haemorrhage or bleeding in the brain.
• Infection of the nervous system.
• Metabolic disorders – change in the metabolites or metabolic process; the process of breakdown of whatever goes into the body or secreted by the body. 
• In infants and children (more than one month but less than 12 months of age):

• Seizures associated with high fever (discussed later).
• Genetic disorders.
• Infections.
• Adolescents (12 to 18 years):

• Injury to the brain.
• Meningitis, encephalitis etc.
• Young adults (18 to 35 years):

• Trauma. 
• Alcohol withdrawal. 
• Older adults (more than 35 years):

• Stroke. 
• Trauma. 
• Brain tumours.
• Alcohol withdrawal. 
• In pregnant women:
• Occurs due to eclampsia, usually in the second or third trimester, this is a serious emergency situation and the mother needs to be hospitalised immediately, early warning signs are swelling legs, feet, vulva, headache, visual disturbances, stomach pain.
• There is usually a genetic factor/family history in unknown causes.

What are the Common Conditions Causing Seizures?

• Severe dehydration (excessive diarrhoea etc). 
• Severe liver diseases caused due to any reason like hepatitis, alcoholic cirrhosis, etc.
• Spread of infections to neural structures. 
• Brain tumours. 

What are the Types of Seizures?

Seizures can broadly be classified as:

• Focal seizures
• Generalised seizures (which can be further classified as):

1. Absent or petit mal seizures
2. Generalised tonic clonic or grand mal seizures
3. Atonic seizures
4. Myoclonic seizures

Types of Seizures Explained

Focal Seizures

• In this type of seizures, the manifestation is relatively simple. They are called focal seizures as the affect only a part of the brain.

Focal seizures without dyscognitive features

• In this type, the consciousness is fully preserved during the seizure. 
• There may be altered movements, like involuntary abnormal jerks of a single limb. 
• Change in any of the five senses if it involves the sensory system – touch (loss of sensation, tingling or numbness), change in taste, smell, hearing.
• There may also be temporary paralysis following the seizure, this is known as Todd’s paralysis.

Focal seizures with dyscognitive features

• The characteristic feature of this seizure is that the seizure activity may be accompanied by a transient impairment of the patient’s ability to maintain normal relations with the environment. 
• Inability to respond to verbal commands. 
• Sudden arrest in behaviour, staring into a distance or motionless stare.
• Involuntary, automatic behaviours like chewing, lip smacking, swallowing, picking movements of the hands or even running. This is known as automatisms. 
• The patient is unable to recall the events that happen during the seizure.
• There is usually an aura or a warning sign before the onset of this type of seizure

Generalized Seizures

• These seizures involve a larger area of the brain. 

Absent or Petit Mal Seizures

• It lasts only for a few seconds. 
• It is characterised by loss of consciousness and loss of postural control, associated with staring and unresponsiveness and blinking, chewing, abnormal hand movements.
• It usually occurs in children and early adolescents.
• Usually occurs without others even noticing the symptoms, very hard to diagnose. 
• Unexplained day dreaming and decline in school performance is a sign that the child is suffering from this condition. 

Generalised Tonic Clonic Seizures or Grand Mal Seizures 

• This is what is commonly known as the classical “fits”.
• There are no warning signs before the occurrence of this seizure and begins abruptly.
• In the first phase of this seizure, there is contraction of all the muscles of the body leading to a cry, followed by biting of the tongue and bluish discoloration of the skin.
• This is accompanied with increased heart rate, BP and pupil size.
• The next phase which occurs after 10-20 seconds, there is relaxation of the muscles which progresses throughout the body. 
• This is followed by unresponsiveness, loss of muscular activity, excessive salivation, loss of bowel and bladder control. 
• The patient regains consciousness over a few minutes to a few hours with confusion, headache and body pain. 

Atonic Seizures 

• Sudden loss of muscle tone, loss of posture and impaired consciousness for 2-3 seconds.

Myoclonic Seizures 

• Sudden, short, jerky contractions of muscles in one part of the body or the whole body.
• Normally it is seen while falling asleep or during hiccups.
• In diseased conditions, it is seen in degenerative diseases of the brain, metabolic disorders or when there is impaired oxygen supply to the brain causing injury to the brain. 

Status Epilepticus 

• It is a condition where the seizure lasts for more than five minutes or when more than one seizure occurs within five minutes without the patient returning to normal. 
• It is a serious condition and the patient needs to be hospitalised immediately.

Seizures In Children With Fever

• It usually occurs in children of 6 months to 3 years of age with fever of 38 degrees or more or fever that is increasing rapidly. 
• Attack usually happens within 24 hours of onset of fever and lasts 10-15 minutes and is a single attack per fever episode. 
• The type of seizure is generalised type.
• There is usually a family history of febrile seizures.
• There is usually no neurological complication following the seizure.
• Treatment involves bringing down the temperature and treating the cause of the fever and in case of a prolonged attack of more than 3 minutes, medication is given.
• Reduction of fever can be done by tepid sponging, which is dipping of washcloth in water and applying it to the child’s underarm, chest, forehead for 3-5 minutes and repeat. 
• Paracetamol (crocin) is also given. 
• In children with history of febrile convulsions it is recommended that an anticonvulsant drug, which is a medicine prescribed for seizures, is given at the onset of fever itself without waiting for the seizure to occur for 3 days. 

Prevention of Seizures

• It is difficult to achieve as the cause of seizures are varied.
• Avoid excessive intake of alcohol.
• Avoid usage of drugs and overdose of drugs causes seizures often.
• Avoid predisposing stimuli like flashing lights, sounds, irritating smells etc. 
• If you are an epilepsy patient, take your medication on a regular basis.
• Always mention your history of epilepsy whenever you visit the hospital for any reason as there may be a correlation.
• Special care needs to be taken in pregnancy, regular visits and tests need to be done.
• Mention history of epilepsy to your doctor when you are pregnant as the anti-epilepsy drugs need to be changed accordingly or else it will affect the baby as all anti epilepsy drugs are not safe during pregnancy. 
• Epilepsy in children, though usually not serious, needs to be attended to, in children more than 3 years of age, it is not common and needs to be checked by a doctor. 
• Regular day dreaming could be a seizure so do not neglect it. 

Treatment of Seizures

• This again depends on the cause. 
• If infectious – antibiotics 
• Trauma – Control bleeding in the brain.
• Neurological disorders/genetic or unknown cause – anti epileptic drugs. 
• If due to brain tumours – surgery may be required.
• It is important to follow the advice of the doctors as repetitive frequent seizures cause brain damage and death.