Seizures

A seizure is a neurological problem in the brain. It is a spasm, an uncoordinated firing of the neurons and the associated electrical charges, along the nerves.

This sounds much worse than it is. Some 8% of us, 8 out of a hundred, will have a seizure at some point in our lives. For the majority of us, some 60% who have one seizure, that will be it.

The important part of having had a seizure is to check, medically, that it actually was a seizure and also that there was only the one.

Our brains work on electricity. To have a thought, or to make a movement, means a current travelling along a pathway through the cells and connections in our brain. All electrical systems have the possibility of a short circuit. A seizure is like, but not exactly the same as, that. Instead of the precise message moving along the necessary path, there is a general firing of the brain processes.

The effect of such a seizure is that the brain freezes up. It can result in a blackout, or we might retain consciousness in a milder seizure. There might just be difficulty in moving. Or there might be tremor, jerking of the limbs. A grand mal seizure – more precisely known as a generalised clonic-tonic seizure – will include violent contraction of the limbs and the loss of consciousness.

The difference is how much of the brain is subject to the abnormal electrical activity at the time. A localised burst will lead to problems with the specific functions of that part of the brain. Say, speech, or vision, or one or more limbs, might be affected by a small seizure. The more generalised the disruption the more functions will be affected up to and including mental and physical control entirely.

A seizure is entirely different from a faint, despite the similarity in effects. A faint is to do with the circulation of blood in the body, a seizure in the brain. Faints are more common, many more of us will have one over a life. Medical treatment starts with distinguishing between a faint and a seizure.

Then progresses through the various possible causes of a seizure if there was one. There are possible physical causes of seizures, each of which can and should be treated.

It is always necessary to have a seizure investigated. One important point is that you may not drive for 6 months after having a seizure. You typically can drive after a faint. So, investigation to distinguish between a seizure and a faint is always necessary for legal, not just medical, reasons.

There are a number of possible physical causes of both faints and seizures. Treatment is necessary in order to discover whether one of these is responsible. For example, low blood sugar from diabetes can lead to a faint. A brain tumour can cause a seizure.

So can lifestyle issues like alcohol consumption, recreational drugs, some medications and other illnesses cause either a faint or a seizure.

Treatment to determine the cause can result in the removal of that factor which created the seizure.

Treatment of a seizure is a diagnostic investigation, a pathway to determining the cause. A specific seizure will not be treated in the sense of an action being carried out. The task is to first detect whether a seizure occurred, then to consider whether there is a physical cause or not.

The treatment course for a seizure starts with considering whether you had a seizure at all. Since seizures are transient and have no physical marker that they have happened, investigation is necessary. A blackout can have a number of causes, including a faint or seizure.

A GP, perhaps with the aid of a cardiologist, will usually be able to determine between a faint and a seizure. Faints are to do with the circulatory system and are treated by addressing the underlying cause. A suspected seizure is then investigated further. There are certain physical causes that need to be checked.

Alcohol or drug use, medications, other lifestyle issues perhaps are possible. These are again then treated by addressing the underlying causes.

Even when a non-specific seizure is suspected it is shown to have happened in about only a half of the cases that present.

An eyewitness account of the seizure is very helpful. By the very nature of a seizure the patient will not be aware of exactly what happened. If someone was with them when it happened then they too should attend with the neurologist to describe events. If direct presence is not possible then a written description is still an aid.

The neurologist will work with the full clinical history, such descriptions from the patient and witnesses that can be gained, to make the diagnosis of a seizure having happened. Family history and background factors, lifestyle, all are taken into account.

A brain scan may be performed, an electrocardiogram (ECG, looking at the electrical activity of the heart) as well. Especially in younger patients an EEG (electroencephalogram, an examination of the electrical activity in the brain) can be very useful and so will be done.

The purpose of this diagnostic pathway is to decide whether a seizure did in fact take place. First decide whether it was a faint or a seizure. If a seizure then is there some physical cause behind it? Then treatment will be directed at that underlying cause like medications or lifestyle and consumption factors. If not then the diagnosis can be a non-specific seizure.

The first question is did I have a seizure? The second is can we identify a specific cause for the seizure?

The specific treatment at this point is to watch and wait. Having agreed that there was a seizure, that it did not have a specific physical cause, then the situation is monitored. For most people who have a seizure that is the only incidence in their lifetime.

It is repeated seizures that then become described as epilepsy and then go on to further treatment.

There is no specific recovery time from seizure treatment. There is the legal issue that driving is not allowed for the 6 months after a seizure.

Other than that, the treatment is to have ruled out issues that require particular treatment.

For the seizure alone the treatment is continued monitoring to see if there is a repeat.

There are no risks to seizure treatment. The purpose of the investigatory pathway after a seizure is to rule out those possible causes that might require treatment.

From circulatory problems that might cause a faint through to lifestyle or medication issues that might be a physical cause of the seizure.

The seizure treatment process is, in itself, to identify and so be able to treat those risks. It is about the removal of risk.

Repeated seizures are, by definition, classed as epilepsy which is another subject.