Seizures of various origins must be distinguished from true epilepsy. This is necessary for adequate treatment of seizures, as well as to create a clear idea of the prognosis of the disease. Many convulsive syndromes, sometimes companions throughout life, are easily eliminated through lifestyle adjustments and special diets.
During the onset of a seizure, nerve cells located in a specific part of the brain become overexcited and start to work in an irregular rhythm. As a result, it leads to disruption of brain activity. This violation affects the usual human behavior, movements, sensitivity, sometimes leads to loss of consciousness. Attacks can last from a second to several minutes.
The seizure begins in a specific area of the brain and then affects the functioning of the entire brain. The causes of seizures directly depend on which part of the brain it occurs in.
For example, symptoms may include:
- twitching, tingling in a specific part of the body
- the sensation of strange smells, tastes
- a sudden rush of fear
- violent movements
- unusual memories
Types of seizures
- Tonic-clonic seizures. The tonic-clonic begins with convulsions, in which the human body tenses, the arms bend, the legs, head, and neck are extended and the jaws are sharply compressed – this is the “tonic” phase. The person falls to the ground, sometimes utters a hoarse cry, and loses consciousness for several minutes. During this time, it seems difficult or stops, the body twitches, saliva may form in the mouth, and urinary incontinence may occur. This is the “clinical” phase. After a while, the twitching of the muscles subsides and consciousness returns. A person feels confusion and drowsiness for some time from strenuous muscular work.
- Lack of seizures. It is a generalized seizure, most often seen in children between three and fourteen years of age. An absence seizure looks much milder than a tonic-clonic one, and, in fact, sometimes looks like daydreaming. Therefore, primary school teachers often notice this disease before everyone else. Absence is usually characterized by short-term switching off of consciousness and gazing at one point, blinking or rolling the eyes upward.
- Myoclonic seizures. Myoclonic seizures can usually be short-lived and last only a few seconds. People without epilepsy can also experience myoclonus, but myoclonic seizures in epilepsy usually cause abnormal movements on both sides of the body at the same time.
- Tonic seizures. Tonic seizures are characterized by sudden muscle contraction and tension. His eyes may roll back, and as his chest muscles tighten and contract, it may be difficult for him to breathe. These attacks are short in duration and usually last less than 20 seconds.
- Clonic seizures. With clonic seizures, repeated twitching and muscle spasms occur. It is important to note that holding or repositioning a person cannot stop these movements during an attack. Clonic seizures are considered rare.
- Atonic seizures. During an atonic seizure, muscles suddenly lose tone (or “strength”) due to temporary changes in brain function. These attacks are short-lived and usually last 15 seconds or less. Atonic seizures usually appear during childhood and continue into adulthood. Although a person usually does not lose consciousness and the attacks themselves do not cause injury, the indirect damage can be caused by falls due to lack of muscle control.
Focal seizures (also known as “partial seizures” or “localized seizures”) are usually described by how they look and feel, for example:
- Without impairment of consciousness or perception;
- Including subjective sensory or psychic phenomena;
- Impaired consciousness or perception, or discognitive;
- Turning into a bilateral convulsive seizure.
Simple partial seizures. A simple partial seizure may precede a complex vapor seizure, in which case it is often referred to as a “seizure aura”. Auras are often characterized by short-term discomforts in the abdomen or head, such as anxiety or elevation, buzzing, foul odor, or spots in front of the eyes. People who can learn to recognize the onset of a seizure before it spreads to other parts of the brain can use this as a warning to guard against injury during the seizure itself.
Complex partial seizures. The most common partial seizures are those now called complex partial seizures that were previously known as temporal lobe or psychomotor seizures. A complex partial seizure of three short phases: there is a cessation of what the person is doing, a semi-conscious appearance, and fixation of the gaze. Then, automatic aimless behavior begins, which usually lasts a few minutes. This can be lip-smacking, pulling at clothing, buttoning, and unbuttoning, or twitching fingers. When a person regains consciousness, there is a short period of disorientation and confusion.
Treatment of seizures
Treatment is a long and complex process. Even with the correct selection of drugs and the complete absence of any manifestations for a long time, doctors only talk about a stable remission, but not about the complete elimination of diseases. The basis of therapy is made up of medications:
- anticonvulsants (phenobarbital, clonazepam, lamotrigine, Depakene and others): taken constantly to prevent seizures;
- tranquilizers: eliminate anxiety and relax the body;
- antipsychotics: reduce the excitability of the nervous system;
- nootropics: improve metabolism in the brain, stimulate blood circulation, etc.;
- Diuretics: used immediately after seizures to relieve cerebral edema.
If not enough medication is effective, doctors may resort to surgery. The choice of a special operation depends on the localization of the pathological focus and the form of the disease:
- removal of the pathological formation (tumor, hematoma, abscess) that caused the seizures;
- lobectomy: excision of the area of the brain in which an epileptogenic focus occurs, more often the temporal lobe;
- multiple subpial incisions: used when the lesion is large or impossible to remove; the doctor makes small incisions in the brain tissue to stop arousal;
- callosotomy: dissection of the corpus callosum, which connects both hemispheres of the brain; used for extremely severe forms of diseases;
- hemispherectomy: removal of half of the cerebral cortex; the intervention is rarely used and only in children under 13 years of age due to significant recovery;
- installation of a vagus nerve stimulator: the device constantly stimulates the vagus nerve, which has a calming effect on the nervous system and the entire body.
- Darkening of the eyes, confusion, snorting, and panting may occur;
- Tingling and twitching in a part of the body;
- Incontinence of urine and/or feces;
- Short-term loss of consciousness;
- A special condition preceding epileptic seizures, which has various manifestations: a sudden feeling of fear, nausea, a feeling of numbness, dizziness.
With the appearance of pronounced salivation, foam from the mouth, sudden fainting, loss of consciousness, sharp muscle spasms with twitching of the legs, deviation of the direction of the eyes and head (deviation of the eyes), urgent medical attention is required.
Methods for diagnosing seizures
According to the recommendation of the Epilepsy Foundation of America, the examination should be completed as soon as possible. This will allow you to start treatment in a timely manner and prevent the development of severe neurological symptoms. According to international neurological protocols, the following basic methods are used to diagnose seizures:
- neurological examination;
- blood test;
- Positron Emission Tomography;
- genetic test.
Neurological examination. The purpose of a neurological examination is to assess the functioning of the brain and nervous system. During the examination, the doctor checks muscle tone, sensitivity, coordination, reflexes. Additionally, explores the work of memory and intelligence.
Blood test. The results of general and biochemical blood tests allow a neurologist to exclude infections, allergies, impaired kidney, and liver function in the patient. If necessary, your doctor will prescribe the correct dose of the medication and monitor its effectiveness.
Electroencephalography. Electroencephalography is a recording of the electrical activity of the brain. Special electrodes on the patient’s scalp transmit a signal in the form of waves that are fed onto a special paper tape or computer. These waves differ at rest and during a seizure.
The most effective procedure is one that lasts several days continuously and is accompanied by video surveillance. This allows doctors to record and compare brain activity at different times of the day and night, in states of rest, arousal, sleep, and seizures. Thanks to this data, the neurologist can determine the shape and type of seizures.
MRI of the brain. The procedure allows a neurologist to assess the condition of the brain tissue. It identifies the damage that causes seizures and helps determine the underlying cause of the disease. MRI is a mandatory procedure for the initial diagnosis of seizures.
Positron Emission Tomography. The study shows how much glucose is consumed by different parts of the brain. In the focus of the disease at rest, glucose metabolism is below normal, and during an attack – higher. To enter this area, the patient is injected with a special substance – a radiosensitive analog of glucose, harmless to the body. The higher the consumption, the brighter it looks on the computer screen.
Genetic test. Genetic testing is done based on a sample of the patient’s blood or saliva. Such a study reveals gene mutations characteristic of more than 20 hereditary episyndromes.
First aid for a seizure
- Make sure the patient is not injured. Place the patient on a flat surface, away from furniture and other things that can hurt him.
- Turn the patient’s head to one side and place something soft under the head. This will prevent the patient from suffocating with vomit and will protect him from hitting his head on the floor.
- Unbutton the clothing around the patient’s neck and chest.
- Call an ambulance. The doctor will need to examine the patient to ensure that the seizure has gone without complications and that no hospitalization is required.
- Do not try to keep the patient still. This will not save you from seizures, but bones can be broken.
- Do not try to open the patient’s jaw, if it is closed so tightly that you will not open them without injury. Also, do not insert solid objects into the patient’s mouth, as this threatens broken teeth.
- After the seizure ends, place the person in a comfortable position. It is best to lay him on the side.
- Do not leave him until the doctor arrives.