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Seizure Symptoms, Treatment, Causes, and Types -Doctor Micheal

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By definition, epilepsy is a recurrent disorder occurring in an otherwise healthy person over a period of time. Therefore, it would be more appropriate to state that all patients who have seizures may not be suffering from epilepsy, but everyone who has epilepsy has seizures. The term "convulsion" is applied to describe any of the motor manifestations of a seizure. "Fit" is a layman’s term for seizure.


Victim of seizures


The term "seizure" can be applied to describe any or all of the clinical manifestations of epilepsy. However, when these manifestations occur as isolated episodes or as manifestations of another acute illness such as encephalitis or a toxic metabolic disorder, they are called seizures, not epilepsy.


The article provides information about epilepsy, including symptoms, treatment, causes, and types of seizures.

What causes epilepsy

By cause, epileptic seizures can be classified as:

  1. Idiopathic, in which the brain is macroscopically and microscopically normal.
  1. Symptomatic, in which a definite cerebral lesion is demonstrable.

 

Primary generalized seizures are usually idiopathic. Partial seizures are almost always caused by focal lesions such as craniocerebral trauma, intracranial tumors, brain abscesses, cerebrovascular accidents, glial scars, and others.

 

However, in metabolic, hypoxic, and toxic encephalopathies and some primary diseases of the brain such as bacterial meningitis, viral encephalitis, subacute sclerosing panencephalitis (SSPE), Creutzfeldt-Jakob disease, and lipid storage disorders, there may be generalized convulsive seizures.

 

In the workup of a patient with seizures, clinical history is the most important factor for the initial classification of the seizure type. Complete physical and neurological examinations are necessary to determine the underlying cause.


What are the common types of epilepsy?

Based on clinical symptomatology, epileptic seizures can be broadly divided into two types:

  1. Generalized seizures
  1. Partial seizures

 

Generalized seizures

These are bilaterally symmetrical seizures and do not have a focal onset (primary generalized seizures). They can be further subdivided into seven types:

 

  1. Generalized tonic-clonic seizures or grand mal seizures
  1. Seizures of generalized tonicity
  1. Generalized clonic seizures
  1. Bilateral myoclonic seizures.
  1. Absence seizures—typical petit mal and atypical forms.
  1. Atonic seizures
  1. Infantile spasms

 Partial seizures 

These are characterized by initial symptoms localized to one region of the body, depending on the site of seizure focus in the brain. They can be further subdivided into the following three types:

 

  1. Simple partial motor seizures, including Jacksonian seizures
  1. Simple partial sensory seizures
  1. Complex partial seizures (psychomotor or temporal lobe seizures)

 

Simple partial seizures

Here consciousness is not altered, whereas complex partial seizures may be associated with alteration in consciousness. Partial seizures may progress into generalized tonic-clonic seizures. Unilateral seizures are seizures strictly confined to one side of the body.

 

Unclassified seizures

Are seizures those for which an accurate label cannot be given due to inadequate or incomplete information regarding the seizure pattern. Primary generalized seizures typically begin in the first or second decade of life, are unrelated to mental retardation or focal neurological signs, and have a strong familial tendency.

 

Partial and secondary generalized seizures

On the other hand, can occur at any age, is frequently associated with focal neurological signs or papilledema, and have no familial tendency.


How is each type of seizure present?

Let us examine the manner in which each seizure manifests itself now.

Generalized tonic-clonic seizure (grand mal type)

A generalized convulsion passes through three phases—tonic, clonic, and postictal. The tonic phase starts without any warning symptoms. The arms go into abduction, the elbows flex, and the hands pronate.

 

The mouth opens widely, so do the eyes. Soon, the patient loses consciousness and falls to the ground abruptly. This is followed by the clenching of the jaws, often with biting of the tongue. An epileptic cry may occur when air passes through the partially closed vocal cords.

 

All the muscles go into tonic spasms. Respiration stops for a while, and the patient becomes cyanosed. The pupils become dilated and nonreactive. The tonic phase lasts for about 10 to 15 seconds, and then the clonic phase begins. It starts as a mild, generalized trembling, rapidly progressing to rhythmic, symmetric, intermittent muscular contractions called "clonic jerks."

 

The eyeballs roll-up. Excessive salivation and frothing from the mouth develop. There will be excessive sweating. Micturition, defecation, or seminal ejaculation may occur. During the entire clonic phase, which lasts for 1 to 2 minutes, the breathing is irregular.

 

At the end of the clonic phase, the patient takes a deep breath and remains in a deep coma for an unknown amount of time, ranging from a few minutes to several hours. When he wakes up, he is disoriented and confused (postictal state).

 

He may sleep for several hours and wake up with a headache and body aches. In most cases, the incident is not remembered. Injuries resulting from the fall, violent convulsions, and biting of the tongue are common.

 

This type of convulsion may occur singly or in clusters, either during wakefulness or during sleep. The majority of people begin in their first or second decade. there will be a positive family history of epilepsy. During the interictal period, neurological examination reveals no abnormality.


Seizure Symptoms, Treatment, Causes, and Types


What are the common symptoms of epilepsy?

 

Aura

It is a symptom or symptom complex that the patient experiences just before a seizure and regards it as a sign of an impending seizure, but actually, the aura is the initial event of the seizure itself. The aura may be in the form of palpitation, a sort of sinking or gripping feeling in the abdomen, gas rising up in the epigastrium, or some other undesirable sensation in some part of the body. The patient should be asked about the aura because it may give a clue to the site of the seizure focus. Approximately half the cases of generalized convulsive seizures experience some type of aura.

 

It is characterized by the development of sudden opisthotonus posture with loss of consciousness and marked autonomic manifestations such as sweating and alteration in pulse rate, respiration, and blood pressure.

 

It is characterized by sudden, bilateral, rhythmic clonic movements of the limbs, with or without loss of consciousness and autonomic manifestations as in tonic seizures.

 

It is characterized by sudden, bilaterally regular, isolated jerking of the limbs. Infantile spasms (syn: hypsarrhythmia: salaamspasms): These occur in infants between the ages of 3 and 12 months. Each attack is characterized by sudden forward bending of the trunk and head with the extension of the arms and legs. They occur several times a day. The child may be otherwise normal or show developmental arrest and mental retardation.

 

Atonic seizures

These are characterized by the sudden loss of postural tone with sagging of the head and falling to the ground without losing consciousness (drop attacks), usually occurring in children.

 

Absence seizures

These are characterized by sudden cessation of all activities, loss of responsiveness, and a staring look that lasts for about 3 to 30 seconds. The usual age of onset is 3 to 13 years. These spells may or may not be associated with micromotor activities such as chewing, lip-smacking, fluttering of the eyelids, or rolling of the eyeballs.

 

Usually, the patient is not aware of these episodes. They are recognized by others as brief pauses during the conversation, eating, writing, reading, or any other motor activity. Typical absence attacks can be precipitated by hyperventilation for about 3 minutes.

 

Unlike a grandmal seizure, there is no postictal confusion, drowsiness, or headache. The attacks may occur several times in a day. Atypical absence attacks have a slower onset, longer duration, and gradual cessation. They may be associated with more complex motor activations and automatism.

 

Partial Motor Seizures

These are characterized by the turning of the head and eyes to one side with tonic contractions of the extremity and trunk, without loss of consciousness (adverse seizures). At times, there may be tonic or clonic movements in one part of the body, usually at the angle of the mouth, thumb, or foot, because these areas have greater cortical representation.

 

These attacks usually last for 20 to 30 seconds. When the attack begins in one of these areas and progressively marches to involve contiguous anatomical parts of the body, it is called a Jacksonian seizure. There may be postictal focal paralysis (Todd’s palsy), which may last for a few hours or even up to 3 to 4 weeks.

 

Partial Sensory Seizures

Somatic sensory seizures are characterized by recurrent transient attacks of "pins and needles" sensation, numbness, and rarely pain or thermal sensation over one part of the body. Special sensory seizures are characterized by recurrent, transient attacks of special sensory phenomena, the nature of which depends on the site of lesion in the brain.

 

Complex Partial Seizures

These are characterized by formed hallucinations, illusions, and dyscognitive experiences such as déjà vu (a feeling of intense familiarity), a dreamy state, depersonalization, and others. Affective states such as fear, depression, elation, and automatisms may occur. These are caused by a focus, usually in the temporal lobe, but sometimes in the frontal lobe as well.

 

Status Epilepticus: Status

Epilepticus is defined as "an epileptic seizure which is so prolonged or so frequently repeated as to create a fixed and lasting epileptic condition." In other words, a seizure that is very prolonged or that recurs at brief intervals can be called "status epilepticus." Any type of seizure may go into status epilepticus, although the generalized tonic-clonic convulsive status is more frequent, more serious, and easily recognizable.

Status epilepticus may be of the following types:

  1. Generalized Convulsive Type
  1. partial convulsive type, i.e., epilepsia partialiscontinua, or
  1. nonconvulsive type, i.e., absence status.

When we publish our next post, we will cover the topic of seizure treatment. Please feel free to leave us a comment and forward this information to all of your friends.

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