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Monday, August 18, 2025

Seizures (fits)


Seizures, commonly referred to as fits, are sudden, uncontrolled electrical disturbances in the brain that temporarily alter behavior, movements, sensations, or levels of consciousness. They are not a disease in themselves but are symptoms of an underlying neurological or systemic condition. Seizures can range from brief lapses of awareness to full-body convulsions and may occur as isolated events or as part of a chronic disorder such as epilepsy.

Causes of Seizures

Seizures occur when abnormal bursts of electrical activity disrupt normal brain function. The causes are diverse and can be broadly categorized into neurological, metabolic, infectious, structural, and idiopathic.

1. Neurological Causes

  • Epilepsy (idiopathic, genetic, or acquired)

  • Brain tumors

  • Traumatic brain injury

  • Stroke (ischemic or hemorrhagic)

  • Neurodegenerative disorders (e.g., Alzheimer’s disease)

2. Metabolic and Systemic Causes

  • Electrolyte imbalances (e.g., hyponatremia, hypocalcemia)

  • Hypoglycemia or hyperglycemia

  • Hypoxia (low oxygen levels)

  • Drug or alcohol withdrawal

  • Certain medications (e.g., antidepressants, antipsychotics, antibiotics like imipenem)

3. Infectious Causes

  • Meningitis

  • Encephalitis

  • Brain abscess

  • Neurocysticercosis (common in some developing regions)

4. Pediatric Causes

  • Febrile seizures (in young children with fever)

  • Congenital brain malformations

  • Genetic epileptic syndromes

5. Idiopathic or Unknown Causes

  • In many cases, no definitive cause is identified despite thorough investigation.

Types of Seizures

Seizures are classified into focal (partial) and generalized types, based on where they begin in the brain.

1. Focal (Partial) Seizures

  • Simple focal seizures: Patient remains conscious but may have unusual sensations, twitching, or visual/auditory changes.

  • Complex focal seizures: Impaired awareness, automatisms (lip-smacking, fidgeting), and confusion.

2. Generalized Seizures

  • Tonic-clonic seizures (grand mal): Loss of consciousness, muscle rigidity (tonic phase), followed by rhythmic jerking (clonic phase).

  • Absence seizures (petit mal): Brief lapses of awareness, common in children.

  • Myoclonic seizures: Sudden muscle jerks.

  • Atonic seizures: Sudden loss of muscle tone, leading to falls.

  • Tonic seizures: Sustained muscle stiffening.

  • Clonic seizures: Repeated rhythmic jerking movements.

Symptoms of Seizures

Symptoms depend on the seizure type, but may include:

  • Sudden loss of consciousness

  • Convulsions (jerking of arms and legs)

  • Stiffening of muscles

  • Temporary confusion

  • Staring spells

  • Aura (warning signs such as unusual smells, tastes, or feelings)

  • Incontinence (loss of bladder/bowel control)

  • Tongue biting

  • Postictal phase (drowsiness, confusion, headache after seizure)

Diagnosis

Diagnosing seizures involves a thorough clinical evaluation, medical history, and investigations.

  1. History and Examination

    • Witness accounts of seizures

    • Precipitating factors (sleep deprivation, stress, flashing lights)

    • Family history of epilepsy

    • Neurological examination

  2. Investigations

    • Electroencephalogram (EEG): Detects abnormal electrical activity.

    • Brain imaging (CT/MRI): Identifies structural causes (tumors, stroke, scarring).

    • Blood tests: Assess electrolytes, glucose, renal and liver function.

    • Lumbar puncture: If infection is suspected (meningitis, encephalitis).

Treatment of Seizures

Treatment depends on the cause, seizure type, and patient characteristics. The goals are to control seizures, minimize side effects, and improve quality of life.

1. First Aid During a Seizure

  • Keep patient safe (move away sharp objects, loosen clothing).

  • Do not restrain movements.

  • Do not place objects in the mouth.

  • Turn the person on their side to prevent aspiration.

  • Seek emergency help if seizure lasts longer than 5 minutes or if repeated seizures occur.

2. Long-term Treatment (Antiepileptic Drugs – AEDs)

Antiepileptic drugs help reduce or eliminate seizures by stabilizing neuronal activity.

Commonly Used AEDs:

  • Valproic acid (Sodium valproate)

    • Dose: Adults usually 600 mg/day initially, increased gradually up to 2,000 mg/day (divided doses).

    • Effective for generalized seizures.

  • Carbamazepine

    • Dose: Adults 200 mg twice daily initially, increased up to 800–1,200 mg/day.

    • Effective for focal seizures.

  • Phenytoin

    • Dose: Adults 300 mg/day in divided doses.

    • Effective for tonic-clonic and focal seizures.

  • Lamotrigine

    • Dose: Start at 25 mg/day, titrate slowly up to 100–400 mg/day.

    • Broad-spectrum, fewer cognitive side effects.

  • Levetiracetam

    • Dose: Start 500 mg twice daily, up to 3,000 mg/day.

    • Effective, fewer drug interactions.

  • Topiramate

    • Dose: Start at 25–50 mg/day, titrate up to 200–400 mg/day.

    • Effective for multiple seizure types.

  • Ethosuximide

    • Dose: 500–1,500 mg/day.

    • Specifically for absence seizures.

3. Emergency Management of Status Epilepticus

Status epilepticus is a life-threatening condition where seizures last more than 5 minutes or occur repeatedly without recovery.

  • First-line: Intravenous benzodiazepines

    • Lorazepam 4 mg IV (may repeat after 10 minutes).

    • Diazepam 10 mg IV/rectal if lorazepam unavailable.

  • Second-line: IV phenytoin (15–20 mg/kg), valproate, or levetiracetam.

  • Refractory cases: IV anesthetics (propofol, midazolam).

4. Surgical and Non-pharmacological Treatment

  • Surgery: For drug-resistant epilepsy (temporal lobe resection, corpus callosotomy).

  • Vagus nerve stimulation (VNS): Implanted device reduces seizure frequency.

  • Ketogenic diet: High-fat, low-carbohydrate diet effective in some children.

Precautions and Lifestyle Modifications

  • Medication adherence is crucial to prevent breakthrough seizures.

  • Avoid alcohol and recreational drugs.

  • Maintain regular sleep patterns.

  • Stress management and relaxation techniques.

  • Avoid known seizure triggers (flashing lights, sleep deprivation).

  • Safety precautions: No driving until seizure-free for 6–12 months (varies by country), avoid swimming alone, avoid operating heavy machinery.

Complications

  • Injury during seizures (falls, burns, fractures).

  • Aspiration pneumonia from inhaling saliva/vomit.

  • Sudden unexpected death in epilepsy (SUDEP).

  • Cognitive impairment (in poorly controlled epilepsy).

  • Psychosocial issues (anxiety, depression, social stigma).

Prognosis

  • Many patients achieve good seizure control with appropriate treatment.

  • About 70% of epilepsy patients can remain seizure-free with medication.

  • Prognosis depends on cause, seizure type, age of onset, and treatment adherence.



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