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Epileptic Seizure – Causes, Symptoms and Treatment

An epileptic seizure is a sudden, uncontrolled electrical discharge in the brain that can cause convulsions, loss of consciousness, or other neurological symptoms.

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An epileptic seizure is a sudden, uncontrolled electrical discharge in the brain that can cause convulsions, loss of consciousness, or other neurological symptoms.

What is an Epileptic Seizure?

An epileptic seizure is a brief, usually spontaneous event caused by abnormal, excessive, or synchronized electrical activity of nerve cells in the brain. Symptoms vary widely depending on which area of the brain is affected – ranging from uncontrolled muscle convulsions and loss of consciousness to brief lapses in attention or unusual sensory experiences. When epileptic seizures occur repeatedly and without a clear trigger, the condition is diagnosed as epilepsy.

Causes

Epileptic seizures can have many different causes. A distinction is made between seizures triggered in otherwise healthy individuals and those caused by structural or functional changes in the brain that lead to recurring events.

Structural causes: Brain injuries, stroke, brain tumors, cerebral malformations
Genetic causes: Hereditary changes in ion channels or neural network function
Metabolic causes: Low blood sugar (hypoglycemia), electrolyte imbalances, liver or kidney failure
Infections: Meningitis, encephalitis
Provoked seizures: Sleep deprivation, fever (febrile seizures in children), alcohol or drug use
Idiopathic causes: No identifiable cause; genetic predisposition suspected

Symptoms

The symptoms of an epileptic seizure depend strongly on which part of the brain is involved. Several seizure types are distinguished:

Focal Seizures

Focal (also: partial) seizures begin in a specific area of the brain. They may occur with or without impairment of consciousness. Possible symptoms include:

Twitching of one side of the body or individual limbs
Tingling or numbness
Olfactory or gustatory hallucinations
Automatisms (e.g., lip-smacking, fidgeting)

Generalized Seizures

Generalized seizures involve both hemispheres of the brain from the outset. Well-known types include:

Tonic-clonic seizure (Grand Mal): Sudden loss of consciousness, stiffening of the body (tonic phase), followed by rhythmic jerking (clonic phase)
Absence seizure: Brief episodes of staring or inattentiveness, usually only a few seconds, typically without falling
Myoclonic seizure: Brief, lightning-like muscle jerks
Atonic seizure: Sudden loss of muscle tone, high risk of falls

Diagnosis

Diagnosing an epileptic seizure involves a thorough medical evaluation and a range of diagnostic procedures:

Medical history: Detailed account of the seizure event from the patient and any witnesses
EEG (Electroencephalogram): Measurement of brain electrical activity, often showing epilepsy-typical patterns
MRI (Magnetic Resonance Imaging): Brain imaging to detect structural abnormalities
Blood tests: To rule out metabolic causes (e.g., blood glucose, electrolytes)
Lumbar puncture: If a central nervous system infection is suspected

Treatment

Treatment depends on the underlying cause, seizure type, and frequency of episodes.

First Aid During a Seizure

Protect the person from injury by removing dangerous objects nearby
Place the person in the recovery position (after the seizure ends)
Do not put any objects in the mouth
Call emergency services (911 or local number) for a first seizure, a seizure lasting more than 5 minutes, or multiple seizures in a row

Medication

For recurring seizures (epilepsy), antiepileptic drugs (also called anticonvulsants) are used. Commonly prescribed medications include:

Valproate
Lamotrigine
Levetiracetam
Carbamazepine

The choice of medication depends on the seizure type, the age of the patient, and any coexisting medical conditions.

Surgical Treatment

In cases of drug-resistant epilepsy, neurosurgery may be considered to remove the seizure-generating area of the brain.

Additional Treatment Options

Ketogenic diet (particularly effective in children)
Vagus nerve stimulation (VNS)
Deep brain stimulation (DBS)

References

Fisher RS et al. - ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia, 55(4):475-482, 2014.
World Health Organization (WHO): Epilepsy Fact Sheet. who.int, 2024.
Scheffer IE et al. - ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4):512-521, 2017.

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