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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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Things worth knowing about "Epileptic Seizure"

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

  1. Fisher RS et al. - ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia, 55(4):475-482, 2014.
  2. World Health Organization (WHO): Epilepsy Fact Sheet. who.int, 2024.
  3. 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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