Understanding Seizures and What to Do If You Have One

Having a seizure can be a scary experience, especially if you have never had one before. Seizures are actually more common than you might think: one in 10 adults will have a seizure in their lifetime, and about 1.2 percent of the population will develop epilepsy, defined as having two or more seizures over a lifetime.

A seizure occurs when there is a sudden, temporary surge of electrical activity in the brain. The uncontrolled electrical activity overloads the brain’s normal circuitry and causes a seizure, along with an array of potential symptoms.

There are dozens of different types of seizures. They can be classified as generalized, which affect the entire brain; or focal, which start in just one area of the brain and may or may not spread. Seizures can also be classified according to their symptoms or the severity of the event. For instance:

• A dialeptic (or petit mal) seizure is characterized by the person pausing in whatever activity they are performing, staring off into space, and having a decreased awareness of and interaction with their surroundings.
• A tonic-clonic (or grand mal) seizure is much more intense, and is accompanied by the type of symptoms we often associate with seizures – uncontrolled stiffening, shaking and a complete loss of consciousness.

Even if you have just one mild seizure with no obvious after-effects, it is still important to seek medical attention, recommends University Hospitals neurologist and epilepsy specialist Jonathan Zande, MD. A seizure can be a sign of another health condition that may need treatment, or it could signal the onset of epilepsy. A thorough exam by a specialist will be able to pinpoint any underlying disorders and help develop a treatment plan.

What Causes a Seizure?

A seizure can be triggered by a variety of health events or conditions. Things like stroke, brain trauma (a concussion or traumatic brain injury), or a brain tumor can all make a person more susceptible to seizures. Non-brain-related health issues can also cause seizures, including poorly controlled blood sugar, chronic kidney issues, metabolic or autoimmune disease, alcohol or substance use, or a viral illness.

However, many times a seizure’s cause is unknown. In such cases, a person’s predisposition toward seizures may come down to tiny, microscopic differences in the brain, says Dr. Zande. These differences can cause neurons to become disorganized in certain areas of the brain, increasing the risk for seizures.

When to Seek Medical Attention

Severe seizures, such as tonic-clonic, are considered a medical emergency. You should go to the emergency room for a seizure that lasts for longer than five minutes or if you experience loss of consciousness, trouble breathing or other severe symptoms.

For less severe seizures, it is still important to receive follow-up medical care with your doctor, who may refer you to a neurologist for further examination. Your doctor will likely run several tests, including an electroencephalogram (EEG), which records the electrical activity in the brain, and a brain scan such as computed tomography (CT) or magnetic resonance imaging (MRI) scan. You doctor may also order lab tests, such as complete blood count, blood chemistry, blood sugar and toxicology tests, and/or cerebrospinal fluid analysis.

Treatment for Seizures

For a one-time seizure, you may not need further treatment for the seizure itself. Depending on the findings from your follow-up tests, you may need to treat the underlying cause of the seizure. However, if you have had multiple seizures or you are at risk for further seizures, your doctor will discuss treatment options with you.

Medication. There are about 40 different seizure medications available in the U.S. One of the most commonly prescribed is Levetiracetam (Keppra) because it is very effective with few side effects. However, there are a variety of other very effective medications that may be used instead, based on the patient’s individual symptoms and tolerance.

It is important that these medications be taken regularly and consistently in order to best control seizures. Some people will need to take these medications indefinitely. Others may be able to wean off medications after a few years of being seizure-free.

Surgery. About one-third of epilepsy patients will not respond to medications. In these cases, epilepsy surgery can reduce the risk of further seizures and even cure them entirely. The earlier surgery is done the more effective it can be.

The most common type of epilepsy surgery is when surgeons either remove the portion of the brain that is causing seizures, or disrupt the pathways that seizures use to spread. Before surgery, the epilepsy team will perform tests and studies to pinpoint the precise area of the brain that is affected. Then a multidisciplinary team will meet to go over the results and determine how to proceed. This team may consist of neurosurgeons, epileptologists, neuropsychologists, and others.

Other types of surgery involve electrical brain stimulation, in which a device is permanently implanted into the brain and releases regularly timed electrical signals to disrupt seizure activity. While these newer techniques are not always as effective as epilepsy surgery, they are showing promise in being able to reduce the number of seizures a patient has, and/or the amount of medications needed to achieve seizure control.

Restrictions with Seizures

With any seizure, especially when consciousness is altered, there are certain restrictions you must adhere to for your own safety. Because seizures are unpredictable and can happen without warning, it is important for patients to take safety precautions both before and after treatment has started, Dr. Zande explains.

The biggest one is driving. Until seizures are under control, patients should not operate a motor vehicle. Once you are on a treatment regimen that is working and are six months seizure-free, you can likely resume driving if you and your doctor decide it is safe to do so.

Other seizure safety measures include things such as:

• Take showers instead of baths to reduce risk of drowning
• Use caution climbing stairs and avoid ladders and platforms
• Use non-breakable dishes, cook using the back burners of the stove or the microwave, and keep hot liquids covered to avoid injuries or burns
• Injury-proof your home by padding sharp furniture corners, installing anti-skid mats in showers, and keeping walkways and floors clear of cords and other objects
• Do not operate heavy machinery or lift heavy objects

While epilepsy patients tend to have more quality of life issues compared with other chronic conditions, it is a very treatable condition in most cases.

“Our goal is to help patients live the fullest lives possible,” says Dr. Zande. “As I tell my patients, your brain shouldn’t seize your body – it should seize your day.”

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The neurology and neurosurgery experts at University Hospitals provide highly skilled care and management for seizures, epilepsy and other neurological disorders.