Seizure Disorder—Adult

Author: Rosalyn Carson-DeWitt, MD
En Español (Spanish Version)
More InDepth Information on This Condition

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Definition

A seizure happens when there are certain types of abnormal electrical activity in the brain. During a seizure, you may:

  • Lose consciousness
  • Stare into space
  • Have convulsions (abnormal jerking of the muscles)
  • Experience abnormalities of sensation or emotion

When two or more seizures occur, it is considered a seizure disorder. This condition is also known as epilepsy.

Seizure disorders may be classified by the part of the brain they affect and the kinds of symptoms they cause. The main categories are:

  • Generalized seizure disorder—onset is throughout the brain, not from a single focal location
  • Partial seizure disorder (focal seizure)—begins within certain areas of the brain

Brain Cells (Neurons)

© 2009 Nucleus Medical Media, Inc.

Causes

Seizures are caused by abnormal brain function. Seizure disorders can start at any age.

For most people, it is not known what causes the malfunction. Some known causes include:

Risk Factors

The following factors increase your chance of developing some seizure disorders:

If you already have a seizure disorder, the following factors can increase your chance of having a seizure:

  • Sleep deprivation
  • Alcohol
  • Hormonal changes (such as those that occur at points during the menstrual cycle)
  • Stress
  • Flashing lights, especially strobe lights
  • Use of certain medicines
  • Missing doses of anti-epileptic medicines

Symptoms

There are many kinds of seizure disorders with a variety of symptoms, such as:

  • Aura—a sensation at the start of a seizure, may involve the perception of an odd smell or sound, spots appearing in front of the eyes, or unusual stomach sensations
  • Staring
  • Loss of consciousness
  • Repeated jerking of a single limb
  • Generalized convulsion with uncontrollable jerking of muscles throughout the body
  • Hand rubbing
  • Lip smacking
  • Picking at clothing
  • Perception of an odor, sound, or taste
  • Loss of bladder or bowel control
  • Postictal state—a state of drowsiness, alteration in responsiveness, and/or confusion that commonly occurs after a generalized tonic-clonic seizure; may last minutes, hours, or days

Symptoms of generalized seizure disorders include:

  • Generalized tonic-clonic seizures—loss of consciousness, uncontrollable jerking of muscles throughout the body
  • Absence seizures—staring, eye blinking, or eye rolling

Symptoms of partial seizure disorder include:

  • Complex partial or temporal lobe seizures:
    • May lose contact with reality, stop purposeful activity, and begin a series of automatic gestures (eg, lip smacking, hand-wringing, or picking at clothing)
    • May appear as a brief moment of confusion or loss of attentiveness
    • May have a perception of unusual sights, sounds, or smells
  • Simple partial seizures:
    • Does not involve a loss of contact with reality or a loss of consciousness
    • Single area of the body may move uncontrollably (eg, leg or arm shaking)
    • May include the perception of an odor, sound, or taste, or an unrelated emotion

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a neurologist. These doctors specialize in the nervous system and brain.

Tests may include the following:

  • Blood tests—to look for abnormal levels of different substances in the blood
  • Electroencephalogram (EEG)—a test that uses sensors to evaluate electrical brain activity.
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head (used in some cases)
  • Lumbar puncture —a test of the cerebrospinal fluid (CSF) from the lower back; may be done to look for infection or bleeding
  • Magnetoencephalography (MEG)—an imaging device that measures the brain's magnetic fields

Treatment

The goals of treatment are to:

  • Treat the underlying cause (if known)
  • Prevent seizures—may be done through medicine, surgery, or special therapies
  • Avoid factors that stimulate seizure activity

Anti-epileptic Medication

There are a wide variety of medicines that may be used. Some of these include:

These drugs may be given alone or in combination.

Surgery

If medicine does not work or the side effects are too severe, you may need surgery. Surgery involves the removal of the seizure focus. This is the area of the brain that has been identified as starting the seizure. Surgery is only an option for people who have very localized areas of the brain involved.

Vagus Nerve Stimulation (VNS)

A device is implanted in the chest. It will provide intermittent electrical stimulation to the vagus nerve. It is not clear how this works. Somehow it prevents or decreases the frequency of seizures. You may still require medicine. The dosage may be less.

Ketogenic Diet

This is a very strict diet. It is high in fat and low in carbohydrates and proteins. This diet keeps the body’s chemical balance in ketosis. Ketosis decreases the frequency of seizures. The reason is unknown. Following a ketogenic diet is most successful in children. It is less successful in adults.

Modification of Activity

If you have a seizure disorder, you can take the following steps to try to decrease the chance of a seizure:

  • Get enough sleep.
  • Avoid excessive alcohol intake. Alcohol can make seizures more likely.
  • Avoid hyperventilating.
  • Avoid places where flashing or strobe lights are in use.
  • Wear a medical alert bracelet. That way, if you have a seizure, people around you will understand what is happening. They will be able to take appropriate steps to be helpful.
  • Consider keeping a seizure log. Record things that were happening around the time of a seizure. This will help to identify a seizure trigger.
  • Take your seizure medicines according to the prescription.

Prevention

There are no known ways to prevent every type of seizure disorder. You can take steps to prevent brain injuries which could lead to seizures:

  • Always wear a helmet when using bikes, rollerblades, skateboards, or scooters.
  • Wear protective headgear when playing contact sports.
  • Dive in safe depths of water.
  • Always wear a seatbelt.
  • Avoid using street drugs.
  • If your baby or child has a high fever, get treatment right away.
  • Get prenatal care. If you have high blood pressure during pregnancy, get proper treatment.
  • If you have a chronic condition, get proper care.

If you have a very severe seizure disorder, some changes may be needed to prevent serious injuries, such as:

  • Depending on your condition, avoid driving.
  • Do not swim or bathe alone.
  • Do not work on ladders or ledges.
  • Avoid or modify athletic activities.

Talk to your doctor about these kinds of issues.

Resources:

Epilepsy Foundation

http://www.efa.org/

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/

Canadian Resources:

Center for Epilepsy and Seizure Education

http://epilepsy.cc/

Epilepsy Ontario

http://www.epilepsyontario.org/

References:

Cecil RL, Goldman L, Ausiello DA. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: WB Saunders Company; 2004.

Epilepsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 2009. Accessed July 8, 2009.

Ferri FF. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby Elsevier; 2004.

Goetz CG. Textbook of Clinical Neurology. 2nd ed. Philadelphia, PA: WB Saunders Company; 2006.

Kasper DL. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005.

Magnetoencephalogram (MEG). About Kids Health website. Available at: http://www.aboutkidshealth.ca/. Updated February 2006. Accessed October 21, 2009.

12/20/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: 2007 safety alerts for drugs, biologics, medical devices, and dietary supplements: Carbamazepine (marketed as Carbatrol, Equetro, Tegretol and generics). Medwatch. US Food and Drug Administration website. Available at: http://www.fda.gov/medwatch/safety/2007/safety0...tm#carbamazepine.

5/14/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 May 2. [Epub ahead of print]

11/10/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Sabril approved by FDA to treat spasms in infants and epileptic seizures. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnounce...ts/ucm179855.htm. Updated August 21, 2009. Accessed October 8, 2009.

Last reviewed September 2010 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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