Friday, April 16, 2021

JULIAN WILLETT'S COLUMN

What are seizures?

Physician summary of this reasonably common medical event.

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While there are popular culture references to seizures ranging from television to plays, as in a production of Lord of the Flies where I played the character, Simon, who had epilepsy, there are gaps in public knowledge. General knowledge of seizures is relevant because they are common enough that it is reasonably possible you know someone who has had a seizure, whether as an adult or a child.

Before delving into this medical event, it is worth noting that seizures do not mean someone necessarily has a seizure disorder. Many things can cause seizures, including seizure disorders, withdrawal from alcohol, sleep deprivation, and strokes, to name a few¹. Seizures can be provoked, such as an external factor like a stroke or unprovoked, a genuine seizure disorder if recurrent¹. The brain is somewhat like an easily startled cat. If it is exposed to things it is used to physiologically, it will be okay. If there are any irritating stimuli or distortions in what it is used to, problems can arise.

What are seizures?

Seizures are when there is synchronous and excessive electrical activity in the brain¹. Given that the nervous system works through electrical activity, this excess can produce feelings or movements when the activity involves the brain’s parts that are responsible for these actions. So when there are repeated cycles of electrical activity affecting the part of the brain responsible for taste, someone can experience taste without anything in their mouth.

Seizures are classified most basically on how much of the brain they involve. There are partial seizures (seizures that affect a more focused part of the brain) and generalized seizures (seizures that affect the majority/the whole brain). This distinction is complicated in that partial seizures can “spread” and develop into generalized seizures. Such an evolution is the most common type of seizures in adults¹.

How common are seizures?

Around 41 out of every 1000 people has a form of epilepsy¹. Approximately 25–30% of people presenting with a seizure for the first time are determined to have had the event due to something beyond epilepsy¹. So if we thought of ten people in a room who had seizures, around three of them will have had a seizure due to something external. Around one out of ten people, think those ten people in a room with ninety others, will have a seizure sometime in their life². The most common cause of seizures in older adults is due to non-epilepsy conditions, like strokes¹.

What are the symptoms of a seizure?

Individuals who have a seizure often lose consciousness, so they usually cannot say what happened. Medical histories usually rely on EMS or other individuals who were present at the scene. Sometimes patients feel peculiar before a seizure occurs, called an aura¹. Feeling peculiar does not mean that you are about to have a seizure, as it can also happen for those who experience migraines and for unknown reasons.

How are seizures treated?

In many cases, seizures stop on their own. The clinical evaluation will entail seeing if any factors predisposed the individual to the event, such as the patient’s electrolytes being imbalanced, new medications, or alcohol use disorder history. A first-time, run-of-the-mill seizure usually does not require individuals to be started on anti-seizure medication¹.

What is the typical prognosis for someone who has a seizure?

This is ultimately determined by what caused the seizure¹. The prognosis of someone who had a seizure due to a stroke versus an undetermined cause understandably can be very different¹.

What should be done if someone has a seizure?

Absolute number one: DO NOT TRY TO PUT ANYTHING IN THEIR MOUTH. The myth that you need to prevent someone from swallowing their tongue is false. If you put something in the mouth of someone having a seizure, you can get injured, the person having the seizure can get injured (I have heard stories of patients who chipped teeth because a family member tried to hold something in their mouth per the myth), and the person having the seizure can die if the thing put in their mouth somehow goes into their throat and obstructs the airway. Do not attempt to hold the individual down or in place because this can increase the risk of injuries². Do not provide water or food until the individual becomes fully alert after the seizure, which can sometimes take a few hours².

The best thing that someone can do for an individual having a seizure is to ease them safely onto the floor if possible, remove anything that could interfere with the individual’s breathing, like a tie, move anything that could harm the individual on the floor away from them, turn the individual to their side (if possible), put something soft under their head, remove glasses if they are wearing any, and time the seizure².

While seizures can be scary to observe, especially when you care much for the person having the seizure, they are generally not emergencies². Status epilepticus, a medical emergency, is when a seizure lasts longer than five minutes. This is why it is useful to time the seizure if possible. Most seizures are shorter than this, and people will be alright to get checked out at the hospital without necessarily needing to call 911 (the CDC reference I am using provides advice regarding when to call 911)².

References:

  1. https://www.ncbi.nlm.nih.gov/books/NBK430765/
  2. https://www.cdc.gov/epilepsy/about/first-aid.htm

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JULIAN WILLETT, MD

Medika Columnist

M.D. trained in the US, now researching SARS-CoV-2 and COVID-19 in Canada for his Ph.D. After earning my Ph.D., I will be pursuing an Anatomic Pathology residency embracing my path towards being a physician-scientist. My academic interests are directed towards topics that provide the greatest net benefit for the greatest number of people. I love complicated, messy, and poorly understood topics.

I enjoy writing in my spare time, along with 3D printing and staying connected with my family. I have been a longstanding proponent for global health with projects ranging from supporting Doctors without Borders (MSF) to Syrian refugees (Syrian American Medical Society).

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