Seizure: what to do, causes, symptoms, can it kill?

What is seizure?

Seizure is a disorder in which abnormal electrical discharges in the brain cause the muscles to contract and relax quickly in a disorderly manner. Often, the individual loses consciousness during the process. It is often confused with an epileptic seizure, however, it can be caused by several conditions unknown to the patient.

Convulsive attacks usually last between 1 and 2 minutes, and can last up to 5 minutes. When it is over, the individual often does not even remember what happened and suffers from unpleasant sensations such as tiredness and confusion.

It is estimated that 2% of adults have had a seizure at some point in their lives. Of these, about a third had a second seizure. These seizures can be epileptic (related to Idiopathic Epileptic Disorder), but they often have another cause, being called “non-epileptic”.

It is not uncommon for the patient to experience strange sensations before convulsing, but it cannot be predicted with certainty with whom, how and when a seizure will happen.

Index – in this article you will find the following information:

  1. What is seizure?
  2. How does the seizure occur?
  3. Difference Between Seizure And Epilepsy
  4. What are the types of seizures?
  5. What causes a seizure?
  6. Sleeping seizure
  7. Groups of risk
  8. How is a seizure manifested?
  9. Seizure: what to do?
  10. How is the seizure diagnosed?
  11. Is seizure curable? What is the treatment?
  12. Medicines
  13. Surgeries
  14. Other treatments
  15. Prognosis
  16. Sequelae and complications
  17. Can seizure kill?
  18. How to prevent seizures?

How does the seizure occur?

The brain is made up of nerve cells called neurons, which function through electrical impulses and communicate through chemical structures called neurotransmitters.

The neuron tends to remain inert until some stimulus “fires” it, that is, cause it to produce and send an electrical impulse. These shots release neurotransmitters that are picked up by other neurons (a process called synapse), causing them to also fire, and so on.

The seizure happens when there are abnormal electrical discharges, in a kind of “short circuit” in the brain. Depending on where these discharges occur, they can affect a person’s cognition and movement.

In the case of seizures, the affected parts of the brain are those responsible for the movement of the muscles. Thus, the individual’s muscles start to work according to the signals that the brain emits (which are confused and do not obey an order), causing the person to lose control over himself.

Not infrequently, these shots cause the person to lose consciousness. Therefore, she may need help not to hurt herself during the seizure.

Difference between seizure and epilepsy

The word ” epilepsy ” generally refers to Idiopathic Epileptic Disorder, in which the person suffers from several bouts of excessive and abnormal activity in the brain cells, including, but not limited to, seizures.

Thus, the seizure can be considered a type of epileptic seizure , but it is not always related to epilepsy itself.

What are the types of seizures?

There are several ways to classify seizures. This is because these classifications depend on the cause and the area of ​​the brain where the seizure process begins. Understand:

Epileptic and non-epileptic seizures

Seizures of the epileptic type have no apparent cause, occurring suddenly. As for the non-epilepsy are caused by disorders or conditions that may be affecting the brain, such as injury or infection.

Partial or focal seizures

Partial (focal) seizure occurs when only a part of the brain hemisphere suffers from disordered discharges of electrical impulses. This type of seizure can also be classified into subcategories such as simple and complex partial seizures:

  • Simple partial seizure: In this type, electrical discharges begin in one part of the brain and are limited to that space, not spreading to other parts;
  • Complex partial seizures: Occurs when electrical discharges are not confined to one part of the brain and pass to the other parts, causing other symptoms.

Generalized seizures

When discharges occur in all areas of the brain, what is called a “generalized seizure” occurs. These seizures can be primary (discharges begin in the deep central part of the brain and spread to both sides) or secondary (begin with a simple partial seizure, which spreads throughout the brain).

In generalized seizures, we can see more subcategories, which are classified according to the muscle activity and affected body parts:

  • Tonic generalized seizures: Muscle tone increases, causing the muscle to contract and tense;
  • Generalized atonic seizures: It is characterized by a complete loss of muscle tone, that is, there is total muscle relaxation, often accompanied by loss of consciousness;
  • Myoclonic seizures: It causes rapid spasms of one or several members of the body, including the trunk (chest and abdomen region), which can cause loss of consciousness;
  • Tonic-clonic seizures: Probably the most well-known type, it is characterized by the rapid alternation between contraction and relaxation of the muscles, with temporary loss of consciousness.

Febrile seizure

It occurs in the first 24 hours of fever , being more common in children under 5 years of age. It is caused by an increase in body temperature, which affects brain function and promotes an unusual response.

Fortunately, this type of seizure is harmless and usually passes when the fever is resolved. However, it is important that parents take the necessary precautions so that the child does not get hurt during the attack, in addition to taking him / her to the doctor as soon as possible to investigate and treat the fever.

Conversive seizure

Caused by psychological factors such as neuroses, the conversion type has symptoms similar to the different types of seizures, but there is no change in brain activity.

What causes a seizure?

There are many factors that can trigger a seizure attack, ranging from metabolic processes to brain damage. In some situations, the cause of the disorder is never known.

Metabolic abnormalities

Abnormal blood sugar levels ( hyperglycemia or hypoglycemia ), calcium, magnesium, vitamin B6 and sodium can all be triggers for seizures.

These abnormalities are usually only linked to seizures when they occur in children and, when resolved, the attacks tend to cease. When it occurs in an adult, the cause is likely to be different, as well as in children who have corrected the abnormalities and continue to manifest the condition.

Brain injuries

Seizures are often caused by brain damage at delivery, malformations or conditions that damage the brain even after adulthood. People who have suffered head injuries, stroke or brain tumors are at risk for seizures at any time.

Drugs of abuse and drugs

Not infrequently, the use of drugs of abuse or even inadequate dosing of certain drugs can cause seizures.

People who suffer from alcoholism , when stopping drinking abruptly, may experience seizures.

Idiopathic seizures

When it is not possible to identify a cause for seizures, they are called idiopathic. People who suffer from repeated idiopathic seizures may be carriers of Idiopathic Epileptic Disorder, but further investigation is always recommended in order to find the correct diagnosis.

Table of examples

To understand the causes more objectively, look at the table below:

Cause

EXAMPLES

High fever

Insolation

Infections

Brain infections

Abscess

AIDS

Malaria

Meningitis

Anger

Syphilis

Tetanus

Toxoplasmosis

Viral encephalitis

Metabolic disorders

High blood sugar or sodium levels

Low blood sugar, calcium, magnesium or sodium

Other disorders

Renal or hepatic impairment

Hypothyroidism

Vitamin B6 deficiency

Lack of oxygen in the brain

Cardiac arrest

Carbon monoxide poisoning

Drowning

Choking

Vasculitis

Structural injuries and damage to the brain

Brain tumour

Head injuries

Hydrocephalus

Intracranial hemorrhage

Stroke

Abnormalities at birth

Congenital deficiency

Hereditary metabolic diseases

Injury during childbirth

Cerebral edema

Eclampsia

Hypertensive encephalopathy

Drugs

 Buspirone

Camphor

Chlorpromazine

Ciprofloxacino

Chloroquine

Clozapine

Cyclosporine

Imipenem

Indomethacin

Meperidine

Phenytoin

Theophylline

Overdose of tricyclic antidepressants

Drugs of abuse

Amphetamines

Cocaine overdose

Abstinence

Alcohol

General anesthetics

Sedatives and sleeping pills

Exposure to toxins

Lead

Strychnine

Sleeping seizure: is it possible to have a seizure at night?

It is estimated that about 7 to 45% of patients with epilepsy also have nocturnal seizures , with some of these people suffering from the attacks only when they are sleeping, unaware of the problem.

This type of seizure usually occurs in the lightest stages of sleep (stages 1 and 2), in which there are significant changes in the frequency of brain waves. These stages happen not only when falling asleep, but also when waking up, so it is possible that the person has the attacks in the first or last 2 hours of sleep.

These are, in general, partial seizures that interfere with the quality of sleep. The patient may suffer from hypersomnia (excessive sleep during the day) and sudden awakenings, in addition to bed-wetting, rolling and falling or even throwing their belongings – such as pillows and blankets – away.

Because of these symptoms, nocturnal seizures are easily confused with other sleep disorders (parasomnias). The best way to diagnose the problem is polysomnography , an exam that measures brain waves and other vital functions during sleep.

Groups of risk

There are some people who are more at risk of having a seizure. Are they:

  • Epileptics: People who suffer from epilepsy are already more likely to suffer a seizure (as well as other types of epileptic seizures), especially when they are under physical or emotional stress, they consume alcoholic beverages, when they do not sleep properly, stop drinking or use sedatives;
  • Children: Due to the nervous system still forming and the possibility of injuries during childbirth;
  • Accident sufferers : Accidents involving the head part can cause brain damage, which can lead to seizures. These attacks do not always appear right after the injury, but they can take a while to manifest.

How is a seizure manifested?

Because of media representations, we are used to thinking that when a person is convulsing, he falls to the ground and struggles. Although this image can happen in some cases, this is not always the way the attack happens.

It is important to note that the symptoms vary from person to person and according to the type of seizure they are having. It is estimated that about 70% of people have only one type of seizure, while the rest can suffer from two or more types.

Pre-convulsive symptoms

Some people have pre-convulsive symptoms, called “aura”, characterized by unusual sensations, such as:

  • Strange smells or tastes;
  • Cold in the belly;
  • Feeling of familiarity (déjà vu) or of strangeness in common situations (never vu);
  • Visual hallucinations;
  • Inability to speak and understand.

In general, these symptoms precede a lack of awareness.

After losing consciousness

When the individual is no longer conscious, the way the seizure manifests is seen by those close to him. These manifestations include:

  • Involuntary and uncoordinated muscle contractions and spasms, which can resemble tremors, in one or more members of the body;
  • If standing, the individual may fall to the ground;
  • Intense salivation (drool), which can assume a foamy characteristic;
  • With involuntary contractions, the individual may bite the tongue, leaving traces of blood on the drool;
  • Paleness of the skin and lips;
  • If the muscle of the tongue relaxes, it can go “backwards” and prevent the passage of air through the glottis, leaving the individual without breathing, acquiring a bluish color on the skin;
  • Loss of bladder and bowel control;
  • Contraction of the jaw with the jaw, which can lead to fractures in the teeth (due to a type of bruxism);
  • Vomiting.

When there is no loss of consciousness

The individual can:

  • Blink of an eye;
  • Present a fixed gaze (usually towards the forehead itself);
  • Chew or beat your lips (tremor);
  • Move your hands, arms and legs in a strange way;
  • Emitting meaningless sounds;
  • Do not understand what is being said;
  • Resist attempts at help.

After the convulsive attack

After the end of the attack, some people may experience headache , confusion and tiredness, in addition to the pain of possible injuries that they acquired during the crisis.

Seizure: what to do?

Being around someone at the time of a seizure can be a very stressful situation , but it is important to remain calm and help the individual to prevent him from getting hurt. Some first aid tips that help at this point are:

  • Help him to lie down, to prevent him from falling abruptly;
  • Loosen the individual’s clothes, mainly around the neck, opening ties, collars, belts, removing necklaces, scarves, among other accessories;
  • Lay the patient on his side to prevent the tongue from falling backwards, preventing breathing, or from drowning in his own vomit, if applicable;
  • Try to put a protection between the patient’s teeth, like a piece of rolled up cloth, taking care not to get hurt. Avoid “hard” objects like spoons, which can be more of a hindrance than help;
  • Support the patient on several pillows or soft objects, in order to prevent him from rolling to the side and injuring himself with an object nearby;
  • Remove any dangerous objects in the vicinity of the patient. This includes toys, stationery, any solid and hard object;
  • Wait until the patient regains breathing and consciousness, if applicable;
  • There is no need for medications during or after seizures, except in cases of repeated seizures without breaks or when the attack does not stop. In this case, the patient should be referred to an emergency room, where he will be treated according to the crisis;
  • Try to write down data such as when the seizure started, what happened before the seizure and the duration of the attack, in order to pass it on to the doctor responsible for the patient.

What not to do?

There are some attitudes that seem right at the time of the seizure, but which can be wrong and are capable of putting the health of the patient and those close to him at risk. Some things you shouldn’t do are:

  • Prevent movements: Due to frantic impulses, trying to prevent the patient’s movements can lead to musculoskeletal injuries;
  • Shaking or shaking the person: It causes shortness of breath in the patient, who at this point may already be having trouble breathing;
  • Place the hand on the patient’s mouth: Because of the strong involuntary contractions, the patient can hurt him;
  • Throwing water on the victim’s face: This technique, widely used to wake people asleep, does nothing to help an individual convulsing. On the contrary, it can end up accidentally aspirating the water, causing drowning.

When should I call for help?

Help should be called when the person has been convulsing for more than 5 minutes and has no signs of improvement. In these cases, it is called the status epilepticus , in which the seizure does not stop.

It is extremely important that there is medical supervision in this state, as there are intense muscle contractions and, often, shortness of breath and increased body temperature.

If there is no rapid treatment, the heart and brain can suffer overload and permanent damage, which can lead to death.

How is the seizure diagnosed?

The diagnosis of the seizure is usually made by a neurologist , but it can often also be performed by a general practitioner or pediatrician. There are several ways to diagnose the seizure, the main one being the patient’s history.

However, the diagnosis has other steps, which help to rule out the possibility of other problems, as well as assist in determining the type of seizure.

Better understand the techniques used to assist in the diagnosis of seizures:

Patient history

The doctor will evaluate the patient’s history, listening to both what the patient has to say and people who witnessed the attack. For this reason, it is extremely important that the people present write down all possible data about the crisis.

It can be asked if, after the crisis, the patient regained his consciousness normally, if he was drowsy, if he was able to speak and answer questions, remember what happened, if the movement returned to normal or was impaired, among other issues related to recovery.

More questions to ask are whether the patient had any strange feelings that preceded the attack, such as a premonition or feelings of déjà vu, in addition to the possibility that the attack was triggered by some external stimulus such as pulsating sounds and lights.

The patient must report if he has any condition that is a risk factor for seizures, such as stroke, brain infections, head injuries, among others. You should also mention whether you use any type of drug, including alcohol, and whether you have stopped using it recently.

Electroencephalogram (EEG)

The electroencephalogram records the electrical activity of the brain for a certain period of time and can help to see abnormalities in that activity, usually demonstrated by wave peaks and abnormal waves (such as waves produced during sleep while the individual is awake).

The problem is that he cannot diagnose the seizure alone, besides that, between one seizure and another, the brain may not show any kind of alteration in its activity, causing a normal result.

Depending on the case, patients may be hospitalized for 2 to 7 days until an electroencephalogram is obtained that has significant results. In such cases, the exam can be recorded on video.

If the patient is using an anticonvulsant, the doctor may ask him to stop taking the medication for a certain time to increase the chance of a seizure during the exam. This is done to be able to identify where it starts and what type of seizure occurs.

Blood and urine tests

In order to check for chemical imbalances, a blood or urine test can be performed. These imbalances can be the cause of the seizure and, when resolved, the person does not have attacks again.

The urine test, in particular, is able to detect other drugs that were not reported by the patient – often out of shame or even not knowing that he consumed that substance.

The patient’s blood sugar, sodium, calcium and magnesium levels are checked to determine if liver and kidney function is not affected.

Electrocardiogram (ECG)

Made to measure the heart rhythm, the electrocardiogram consists of the application of electrodes to the patient, which are capable of measuring the electrical activity of the heart.

If the patient has an abnormal heart rhythm, the possibility that the oxygen supply to the brain is insufficient is great. This condition can cause loss of consciousness and even seizure.

Read more: What is the purpose of the Electrocardiogram (ECG)?

Magnetic resonance imaging (MRI)

It is an image exam that uses a magnetic field to create detailed images of the organs, including the brain. It is mainly used to check that there are no changes in the structure of the brain, such as hemorrhages, clots, tumors, among others.

Computed tomography (CT)

A more accessible alternative to MRI, computed tomography uses X-ray machines that revolve around the patient’s body, taking cross-sectional radiographs. It is able to diagnose the same conditions mentioned above.

Lumbar puncture

When a brain infection is suspected, such as meningitis or encephalitis , a lumbar puncture is performed in order to collect material for analysis.

The material collected is cerebrospinal fluid, which flows through the spinal cord (a mass of nerves that descends from the brain to the lumbar region, responsible for communication between the brain and the rest of the body), coming from the brain itself.

The examination consists of performing a puncture, with a hollow needle, between the 3rd and 4th or 4th and 5th lumbar vertebrae, below the end of the spinal cord, where a portion of the liquid to be analyzed is stored. The exam is done under local anesthesia.

Is seizure curable? What is the treatment?

Just as one patient may have a seizure only once, another may continue to have seizures throughout his life. The possibility of healing the attacks is more related to the condition that caused the crises. That is: the seizure may or may not have a cure .

Treatment is usually done with anticonvulsant medications and, in more severe cases, surgeries. Understand:

Seizure medications

The medications are used to prevent seizures and are of continuous use, that is, they should not be interrupted just because the patient has an improvement in the amount of seizures.

They are indicated only when the person has more than one seizure that is not caused by reversible causes (such as metabolic changes).

Some medications prescribed by doctors are:

  • Carbamazepine ;
  • Sodium Valproate ;
  • Valium ( Diazepam );
  • Etosuximide ;
  • Gabapentin ;
  • Lamotrigine ;
  • Gardenal ( Phenobarbital );
  • Phenytoin ;
  • Primidone ;
  • Topiramate .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Seizure surgeries

Surgery is indicated only in cases where the person has several convulsive episodes and the use of medications has no effect. There are two types of surgery: those that remove a portion of the brain and those that interrupt the nerve pathway, causing it to lose connection with other nerves and preventing exacerbated changes.

It is worth remembering that all these surgeries carry very high risks, since the brain is the main responsible for most of the functions of our organism. The possibility of operation should be considered taking into account the advantages and disadvantages, in addition to the patient’s will.

Lobectomy

Usually indicated for simple or complex partial seizures, this type of surgery removes only the part of the brain where the crisis begins.

The brain is divided into lobes and surgery can remove the entire lobe or just a part of it. In extreme cases, an entire hemisphere can be removed from the brain, with a surgery called a hemispherectomy. However, depending on the patient’s age, he may not survive.

Callosotomy

The corpus callosum is a nerve bridge that connects one side of the brain to the other. In callosotomy, the nerve fibers that make up this tip are cut, with no removal of brain tissue.

This surgery is usually more suitable for generalized tonic-clonic and myoclonic seizures.

This procedure does not always solve the seizure problem, but the attacks are limited to only one side of the brain, as they cannot spread to the other, due to the lack of connection of the corpus callosum.

Fortunately, this procedure improves the patient’s concentration, which can lead to gains in intellectual function.

Multiple subpial transection

Sometimes, the part of the brain where seizures originate is responsible for important functions, such as movement and language. Therefore, removal of these areas is not recommended.

In these cases, the technique of multiple subpial transection can be used , which consists of small incisions in the brain, in the regions that help the propagation of electrical impulses. By damaging these parts, intense crises can be avoided.

Other treatments

Depending on the cause of the seizure, other types of treatment may be applied.

If the seizure is caused by some metabolic alteration, such as hypoglycemia, a dose of glucose is administered and treatment is sought for the condition that led the patient to this condition. No anticonvulsant treatment is required.

Another example is in the case of the conversion crisis, which should be treated preferably by a psychiatrist, together with a psychoanalyst or psychologist.

Prognosis

Being diagnosed with seizures can be disconcerting, especially when you don’t have a lot of information on the subject. However, it is worth remembering that, in most cases, the prognosis is favorable . Many people are able to leave the medication after a while, without recurrence after the end of use.

This is due to the plasticity of the brain, a phenomenon that causes neurons to adapt, changing both the anatomical and functional structure of the brain. In this way, the brain recovers, which often leads to the cessation of seizures.

Seizures and complications of the seizure

Although it is rare, seizures can cause serious sequelae.

Serious injuries

Due to the lack of control, the patient can bump or hit sharp and piercing objects, resulting in serious injuries. In addition, due to frantic contractions and relaxation, there is an increased risk of muscle damage.

Accidents

Depending on when the patient has the crisis, he may be involved in accidents, such as traffic or work accidents. This is because the attacks can occur at any time and the individual can lose control of the car while driving, get injured when operating machinery at the workplace, among other situations.

Brain damage

Due to the overload of electrical impulses, the individual may have irreversible brain damage. In some cases, there is a decrease in the flow of oxygen to the brain, which can result in necrosis of some parts of the brain tissue.

Can seizure kill?

Unfortunately, seizure can kill . Although it is rare, this possibility cannot be excluded, which can occur either indirectly or directly.

When having a seizure, the patient may drown with his own saliva, blood or vomit. The risk of getting involved in serious accidents is also greater, as mentioned above.

Sudden Unexpected Death in Epilepsy (SUDEP)

In individuals with uncontrolled seizures, a condition known as Sudden Unexpected Death in Epilepsy may occur. The patient is found dead and, at autopsy, no cause of death is found.

Another interesting fact is that there is no evidence of seizures at any time near the time of death, that is, it is not known whether the individual died during a seizure or if it was sudden.

One theory of why this happens is that seizures can sometimes inhibit or interfere with brain areas responsible for vital functions, such as breathing and heartbeat. In this case, there is difficulty in breathing and maintaining the heart rate. Thus, the patient may die of asphyxiation, due to lack of oxygen in the brain and heart, or from cardiac arrest.

How to prevent a seizure?

There is no specific way to prevent seizures, as it can often happen for no apparent reason. However, some tips are:

  • Always use appropriate protective equipment when riding a bicycle, rollerblading, motorcycle, or when performing any high impact activity that can cause head injuries;
  • Wear a seat belt when you are in the car or in any form of transport;
  • If you are epileptic, avoid exposure to certain flashing sounds and lights, factors that can trigger a crisis.
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