Seizure Disorder

A seizure disorder includes any condition in which there are repeated episodes of seizures of any type.  In the brain, neurons must be timed correctly to control body movements and keep organs functioning correctly.  When neurons misfire, a seizure occurs which can influence a person's consciousness, movement or actions.  Usually, this state exists for just a few moments before everything appears to return back to normal.  A seizure disorder affects about 0.5% of the population; a single seizure does not mean that someone has epilepsy. Psychomotor epilepsy is also known as temporal lobe epilepsy or complex partial seizures.  Epilepsy is a chronic brain disorder in which the electrical activity of the brain is periodically temporarily interrupted resulting in a seizure.

Epilepsy, also called idiopathic seizure disorder, is a common cause of seizures and is characterized by seizures of any type that occur on a chronic, recurrent basis that cannot be attributed to any other cause.

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage or panic attacks, and any disorder that causes loss of consciousness or that causes tremors or tics as symptoms (abnormal muscle movements that are not caused by abnormal brain electrical activity).

Incidence; Causes and Development

Epilepsy affects people in all nations and of all races.

While epilepsy may be caused by some original injury, that injury is usually unknown.

Known causes of seizures include:

• High fever in children
• Metabolic abnormalities found in diabetes mellitus, electrolyte imbalances, kidney failure, uremia, nutritional deficiencies and phenylketonuria (PKU)
• Alcohol and drug use or withdrawal
• Hormone changes experienced during pregnancy and menstruation
• Brain injury.  May affect any age, but the highest incidence is in young adults.  Seizures usually begin within 2 years of the injury.  Early seizures (within 2 weeks of injury) do not necessarily indicate that chronic seizures (epilepsy) will develop.
• Congenital defects and birthing injuries.  Seizures usually begin in infancy or early childhood.
• Tumors and brain lesions that occupy space.  These are more common after age 30.They may begin as partial seizures and progress to generalized tonic-clonic seizures.
• Degenerative disorders such as senile dementia which affect older people.
• Infections of the brain, any severe infection of any part of the body, and chronic infections such as neurosyphilis and AIDS.

Seizures can sometimes be triggered by an illness or by sensory stimuli such as lights, sounds or touch.  The amount of stimulation required to cause a seizure is called the seizure threshold.  Many people with epilepsy are considered to have a low seizure threshold, whether or not their seizures are stimulated by external influences.

Signs and Symptoms

Epilepsy may involve non-specific symptoms and/or signs that may occur along with the seizures, including headache, changes in mood or energy level, dizziness, fainting, confusion or memory loss.  An aura - a sensation indicating a seizure is imminent - may occur in some persons just prior to a generalized seizure.

There are over 30 different types of seizure and each type has its own characteristics.  Seizures are classified as either generalized or partial depending upon how much of the brain is affected.  Generalized seizures are divided into tonic-clonic and absence seizures.

Generalized - Tonic-clonic seizures (also known as grand mal seizures) have these characteristics:

• they last 1 to 5 minutes
• they involve the entire body with falling, stiffening and jerking
• the person may cry out
• there may be tongue biting
• the sufferer may become bluish through lack of oxygen during the seizure
• the sufferer may urinate or have a bowel accident during the seizure
• tiredness will usually result.

A prolonged seizure is dangerous because during its course the brain does not get enough oxygen, blood or other nutrients.  A clonic-tonic seizure lasting longer than 10 or 15 minutes can be considered a medical emergency.

Generalized - Absence seizures (also known as petit mal) have these characteristics:

• they last a few seconds
• there may be a staring spell and/or eye blinking
• the sufferer may appear to be day dreaming

Partial - Complex seizures have these characteristics:

• they last 1-2 minutes
• the sufferer appears to be engaged in purposeless activity
• consciousness may be impaired
• the sufferer may appear confused, drunk or drugged
• the sufferer may fidget with clothing
• the sufferer may smack their lips
• if restrained, they may struggle.

Partial - Simple seizures are characterized by:

• the jerking of one limb or one side of the body
• the patient usually remaining conscious
• the patient perhaps saying that they are having a seizure.

Psychomotor epilepsy has cyclical phases.  The pre-seizure stage can last for hours or up to seven days with symptoms of moodiness, depression, anxiety or constant low-level anger, irritation, or annoyance, accompanied by general unhappiness and constant arguments.

The seizure stage of 60 to 90 seconds can include misperceptions of the environment, hallucinations, and bizarre sensations.  Between seizures, personality is affected by excessive, tangential speech, overly emotional feelings, and lack of sexual desire.  Under physical or emotional stress, psychotic episodes can occur.

Diagnosis and Tests

The diagnosis of epilepsy and/or seizure disorder involves noting down a careful history of seizure activity.  A physical examination, including a detailed neuromuscular examination, may be normal or may show localized abnormalities of brain function.  An electroencephalograph (EEG), a reading of the electrical activity in the brain, usually confirms the presence of various types of seizures and may indicate the location of the lesion.

Treatment and Prevention

According to the Epilepsy Foundation of America seizures can be successfully controlled by appropriate medication and treatment in about 85% of cases.  Serum carnitine levels should be monitored in children treated with antiepileptic drugs.  As children treated with Dilantin, Tegretol or phenobarbital experienced significant declines in total carnitine levels.  [J Child Neurol 1998;13: pp.546-9]

References and Further Information

New York University Comprehensive Epilepsy Center: The largest epilepsy program in the Eastern United States, offering testing, evaluation, screening, treatment, drug trials, alternative therapies and surgical intervention for children, adolescents, and adults with all forms of epilepsy.