Seizure Disorder: An Overview

An overview
Seizure Disorder
12/07/2021 Sushant Satyal 1

Contents
 Introduction
 Some Definitions
 Brain Activity During Seizure
 Types of Seizure
 Percentage of various types of seizures all over the
world
 Common Symptoms
 Seizure have a beginning, middle and end

Contd….
 Causes and examples
 Drugs used to treat Seizure
 Home Care
 What to expect at Your Office Visit
 Precautions
 Conclusion

Introduction
 Normal brain function requires an
orderly, organized, coordinated
discharge of electrical impulses.
 Electrical impulses enable the

brain to communicate with the
spinal cord, nerves, and muscles
as well as within itself.
 Seizures may result when the

brain's electrical activity is
disrupted.

Contd….
 Classified as involving parts of the brain
 Involving a small part of the brain: Focal
 Involving the whole part of the brain: Generalized
 Focal Seizures can be simple or complex
 Also classified in terms of body affected

Contd….
 Whole body affected : Generalized
 Small part or side of the body affected: Focal
 Symptom may vary depending on what parts of brain

are involved.
 Some Seizures may hard to notice as they consist of

staring spells
 May cause loss of awareness and shaking of body

Some Definitions
 A sudden, involuntary, time-limited alteration in behavior,
motor activity, autonomic function, consciousness, or
sensation, accompanied by an abnormal electrical
discharge in the brain.
 Seizure (medicine), sudden attack or spasm, as in epilepsy

or a similar disorder. Seizures differ with the type of
condition and may consist of loss of consciousness,
convulsive jerking of parts of the body, emotional
explosions, or periods of mental confusion.

Brain Activity During Seizure
 An electroencephalogram (an EEG) is a recording
of the brain's electrical activity. The procedure is
simple and painless. About 20 small adhesive
electrodes are placed on the scalp, and the brain's
activity is recorded under normal conditions.
Then the person is exposed to various stimuli,
such as bright or flashing lights, to try to provoke
a seizure. During a seizure, electrical activity in
the brain accelerates, producing a jagged wave
pattern. Such recordings of brain waves help
identify a seizure disorder. Different types of
seizures have different wave patterns.

Types of Seizure
A. Primary generalized seizure:

 Begins with a widespread electrical discharge
 Involves both sides of the brain at once
 Hereditary factors are important
B. Partial Seizure:
 Begins with an electrical discharge in one limited area of the
brain
 Related to head injury, brain infection, stroke, or tumor

Contd….
Types of Primary generalized seizure
1. Absence seizures:
▪ Brief episodes of staring
▪ Absence seizures are considered complex absence
seizures
▪ Include a change in muscle activity

Contd….
▪ Most common movement are eye blinks
▪ Complex absence seizures are often more than 10
seconds long
▪ Usually begin between ages 4 and 14
▪ no warning before a seizure, and the person is
completely alert immediately afterward

Contd….
▪ Other movements include slight tasting movements of
the mouth, hand movements such as rubbing the fingers
together ,etc
▪ Children who get them usually have normal development
and intelligence
▪ 70% of cases, absence seizures stop by age 18

Contd….
2. Atypical absence seizure:
▪ Atypical (a-TIP-i-kul) means unusual or not typical
▪ Person will stare but often is somewhat responsive
▪ Eye blinking or slight jerking movements of the lips may
occur

Contd….
▪ Hard to distinguish from the person's usual behavior,
especially in those with cognitive impairment
▪ Generally begins at the age of 6
▪ Most of the children affected have below-average
intelligence

Contd….
▪ Other types of seizures that are difficult to control
▪ Seizures usually continue till adulthood
▪ Daydreaming and inattentiveness can mimic these
seizures
▪ Diagnosis can be difficult if the behavior during seizures is
similar to the child's usual behavior

Contd….
3. Monoclonic seizures:
▪ Very brief jerks, last only for 2 to 3 sec
▪ seizures usually cause abnormal movements on both
sides of the body at the same time
▪ Myo" means muscle and "clonus" (KLOH-nus) means
rapidly alternating contraction and relaxation

Contd….
▪ Seizures usually begin in childhood, but the seizures can
occur at any age
▪ Seizures occur in reflex epilepsies, triggered by flashing
lights or other things in the environment
▪ Syndromes usually can be diagnosed on the basis of the
medical history and often EEG patterns

Contd….
4. Atonic Seizures:
▪ Atonic" (a-TON-ik) means "without tone
▪ In an atonic seizure, muscles suddenly lose strength
▪ Eyelids may droop, the head may nod, and the person
may drop things and often falls to the ground
▪ Also known as "drop attacks" or "drop seizures

Contd….
▪ The person usually remains conscious
▪ Another name for this type of seizure is “akinetic”
▪ (A-kin-ET-ik), which means "without movement“
▪ Seizures often begin in childhood
▪ Often last into adulthood
▪ People with atonic seizures are injured when they fall

Contd….
▪ Seizures may cause people to fall when they're standing
often have tonic seizures rather than atonic seizures
▪ Syndromes usually can be diagnosed on the basis of the
medical history and often EEG patterns

Contd….
5. Tonic Seizures:
▪ Usually last less than 20 sec
▪ In such seizures, the tone is greatly increased and the
body, arms, or legs make sudden stiffening movements
▪ Consciousness is usually preserved
▪ Seizures most often occur during sleep

Contd….
▪ Usually involve all or most of the brain, affecting both
sides of the body
▪ Common in people who have the epilepsy syndrome
called Lennox-Gastaut syndrome
▪ Seizures in Lennox-Gastaut syndrome may become more
difficult to control over time

Contd….
6. Clonic seizures:
▪ Seizures consist of rhythmic jerking movements of the
arms and legs
▪ Length vary according to the case
▪ Clonus" (KLOH-nus) means rapidly alternating
contraction and relaxation of a muscle

Contd….
▪ Movements cannot be stopped by restraining or
repositioning the arms or legs
▪ These seizures are rarely found
▪ Common are tonic-clonic seizures, in which the jerking is
preceded by stiffening (the "tonic" part)

Contd….
▪ Sometimes tonic-clonic seizures start with jerking alone
▪ These are called clonic-tonic-clonic seizures
▪ Occur at various ages, including in newborns
▪ Brief and infrequent clonic seizures in infants usually
disappear within very short period

Contd….
▪ Occasionally "jitteriness" in a young infant can be
mistaken for a clonic seizure
▪ Children with neurological impairments with repetitive
movements that could be mistaken for clonic seizures
▪ The EEG pattern will change during a seizure, so video-
EEG is very useful for diagnosis

Contd….
7. Tonic-clonic seizures:
▪ Normally last for 2 to 3 min
▪ More than 5 min calls for immediate medical help
▪ Seizure that lasts more than 30 minutes indicate
convulsion
▪ Person loses consciousness and falls to the floor

Contd….
▪ Tongue or cheek may be bitten, so bloody saliva may
come from the mouth
▪ Person may turn a bit blue in the face
▪ After the tonic phase comes the clonic phase
▪ Arms and usually the legs begin to jerk rapidly and
rhythmically
Contd….
▪ Bending and relaxing at the elbows, hips, and knees
▪ After a few minutes, the jerking slows and stops
▪ Bladder or bowel control sometimes is lost as the body
relaxes
▪ Consciousness returns slowly, and the person may be
drowsy, confused, agitated, or depressed

Contd….
▪ They affect both children and adults
▪ Children who have had a single tonic-clonic seizure, the
risk that they will have more seizures
▪ Some children will outgrow their epilepsy
▪ Tonic-clonic seizures can be controlled by seizure
medicines
Contd….
▪ Patients who are seizure-free for a year or two while taking
seizure medicine will stay seizure-free
▪ Medicine can be stopped gradually
▪ Patients with no epilepsy wave in EEG can stay free with
any medication
▪ People who faint sometimes may develop tonic or clonic
12/07/2021 seizure Sushant Satyal 31

Contd….
Types of Partial seizures

1. Simple partial seizures:
▪ Different from person to person, depending on the part of
the brain where they begin
▪ One thing they all have in common is that the person
remains alert and can remember what happens
▪ Usually last for less than 2 min

Contd….
▪ Doctors often divide simple partial seizures into categories
depending on the type of symptoms the person
experiences
i. Motor seizures
ii. Sensory seizures
iii. Autonomic seizures
iv. Psychic seizures
▪ Anyone can get these seizures
▪ People who have had a head injury, brain infection, stroke,
or brain tumor likely to get them

Contd…..
▪ These seizures often can be controlled by seizure
medicines
▪ Medical disorders such as, stomach disorders or a
pinched nerve can cause some similar symptoms
▪ Some symptoms (such as déja vu) are experienced by
almost everyone at some time

Contd….
2. Complex Partial Seizures:
▪ Usually last between 30 seconds and 2 minutes
▪ Afterward, the person may be tired or confused for
about 15 minutes and may not be fully normal for hours
▪ Seizures usually start in a small area of the temporal lobe
or frontal lobe of the brain

Contd….
▪ Quickly involve other areas of the brain that affect
alertness and awareness
▪ These seizures (usually ones beginning in the temporal
lobe) start with a simple partial seizure
▪ Also called an aura, this warning seizure often includes
an odd feeling in the stomach

Contd…..
▪ Person loses awareness and stares blankly
▪ Most people move their mouth, pick at the air or their
clothing, or perform other purposeless actions
▪ These movements are called "automatisms "
▪ Less often, people may repeat words or phrases, laugh,
scream, or cry
Contd….
▪ Some people do things during these seizures that can be
dangerous or embarrassing
▪ People need to take precautions in advance
▪ Complex partial seizures starting in the frontal lobe tend to
be shorter than the ones from the temporal lobe
▪ Some complex partial seizures turn into secondarily
12/07/2021 generalized seizures Sushant Satyal 38

Contd…..
▪ people who have had a head injury, brain infection,
stroke, or brain tumor are more likely to get seizures
▪ If medication is not effective, some can be eliminated by
epilepsy surgery
▪ Complex partial seizures sometimes resemble
daydreaming or absence sezuires

Contd…..
3. Secondarily generalized seizures:
▪ Start in one limited area of the brain
▪ Can also spread throughout the brain becoming generalized
▪ Convulsive phase of these seizures usually lasts no more
than a few minutes
▪ Preceding partial seizure is usually not very long

Contd….
▪ Happen when a burst of electrical activity in a limited
area (the partial seizure) spreads throughout the brain
▪ Seizures occur in more than 30% of people with partial
epilepsy
▪ Can affect people of all ages who have partial seizures
▪ Seizures of this kind can be controlled with medication

Contd….
▪ Seizures of this kind can be controlled with medication
▪ If not controlled with medication, surgery is another
option
▪ Easily diagnosed through EEG or MRI tests

Percentage of various types of seizures
all over the world
7%
7%
34%
15%
Simple partial
Other generalized
Partial unknown
Absence
Myoclonic
Unclassified
17% 20%

Common Symptoms
 Change in consciousness, so that you can't remember
some period of time
 Change in emotion, like unexplainable fear, panic, joy,
or laughter
 Change in sensation of the skin, usually spreading
over the arm, leg, or trunk

Contd….
 Changes in vision, including flashing lights, or (rarely)
hallucinations (seeing things that aren't there)
 Loss of muscle control and falling, often very suddenly
 Muscle movement such as twitching that might
spread up an arm or leg

Contd….
 Muscle movement such as twitching that might
spread up an arm or leg
 Muscle tension/tightening that causes twisting of the
body, head, arms or leg
 Tasting a bitter or metallic flavor

Seizure have a beginning, middle and
end
 Beginning State:
 This stage can be said as warning or aura
 Sometimes an individual may not be aware of such aura
 In middle stage this aura is followed by other symptoms
 It may be considered as simple partial seizure
 Middle State:
 People have aura in beginning, the aura may convert into
convulsion
 For those who don’t have aura, the seizure may continue as
complex partial seizure
Contd….
 End state:
 This state represents a transition from seizure back to
normal state
 Also referred as the “Post-ictal period”
 Signifies recovery period of brain
 May last from a second to minutes to hours

Contd….
 If a person has a convulsion, the level of awareness gradually
improves during the post-ictal period, much like a person
waking up from anesthesia after an operation

Contd….
 Early seizure symptoms:  Emotional
 Sensory/ thoughts ▪ Fear/Panic
▪ Pleasant feeling
▪ Déjà vu
▪ Jamais vu  Physical
▪ Smell ▪ Dizziness
▪ Sound ▪ Headache
▪ Taste ▪ Lightheadedness
▪ Visual loss or blurring ▪ Nausea
▪ Racing thoughts ▪ Numbness
▪ Stomach feelings  No Warnings
▪ Strange feelings ▪ Sometimes seizures come with
▪ Tingling feeling no warnings

Contd…..
 Middle Seizure Symptoms :  Emotional:
 Sensory/ thoughts ▪ Fear/Panic
▪ Black out
 Physical:
▪ Confusion
▪ Chewing movements
▪ Deafness/Sounds
▪ ▪ Convulsion
Electric Shock Feeling
▪ Loss of consciousness ▪ Eyes rolling up
▪ Smell ▪ Falling down
▪ Spacing out ▪ Foot stomping
▪ Out of body experience ▪ Hand waving
▪ Visual loss or blurring ▪ Inability to move

Contd….
• Incontinence
▪ Staring
▪ Stiffening
▪ Swallowing
▪ Sweating
▪ Teeth clenching/grind
▪ Tongue biting
▪ Tremors
▪ Twitching movement
▪ Breathing difficulty
▪ Heart racing

Contd….
 Post-ical state:  Physical
 Thought ▪ Bruising
▪ Memory loss ▪ Difficulty talking
▪ Injuries
▪ Writing Difficulty
▪ Sleeping
 Emotional ▪ Exhaustion
▪ Headache
▪ Confusion
▪ Nausea
▪ Depression and Sadness
▪ Pain
▪ Fear
▪ Thirst
▪ Frustration
▪ Weakness
▪ Shame/ Embarrassment
▪ Urge to
urinate/defecate

Causes and examples
Causes Examples
High fever •Heatstroke
•Infections
Brain infections •Abscess
•AIDS
•Malaria
•Meningitis
•Rabies
•Syphilis
•Tetanus
•Toxoplasmosis
•Viral encephalitis

Contd…..
Causes Examples
Metabolic disorders •High blood levels of sugar or sodium

•Kidney or liver failure
•Low blood levels of sugar, calcium,
magnesium, or sodium
•Underactive parathyroid gland
•Vitamin B6 deficiency (in newborns)
Inadequate oxygen supply to the brain •Abnormal heart rhythms

•Carbon monoxide poisoning
•Near drowning
•Near suffocation
•Stroke
•Vasculiti

Contd….
Causes Examples
Structural damage to the brain •Brain tumor
•Head injury
•Hydrocephalus
•Intracranial hemorrhage
•Stroke
Abnormalities present or occurring at •Birth defect

birth •Hereditary metabolic disorders, such as
Tay-Sachs disease or phenylketonuria
•Injury during birth
luid accumulation in the brain (cerebral •Eclampsia

edema) •Hypertensive encephalopathy

Drugs used to treat Seizure
Drug Use Possible side-effects
Acetazolamide Absence seizures when Kidney stones and
other anticonvulsants are chemical imbalance in
ineffective blood
Carbamazepine Generalized seizures A low white blood cell
Partial seizures count (granulocytopenia),
production of too few
blood cells (aplastic
anemia, which can be fatal
disorder), a low platelet
count (thrombocytopenia),
digestive upset, inability to
articulate words, lethargy,
dizziness, and visual
disturbances

Contd….
Drugs Uses Possible side-effects
Clonazepam Atonic seizures Atypical Drowsiness, abnormal
absence seizures behavior, loss of
Infantile spasms coordination, and lost
Myo clonic seizures effectiveness of the drug
after 1 to 6 months
Divalproex Absence seizures Nausea, vomiting,
Febrile seizures abdominal pain, diarrhea,
Generalized tonic-clonic temporary drowsiness,
seizures dizziness, shaking
Infantile spasms (tremor), reversible hair
Juvenile myoclonic loss, weight gain, and liver
epilepsy damage
Myoclonic seizures

Contd…..

Ethosuximide Absence seizures Nausea, lethargy,
dizziness, a low white
blood cell count and a low
red blood cell count
Felbamate Atypical absence seizures, Headache, fatigue, liver
Partial seizures failure, and, rarely, aplastic
anemia (which can be
fatal)
Fosphenytoin Status Epilepticus Loss of coordination,
drowsiness, headache,
rash, and tingling
sensations

Contd….
Gabapentin Partial seizures Drowsiness, dizziness,
weight gain, and headache
In children, aggressive
behavior, mood swings,
and hyperactivity
Lamotrigine Generalized seizures Nausea, vomiting,

Partial seizures indigestion, headache,
drowsiness, dizziness,
insomnia, fatigue, loss of
coordination, double
vision, tremor, rash, and
abnormal menstrual
periods

Contd….

Levetiracetam Juvenile myoclonic Dizziness, weakness,
epilepsy fatigue, loss of
Myoclonic seizures coordination, changes in
Partial seizures mood and behavior, and
increased risk of infection
Oxcarbazepine Partial seizures Headache, abdominal
pain, double vision,
drowsiness, dizziness,
fatigue, nausea, low
sodium levels in the blood,
and a low white blood cell
count

Contd….
Topiramate Atypical absence seizures Confusion, reduced
Partial seizures concentration, difficulty
Primarily generalized finding words, fatigue, loss
tonic-clonic seizures of appetite and weight,
numbness or tingling,
reduced sweating, and
kidney stones
Valproate Absence seizures Nausea, vomiting,
Febrile seizures abdominal pain, diarrhea,
Generalized tonic-clonic weight gain, reversible hair
seizures loss, temporary
Infantile spasms drowsiness, shaking
Juvenile myoclonic (tremor), and, rarely, liver
epilepsy damage

Home Care
 Stay with the person until recovery or you have professional
medical help
 Monitor pulse ,rate of breathing, and blood pressure
 Do not give the person anything by mouth until convulsions
have stopped and the person is fully awake and alert

Contd….
 Do not move the person unless he or she is in danger
or near something hazardous
 Do not place anything including your fingers between
the person’s teeth. You can break person’s teeth, if
you do so.

What to expect at Your Office Visit
The doctor will perform a physical examination and ask

questions to help understand the cause of the seizures, such
as:
 Are there any risk factors ( such as recent head
injury)?
 Did it occur or start on one side of the body?
 Did the person remain awake and aware during
seizure?
 How long the seizure last?

Contd….
 How often do the seizures happen?
 Was there any aura of the seizures?
 Were there any other symptoms present (visual
changes, abnormal smells)?

Contd….
The following tests may be performed:
 Blood tests
 Ct scan or MRI of the brain
 EEG
 Lumbar puncture

Precautions
 People with uncontrolled seizures should not drive.
 Drinking should be avoided
 Medicines should be taken regularly
 Avoid activities such as climbing to high places, biking, and
swimming
 Use of sharp instruments such as knife should be avoided

Conclusion
 Seizure is life threatening disease
 No specific way to prevent seizures
 But it is curable if instruction are followed
 Good habits may help to control seizures

Contd….
 Sleep deprivation, and poor diet must be avoided
 Good sleep habits, stress reduction, proper exercise,
and sound nutrition may help
 Use helmets to avoid head injury
 Have faith in yourself, and seizure is curable!!

Thank You!!

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An overview

12/07/2021 Sushant Satyal 1

12/07/2021 Sushant Satyal 2

12/07/2021 Sushant Satyal 3

 Electrical impulses enable the

 Seizures may result when the

12/07/2021 Sushant Satyal 4

 Classified as involving parts of the brain

 Involving a small part of the brain: Focal

 Involving the whole part of the brain: Generalized

 Focal Seizures can be simple or complex

 Also classified in terms of body affected

12/07/2021 Sushant Satyal 5

 Small part or side of the body affected: Focal

 Symptom may vary depending on what parts of brain

 Some Seizures may hard to notice as they consist of

 May cause loss of awareness and shaking of body

 Seizure (medicine), sudden attack or spasm, as in epilepsy

12/07/2021 Sushant Satyal 7

12/07/2021 Sushant Satyal 8

A. Primary generalized seizure:

12/07/2021 Sushant Satyal 9

Types of Primary generalized seizure

▪ Brief episodes of staring

▪ Absence seizures are considered complex absence

▪ Include a change in muscle activity

12/07/2021 Sushant Satyal 10

▪ Most common movement are eye blinks

▪ Complex absence seizures are often more than 10

▪ Usually begin between ages 4 and 14

▪ no warning before a seizure, and the person is

completely alert immediately afterward

▪ Other movements include slight tasting movements of

the mouth, hand movements such as rubbing the fingers

▪ Children who get them usually have normal development

▪ 70% of cases, absence seizures stop by age 18

12/07/2021 Sushant Satyal 12

2. Atypical absence seizure:

▪ Atypical (a-TIP-i-kul) means unusual or not typical

▪ Person will stare but often is somewhat responsive

▪ Eye blinking or slight jerking movements of the lips may

12/07/2021 Sushant Satyal 13

▪ Hard to distinguish from the person's usual behavior,

especially in those with cognitive impairment

▪ Generally begins at the age of 6

▪ Most of the children affected have below-average

12/07/2021 Sushant Satyal 14

▪ Other types of seizures that are difficult to control

▪ Seizures usually continue till adulthood

▪ Daydreaming and inattentiveness can mimic these

▪ Diagnosis can be difficult if the behavior during seizures is

similar to the child's usual behavior

▪ Very brief jerks, last only for 2 to 3 sec

▪ seizures usually cause abnormal movements on both

sides of the body at the same time

▪ Myo" means muscle and "clonus" (KLOH-nus) means

rapidly alternating contraction and relaxation

12/07/2021 Sushant Satyal 16

▪ Seizures usually begin in childhood, but the seizures can