Зміст
Seizures are one of the most common symptoms of the disease in humans.
A typical generalized seizure has two phases: tonic and clonic, and is often accompanied by urination, tongue biting, and foaming at the mouth. This attack lasts no longer than 3 minutes.
After an attack, a state of limited consciousness usually persists for about an hour. Factors contributing to the occurrence of seizures include: congenital predisposition associated with a low threshold of seizure excitability or morphological changes in the brain.
We talk about epilepsy when a person has recurring seizures. Except in some exceptional cases, epilepsy is not diagnosed or treated in people after their first epileptic seizure. The risk of recurrence of attacks after the first attack in life is 40-50%. This means that about half of these people will not develop a chronic condition such as epilepsy.
What are cramps?
Seizures are sudden, transient and abnormal movement phenomena. A typical tonic-clonic seizure involves loss of consciousness, sudden tonic contraction of muscles throughout the body, followed by generalized inert movements of the limbs and head. This attack typically lasts about 3 minutes. A seizure is a manifestation of temporary disturbances in the functioning of part or all of the brain as a result of abnormal, excessive bioelectrical discharges in nerve cells. It can appear in any group of nerve cells. If the inhibitory mechanisms are not effective enough, the excitation quickly spreads to other cells, leading to a sudden disruption of the entire brain. The seizure then becomes generalized and typically results in loss of consciousness.
It happens that the rapid stimulation occurring in a certain group of cells is limited and affects only some brain structures. Then we deal with “focal” partial seizures. However, if the strength of this discharge is great or the inhibition processes are too weak, the partial seizure is transformed into a secondary generalized seizure.
Development of seizures
A seizure can occur in almost any person: it depends only on the strength of the stimulus used. If the brain structures are healthy and have fully functional inhibitory systems, the strength of this stimulus should be significantly greater than in cases with a reduced excitability threshold. A low threshold of convulsive excitability is not always a pathological phenomenon and is not a permanent sign; for example, the immature brain of young children reacts much more easily with excessive bioelectric discharges to various stimuli than the brain of an adult.
To cause an attack, several factors must act simultaneously. The most important are: the presence of changes that cause excessive excitability of many or many groups of neurons in the brain, generally increased convulsive activity and the appearance of an additional element that contributes to the triggering of an attack. Groups of altered, overly excitable nerve cells are called an epileptic focus. This often occurs near brain lesions such as a scar or tumor, sometimes even very small ones. A single seizure or even many seizures resulting from sudden cerebral hypoxia, poisoning or other disorders are not grounds for diagnosing epilepsy. We deal with epilepsy only when seizures recur frequently and are accompanied by changes in the EEG.
Causes of seizures
- fever (in children),
- central nervous system infections (meningitis, encephalitis, brain abscess),
- head injuries (mechanical injury, sunstroke, electric shock),
- metabolic disorders (hypoglycemia, tetany),
- bleeding into the central nervous system,
- iron,
- poisoning (medicines, chemicals),
- brain tumors,
- withdrawal syndrome (alcohol, drugs),
The two most common causes of seizures in adults are stopping antiepileptic medication and stopping alcohol in people who abuse it. However, in young children, the main cause of seizures is high fever.
Diagnosis of seizures
Diagnosis of the first attack in life includes:
- conversation,
- neurological examination,
- blood analysis,
- EEG,
- possibly a CT scan.
These tests are aimed at identifying the cause of the attack, which determines the choice of treatment. Anamnesis collected from the patient and witnesses to the attack is important here. Thanks to information about the patient’s behavior, it is possible to determine the nature of the attack, its duration, the degree of impairment of consciousness and other symptoms of the nervous system, which often makes it possible to name the type of attack observed.
An important role is also played by a neurological examination, which can reveal many symptoms (paresis or paralysis of the limbs, cranial nerves, imbalance, etc.), and an ophthalmological examination, which allows excluding (or confirm) the presence of a so-called congestive disc in the lower part of the eye, which occurs when intracranial pressure increases, for example, with a brain tumor. Sometimes (mainly in children) biochemical studies are also carried out to exclude tetany, hypoglycemia and genetically determined metabolic disorders.
An EEG examination is significant in diagnosing epilepsy because it can demonstrate the presence of abnormal bioelectrical activity in the brain. This test helps differentiate between seizure type and epilepsy type and helps determine prognosis and treatment. However, in some patients with epilepsy, EEG recordings may be normal. On the other hand, the mere fact of the presence of seizure changes on the EEG never determines the diagnosis of epilepsy. The EEG result should always be interpreted in conjunction with the interview data. Sometimes, to determine the cause of seizures, in addition to an EEG study, it is necessary to conduct a computed tomography (or magnetic resonance imaging) scan.
Febrile seizures
The cause of seizures in newborns may be perinatal fatigue, transient metabolic disorders or sometimes a family history (for example, so-called benign neonatal seizures). However, if seizures extend beyond the neonatal and early infancy period, the possibility of classifying these seizures as epileptic should be considered.
In young children, most often boys aged 6 months and older. Up to 6 years of age, so-called febrile convulsions occur, which most typically go away on their own. Febrile seizures occur as a result of an increase in body temperature above 38 °C, more typically with viral diseases. They take the form of a generalized tonic-clonic or tonic seizure. They last from several tens of seconds to several minutes. If febrile seizures occur many times on the same day and are repeated many times a year, they are called complex febrile seizures, which in 10% of cases herald the development of epilepsy.
Treatment of febrile seizures includes reducing the temperature by cooling the body (cold compresses on the head, chest, and extremities), administering antipyretics (paracetamol, ibuprofen, metamizole) and the specific use of anticonvulsant. If a child is prone to febrile seizures during an infection, the body temperature should not be allowed to rise; as an alternative, an anticonvulsant suppository can be prescribed prophylactically.
Seizures and epilepsy
Epilepsy most often begins in childhood or early adolescence; in approximately 70% of cases, seizures appear before age 18, and only 10% in middle and adulthood. Epilepsy is not a hereditary disease, but a feature that can be passed on from generation to generation is the low threshold of excitability of brain cells, that is, their high tendency to respond with an epileptic discharge to the action of various additional factors. Therefore, people with this tendency can be considered to have a special predisposition to epilepsy.
Epilepsy can be caused by:
- brain damage during intrauterine life or during abnormal birth,
- complications of encephalitis and meningitis, head injuries, hematoma or brain tumor,
- genetically determined disease, such as metabolic syndrome,
- alcohol abuse,
- There are also genetically determined forms of epilepsy, such as juvenile myoclonic epilepsy, fragile X syndrome.
Types of epileptic seizures
There are many types of epileptic seizures with very different symptoms. During large generalized tonic-clonic seizures, the patient suddenly loses consciousness, falls, and a sudden tonic tension of the muscles of the whole body occurs, in which the head is often thrown back, and the limbs are extended. At this time, breathing stops. After a few to ten seconds, the body is shaken by strong generalized spasms of the limbs and head. The patient may then bite their tongue or urinate unconsciously. Usually, the patient is unconscious for some time after the attack, and then drowsy and distracted.
Focal (limited) seizures involve spasms of only parts of the body, such as the arm, face, autonomic or sensory sensations (sensory, olfactory, gustatory, visual), and can also cause mood or perceptual disturbances. Sometimes the only symptom of an attack is a short-term disturbance of consciousness, during which the patient stops what he is doing for a few seconds and returns to it.
Treatment of seizures
Treatment for a seizure involves immediate administration of one of the anticonvulsant medications. Further treatment depends on the identified cause. If the cause of seizures is an organic lesion (tumor, hematoma), surgical intervention may be required.
A definite diagnosis of epilepsy is an indication for long-term pharmacological treatment. Treatment is mainly aimed at stopping the occurrence of epileptic seizures, since repeated seizures can cause further damage to the central nervous system. The goal of treatment is to achieve complete cessation of attacks with the simultaneous absence of side effects associated with long-term use of the drug. The choice of treatment depends on the type of epileptic seizure. At the first stage, the smallest dose of one drug is most often used, and then it is increased. If the cramps do not subside after a certain period, the drug is changed to another. Sometimes two drugs are used simultaneously. The patient takes medications for several or decades, sometimes for life. In more than 70% of patients, seizures disappear under the influence of medications.
The results of treatment depend not only on regular use of medications, but also on avoiding factors that provoke seizures. The most important of them are: poor lifestyle, in particular lack of sleep, alcohol consumption and infections. Mental activity and moderate physical activity reduce the risk of seizures.
Procedure during a seizure
If you accidentally witness an unknown person or family member having a seizure, you should:
- Remain calm – most attacks go away on their own within 2–3 minutes.
- The patient should be protected from falls, cuts, bruises to the head and torso, and injuries caused by the impact of extremities on a hard surface.
- place the patient on his side, in the so-called safe position – this position protects against suffocation.
- During an attack, the patient should be left alone and should not be given fluids or oral medications under any circumstances.
- After an attack, stay with the patient until his condition returns to normal.
- notify the Emergency Service if you witness the incident or if the attack lasts more than 7–10 minutes. If we know that the patient is on long-term treatment and the attack has stopped, this is not necessary.
