Seizures

Seizures

Around 87 people are diagnosed with epilepsy every day

Seizures are much more than just being classed as epilepsy seizures. There are many different causes of seizures, we thought this month we would have a look at the different causes and also how seizures portray themselves, in case you ever need to be dealing with a seizure as a First Aider.

Causes of Seizures

Acute Illness

Acute illness, viruses and bacteria may lead to a seizure, especially if the person who is taking anticonvulsants suffers from vomiting and diarrhoea, which will reduce or prevent the effect of the anticonvulsants.

Alcohol

The opinions on whether alcohol can cause a seizure are varied. However, consuming alcohol may temporarily reduce the risk of a seizure occurring, however when the blood alcohol levels drop the chances may actually increase, even in non-epileptics.

In epileptics, studies have shown that heavy drinking can actually increase the chances of a seizure occurring, but light drinking doesn’t seem to have too much of an effect on the seizure likelihood. Consuming alcohol with food is likely to reduce the risk of a seizure occurring.

However, taking anticonvulsants with alcohol, can reduce the effectiveness of the medication working and therefore actually increase the chances of a seizure.

Breakthrough Seizures

A breakthrough seizure is an epilepsy seizure which occurs even though anticonvulsants have successfully prevented the seizures in patients. Patients may even consider themselves to be free from seizures and therefore patients may not take precautions; this can make breakthrough seizures more dangerous than non-breakthrough seizures. Usually when a breakthrough seizure occurs there is a new trigger to the person’s seizure.

Diet

Malnutrition and overnutrition can cause a seizure in some people. Deficiency in certain vitamins are known to cause seizures, these include B1, B6 and B12.

B1 deficiency has been known to cause seizures especially in alcoholics. B6 is linked to Pyridoxine-dependent seizures which is a rare genetic disorder first recognised in the 1950s. The deficiency of B12 has been reported as commonly causing seizures in children and some adults.

Fever (Febrile Convulsion)

Fever is a common cause of seizure in children due to the fact that the body’s hypothalamus is not fully developed until the age of about 4 years old, although these types of seizures can occur anywhere from 6 months to 6 years of age. Usually they are caused by the rapid rising of the child’s temperature. Any infection that gets into the body, the body will try to fight off, usually a temperature is a by-product of this fighting process, which the hypothalamus is not able to fully deal with, therefore causing a seizure which is called a febrile convulsion.

Head Injury

A severe head injury such as caused by a car accident, fall or sports injury can trigger seizures in a casualty. It can take days, months or even years following the event for the seizures to commence however. Usually these types of seizures are caused as a result of the brain trying to deal with the extreme force that has discharged across the brain. If the damage affects the temporal lobe, it can cause the brain to be starved of oxygen.

Hypoglycaemia

Hypoglycaemia is a diabetic emergency where the body’s blood glucose level has dropped to dangerous levels. The lack of sugar or energy getting to the brain is also called neuroglycopenia. The lack of glucose in the blood can cause a seizure in the casualty.

Insect Stings

Insect stings have been known to cause seizures in some people. There are reports of stings from red imported fire ants and Polistes wasps causing seizures due to their venom.

Medical Conditions

Angelman Syndrome

Angelman syndrome is a genetic disorder that mainly affects the nervous system. Symptoms include:

  • Small head,
  • A specific facial appearance,
  • Severe intellectual disability,
  • Developmental disability,
  • Speech problems,
  • Seizures,
  • Sleep problems.

Children with Angelman syndrome are usually happy in nature with a keen interest in water and are usually identified by the symptoms at the age of one. This syndrome affects 1 in 15,000 children and is the deformity of chromosome 15.

Seizures generally occur in 7 or 8 out of 10 sufferers.

Arteriovenous Malformation

Arteriovenous malformation is an abnormal connection between the arteries and the veins, bypassing the capillaries. Seizures are common in this condition usually because the arteriovenous malformation is supratentorial which is in the temporal lobe of the brain.

Brain Abscess

Brain abscesses are caused when inflammation and infected material collects in the brain tissue. The collection can come from local infectious sources, for example ear or dental abscess, or from remote sources for example the kidneys. It can also be caused by a head injury or surgery that involves a skull fracture. Seizures can be an indicator of a brain abscess.

Brain Tumour

A brain tumour occurs when abnormal cells form within the brain. These tumours can be malignant or cancerous or can be benign tumours. As with Brain Abscess above, seizures are a potential sign of a brain tumour.

Cavernoma

Cavernoma is a condition where a collection of blood vessels form a benign tumour. Because of this malformation of the blood vessels, blood through the cavities is slow, additionally the cells that form the vessels do not form necessary junctions with surrounding cells. It is the haemorrhage of the blood from these vessels that causes a variety of symptoms associated with the disease, of which seizures are a symptom.

Cerebral Palsy

Cerebral palsy is a group of permanent movement disorders that appear in early childhood. Symptoms vary from child to child, these symptoms include:

  • Poor coordination,
  • Stiff or weak muscles,
  • Tremors,
  • Problems with:
    • Sensation,
    • Vision,
    • Hearing,
    • Swallowing,
    • Speaking.

Often children with cerebral palsy will not roll over, sit or crawl as other children their age would be doing as per the developmental norms.

Seizures and problems with thinking or reasoning affect about one third of cerebral palsy children.

Down Syndrome

Down syndrome is a genetic disorder caused by the partial or full appearance of a third copy of the chromosome cell 21. It occurs in about 1 in 1000 children born every year. It affects the child’s physical growth, and their IQ which is typically at about 50, the equivalent of an 8 or 9-year-old.

Approximately 8% of people with Down syndrome have seizures.

Eclampsia

Eclampsia is the onset of seizures or convulsions in women who have pre-eclampsia, which generally occurs in the second half of pregnancy.

Pre-eclampsia is a disorder in which there is high blood pressure in the pregnant woman as well as high levels of protein in the urine and other organ dysfunctionality. The onset can be before, during or after the delivery of the baby. Usually these seizures last up to a minute and are mostly tonic-clonic seizures, and usually are followed by a period of confusion and or coma.

Encephalitis

Encephalitis is the inflammation of the brain. The severity of the condition is variable. The signs and symptoms of encephalitis include:

  • Headache,
  • Confusion,
  • Fever,
  • Stiff neck,
  • Vomiting.

Seizures can be a complication of the inflammation of the brain. Encephalitis in 2015, was responsible for 150,000 deaths in the world with a total of 4.3million people affected by the condition.

Epilepsy

No review of the causes of seizure would be complete with the mention of epilepsy. This is the one condition that everyone will discuss at the sheer mention of the word seizure.

So, what is Epilepsy?

Epilepsy is a group of neurological disorders characterised by epileptic seizures. They can vary from brief nearly undetectable episodes to the full-on body shaking vigorously which can last several minutes. As of 2015, 39 million people have epilepsy, 80% of these in the developing world.

Fragile X Syndrome

Fragile X syndrome is a genetic disorder. It is usually due to the expansion of the CGG Triplet repeat within the Fragile X mental retardation 1 (FMR1) gene on the X chromosome.

The Fragile X mental retardation 1 (FMR1) gene is a protein most commonly found in the brain and is essential in the normal cognitive development and the female reproductive system.

Seizures occur in 10 to 20% of people with Fragile X syndrome.

Meningitis

Meningitis is the inflammation of the meninges, which are the lining of the brain and the spinal cord. We have written a blog in detail on meningitis which you can view here.

Multiple Sclerosis

Multiple sclerosis (MS) is a disease in which the insulating covers of the nerve cells in the brain and the spinal cord are damaged. This disrupts the ability of the parts of the nervous system to communicate which results in a wide-ranging array of signs and symptoms.

It has been found that people with multiple sclerosis are more likely than the general population to suffer from epilepsy, it is somewhere in the region of 2 – 3% of multiple sclerosis sufferers.

Systemic Lupus Erythematosus

Systemic lupus erythematosus also known as lupus is an autoimmune disease in which the body’s immune system mistakenly attacks healthy cells in various parts of the body. The signs and symptoms therefore are wide-ranging. Seizures are a common manifestation of this condition.

Tuberous Sclerosis

Tuberous sclerosis is a rare multisystem genetic disease. This causes benign tumours to grow in the brain, and on other vital organs including the heart, lungs, liver, kidneys and the skin. Seizures remain one of the most common neurological issues of this disease occurring in 85% of individuals.

Medicinal Drugs

Seizures can be a side effect of many drugs that are prescribed by the doctors, the doctor prescribing will always ensure that the patient is aware of this side effect as they prescribe to the person. A few examples of these drugs include:

  • Caffeine,
  • Insulin,
  • Procaine,
  • Propofol,
  • Venlafaxine.

Menstrual Cycle

A subset of epilepsy is a condition called catamenial epilepsy which can make seizures more common during a woman’s menstrual cycle.

Musicogenic Epilepsy

Musicogenic is a rare form of epilepsy. Music is a part of everyday life and usually is pleasurable. For 1 in 10million people, although some statistics say it is more common than this, music is actually the cause of a seizure.

Routinely there is no test for musicogenic seizures like there are for photosensitive seizures.

The stimulus for sufferers varies but includes:

  • Choral,
  • Classical,
  • Instrumental,
  • Jazz,
  • Popular Music.

As well as listening to these types of music other triggers include playing, thinking of or dreaming of music.

Nocturnal Seizures

Nocturnal seizures are a type of seizure which only occurs whilst the person is asleep. This is by definition a difficult type of seizure to diagnose due to its occurrence. The casualty may need to consider other symptoms and signs including:

  • Headache,
  • Having wet the bed,
  • Bitten the tongue,
  • Bone or joint injury,
  • Muscle strains or injury,
  • Fatigue or drowsiness.

Missed Anticonvulsants

A missed or incorrectly timed dose of an anticonvulsant can be a trigger for a breakthrough seizure, we discussed these earlier in the blog. One single missed dose can be enough to cause a seizure in some patients.

Parasites

Certain parasites are known to cause seizures in humans. For example, pork tapeworm and beef tapeworm, can cause seizures when the parasites create a cyst on the brain. Parasitic diseases that can cause seizures include:

  • Echinococcosis,
  • Malaria,
  • Toxoplasmosis,
  • African Trypanosomiasis.

Photosensitive

Photosensitive seizures are caused by flashing lights or with contrasting light and dark patterns. Around 1 in 100 people have epilepsy, and of these around 3% have photosensitive seizures. These type of seizures are less likely to be diagnosed beyond the age of 20 years of age.

Recreational Drugs – Taking

The taking of recreational drugs can seem like a good idea to some, however the taking of certain drugs at high levels of dosage and for long periods can cause some adverse effects which include seizures. The list of these drugs includes:

  • Amphetamines,
  • Ecstasy,
  • Cocaine,
  • GHB.

It is important that the medical staff are clear on what has been taken and what the dosage was as being treated with the wrong antiepileptic drugs can actually make the seizures worse, and/or increase. The use of convulsant drugs, which have the exact opposite effect as anticonvulsants of which examples could be strychnine and picrotoxin will increase seizures and some have been used clinically and are also found naturally.

Recreational Drugs – Withdrawal

The withdrawal of recreational drugs, if not controlled, can actually cause seizures to occur as the body has got so used to the substance being put into the body that it struggles to work effectively without getting the hit of the substance that it has grown so used to.

Sleep Deprivation

This is the second most common cause of seizures and has been known to be the cause of the only seizure a person ever has. The exact reason why deprivation of sleep causes a seizure is unknown, but the most common theory on this is to do with the amount sleep one gets affecting the amount of electrical activity in the brain.

Stress

Stress can cause seizures in people who have epilepsy and is also a risk factor for developing epilepsy. It is thought that the hippocampus in the brain is the most susceptible to stress and prone to seizures.

Seizure Groupings

In May 2017, The International League Against Epilepsy introduced a new method to group seizures. The idea was to group them to:

  • Where they start in the brain,
  • Whether the casualty’s awareness is affected,
  • Whether the seizure involves other symptoms e.g. movement.

Focal Seizures

What happens during the focal seizure completely depends on where in the brain the seizure occurs and what that part of the brain usually does. Some focal seizures involve movement whereas some involve sensations and feelings.

Motor Symptoms (movements) include:

  • A loud cry,
  • Lip smacking or chewing movements,
  • Making strange postures or repetitive movement e.g. cycling or kicking,
  • Repeatedly picking up objects or pulling at clothes,
  • Repetitive jerky movements that affect one or both sides of the body,
  • Suddenly losing muscle tone, limbs going limp, or stiff.

Non-motor Symptoms (sensations and feelings) include:

  • A feeling of numbness or tingling,
  • A sensation that the arm or leg feels bigger than it actually is,
  • A strange feeling or a wave going through the head,
  • A sudden intense feeling of fear or joy,
  • Changes or a rising feeling in the stomach, a sense of déjà vu,
  • Getting an unusual smell or taste,
  • Stiffness or twitching in a part of the body,
  • Visual disturbances such as coloured or flashing lights.

Focal Aware Seizure

A casualty who is having a focal aware seizure will be conscious, and therefore awake and alert. They will know that something is happening to them and will remember the seizure once it has passed. Some sufferers find it hard to put their seizure into words and often they just describe them as feeling strange. Because they are unable to describe their feelings or put them into words to describe it they may be frustrated and upset by it.

You can view a video of how it might feel to have a Focal Aware seizure here, thanks to the Epilepsy Society.

Focal Impaired Awareness seizure

During a focal impaired awareness seizure, a bigger part of one side of the brain is affected. The casualty’s consciousness is likely to be impaired. They are likely to be confused, whilst being able to hear you but not necessarily be able to communicate or understand what you are saying. They may not react as they normally would and may perceive your loud talking as you being aggressive and therefore be aggressive back to you.

This type of seizure generally occurs in the temporal lobe part of the brain but can affect other areas of the brain.

After the seizure the casualty may be confused, this could last a while post seizure, although you may not be able to tell if the seizure has actually ended. The casualty is likely to be tired after the seizure and may not remember what has happened.

You can view a video of how it may feel to be in a Focal Impaired Awareness Seizure here, with thanks to the Epilepsy Society.

Sometimes a focal seizure can lead to a bilateral tonic-clonic seizure, when this happens the casualty will become unconscious very quickly and have a tonic-clonic seizure. If this happens very quickly they may not be aware that it started as a focal seizure.

General Onset Seizures

General onset seizures affect both sides of the brain at once and without any warning. With the exception of the myoclonic seizure the casualty will be unconscious even if for just a short space of time, and will not remember the seizure after the event.

Tonic-Clonic Seizures

These are the most common type of seizure suffered by an epileptic.

At the start of the seizure the casualty will:

  • Become unconscious,
  • Cry out,
  • Go stiff and fall over if standing,
  • Possibly bite their tongue or cheek.

During the seizure the casualty will:

  • Change colour and become very pale or become cyanosed,
  • Jerk and shake as their muscles relax and tighten rhythmically,
  • Have affected breathing which will become difficult or sound noisy,
  • Potentially wet themselves.

After the seizure the casualty will:

  • Return to normal colour and breathing,
  • Potentially feel lethargic, confused, have a headache or want to sleep.

You can view a video of how it may feel to be in a Tonic-Clonic Seizure here, with thanks to the Epilepsy Society.

Clonic Seizures

Clonic seizures involve the jerky motions of the body which can be just one side or both sides of the body, this will depend on where the seizure starts. If they start in one side of the brain, they are called focal motor and if they affect both sides of the brain, they are called generalised clonic.

Tonic and Atonic seizures

Tonic seizures tend to be brief in nature and happen with little warning. These types of seizures involve the casualty’s body becoming stiff and if they are standing they are likely to fall backwards to the floor and injure the back of their neck and head.

An atonic seizure is otherwise known as a drop attack. Usually these casualties will fall forward, potentially causing harm to their face. The reason for the drop is that their muscles have relaxed and gone floppy. Like tonic seizures they usually happen with little or no warning and are brief in their duration.

Other than the possible injuries which have been caused by the drop to the floor, the casualties are likely to recover from the seizure very quickly.

You can view a video of how it may feel to be in an Atonic Seizure here, with thanks to the Epilepsy Society.

Myoclonic Seizures

Myoclonic simply means muscle jerk.

Muscle jerks should not always be assumed to be epilepsy as some people have them as they go to sleep and are completely unrelated to epilepsy. Myoclonic seizures however, can occur in clusters whereby there are a lot in a short space of time and are usually brief in their duration. If they do occur in clusters, the next one is likely to occur shortly after the casualty awakes from their previous seizure.

The casualty is likely to be conscious through these seizures, but they are still classed as generalised seizures as the casualty is likely to have other types of seizure as well as myoclonic.

You can view a video of how it may feel to be in a myoclonic seizure here, with thanks to the Epilepsy Society.

Absence Seizures

Absence seizures are very common in children, they can happen frequently and can be very difficult to identify. The come in two types, typical absence and atypical absence.

Typical Absence

The typical absence seizure portrays itself in the person becoming blank and unresponsive for as short a time as a few seconds. The casualty may stop what they are doing, stare into space, and their eyelids may flutter and blink. They will be totally unaware of what is happening around them, should they occur as the person is walking the casualty will continue to walk but have no awareness around them.

Atypical Absences

These are very similar to the typical version of an absence seizure however they tend to start and end more slowly. The other big difference being the change in the muscle tone and the limbs could go limp, also the casualty could drop to the floor.

You can view a video of how it may feel to be in an absence seizure here, with thanks to the Epilepsy Society.

Unknown Onset Seizure

This is a term that is used by doctors if they are unsure as to where in the brain the seizure occurred. This could be because the casualty was alone, asleep or the seizure went unwitnessed.

Finally, let’s look at what you can do as a First Aider for a casualty who is having a seizure, but do remember that the best way to know what to do for your casualty is to attend a First Aid course.

The treatment you shall provide will vary depending on if the casualty is having a muscle jerky seizure or a non-motion seizure.

General Onset Seizures

  1. As the casualty is falling, try to catch them and clear the area that they are going to land in,
  2. Allow the seizure to occur DO NOT hold them down.
    a. Time the seizure and call an ambulance if:
    i. The seizure is 3 minutes long, or
    ii. Is 2 minutes longer than is normal for the casualty, or
    iii. They hurt themselves as they fell to the floor, or
    iv. They have a second seizure, or
    v. It’s their first ever seizure, or
    vi. You’re not sure.
    b. Loosen any tight clothing from around the neck.

NEVER:

  • Put anything in the casualty’s mouth,
  • Try to restrain the casualty.

After the seizure,

  1. Open the Airway and check breathing,
    a. If necessary:
    i. Place in Recovery Position, or
    ii. Start CPR.
  2. Move bystanders to protect dignity and modesty of casualty,
  3. Call 999/112 for emergency help if you cannot wake them after 5 minutes.

Focal and Absence Seizures

  1. Guide the casualty away from possible danger,
  2. Help the casualty to sit or lie down in a quiet place,
  3. Be calm and reassuring, don’t do anything that could frighten them,
  4. Stay with the casualty until they are fully alert,
  5. If the casualty is unaware of their condition advise them to seek medical advice.

DID YOU KNOW…..

St. Valentine is also the patron saint of Epilepsy?

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