Seizures: Types and Treatments

A seizure happens when your brain experiences a brief surge of excessive electrical activity. It can cause changes in behaviour, movements, feelings, or levels of consciousness. Seizures vary widely in severity and manifestation, from brief lapses of attention or muscle jerks to severe and prolonged convulsions. They are commonly associated with epilepsy, but not all seizures mean a person has epilepsy.

What are the types of seizures?

Seizures are categorised into two groups:

Generalised seizures: Affecting both sides of the brain

• Absence seizures (petit mal seizures): Characterised by brief, sudden lapses in attention, these seizures often appear as staring spells.
• Tonic-clonic seizures (grand mal seizures): These are the most recognisable type of seizure, involving a combination of muscle stiffness (tonic phase), followed by rhythmic muscle contractions (clonic phase). The person may lose consciousness, fall to the ground, and have convulsions. 

Focal seizures: Affecting only one area of the brain

• Simple partial (focal) seizures: During these seizures, the person remains conscious and aware. They may experience unusual sensations or movements, like a tingling feeling, a strange taste or smell, or involuntary jerking of a body part.
• Complex partial (focal) seizures: The person may appear awake but be unresponsive and unaware of their surroundings. They might make repetitive movements, such as hand rubbing, lip-smacking, or walking in circles.

What is the difference between seizure and epilepsy?

Seizures are isolated episodes of abnormal electrical activity in the brain. When seizures become a regular problem, this condition is called epilepsy. Typically, an individual with epilepsy is diagnosed following at least two seizures that were not brought on by a known medical condition.

What are the risk factors of seizures? 

The risk factors of seizures are:

• Babies born undersized for their age
• Babies experiencing seizures within the first month of life 
• Babies born with abnormal brain areas
• Severe brain injury
• Brain tumours
• Brain infections (abscesses, meningitis, encephalitis)
• Stroke 
• Cerebral palsy
• Conditions involving intellectual and developmental disabilities
• Family history of epilepsy or fever-related seizures
• Autism spectrum disorder
• Using illegal drugs (such as cocaine)
• Mild head injuries

What are the warning signs before a seizure? 

The warning signs before a seizure, often referred to as auras or prodromal symptoms, can vary significantly from person to person and depending on the type of seizure. The warning signs may include:

• Anxiety or fear 
• Nausea
• Vertigo (the sensation of spinning or moving)
• Visual symptoms (such as flashing bright lights)
• Experiencing sudden fear, anxiety, panic, déjà vu (feeling like a situation is eerily familiar)
• Headache
• Sweating
• Sudden mood swings 

What happens after a seizure episode?

Following a seizure episode, the individual will go through a recovery phase (or the ‘post-ictal’ phase) before resuming to their usual/normal state. During this phase, the individual may feel confused, exhausted, sore, thirsty, weak, ill, anxious, lose control of bladder or bowel, or experience a headache. They may or may not recall the seizure. It could take hours or days to return to their normal state.

Can seizures hurt?

Although some seizures rarely cause problems, there is a possibility of some common injuries occurring (such as bruises, cuts, burns, and falls). More serious complications, for example, fractured bones, concussions, bleeding in the brain, or breathing problems, are more common in patients who have generalised seizures with falls or those with lengthy or repeated seizures.

How are seizures diagnosed?

Diagnosing seizures involves a combination of clinical evaluations, medical history, and diagnostic tests.

• Electroencephalogram (EEG): To check for unusual electrical activity in the brain using electrodes placed on the scalp.
• Blood tests: To look for infections, electrolyte imbalances, genetic conditions, or other metabolic issues that could be causing seizures.
• Imaging tests such as computerised tomography (CT) scan and magnetic resonance imaging (MRI): To look for unusual growth, damage, or scarring in the brain.
• Lumbar puncture: In some cases, especially if an infection like meningitis is suspected, a lumbar puncture may be done to analyse the cerebrospinal fluid surrounding the brain and spinal cord.

How are they treated?

The treatments for seizures are as follows:

• Medications: Medications such as anti-epileptic drugs (sodium valproate, carbamazepine, and lamotrigine) can help control seizures by changing the levels of chemicals in the brain. 
• Surgery: To remove a small area of the brain that is causing seizures.
• Vagus Nerve Stimulation (VNS): A small device, similar to a pacemaker, is implanted under the skin of the chest. Wires from the device are connected to the vagus nerve in the neck.

How are seizures managed?

There is no one-size-fits-all for managing seizures. However, you can practise these self-management strategies to better control your seizures:

• Track your seizures.
• Avoid seizure triggers (such as flickering lights or sleep deprivation).
• Take your seizure medicines as prescribed.
• Keep a healthy weight by following a well-balanced diet and exercising regularly.
• Avoid smoking, excessive alcohol consumption, or other substance abuse.
• Manage your stress.

Make an appointment at Pantai Hospitals

Get in touch with us to book an appointment today if you have concerns or questions regarding seizures. A dedicated and expert team of neurologists at Pantai Hospitals is available for consultation to provide the best care and assistance. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.