Epileptic seizure

From Wikipedia, the free encyclopedia "Seizure" redirects here. For non-epileptic seizures, see Non-epileptic seizure. For other uses, see Seizure (disambiguation).

Epileptic seizure
Classification and external resources Generalized 3 Hz spike and wave discharges in EEG G40, P90, R56 ICD-10 345.9, 780.3 ICD-9 19011 DiseasesDB neuro/415 neuro/694 eMedicine D012640 MeSH Epileptic seizures (colloquially a fit) are brief episodes of "abnormal excessive or synchronous neuronal activity in the brain".[1] The outward effect can vary from wild thrashing movement (tonic-clonic seizure) to as mild as a brief loss of awareness (absence seizure). The syndrome of recurrent, unprovoked seizures is termed epilepsy, but seizures can occur in people who do not have epilepsy. Additionally there are a number of conditions that look like seizures but are not. After a first seizure, treatment is generally not needed unless specific problems are found on either electroencephalogram or imaging of the brain.[2] About 5-10% of all people will have an unprovoked seizure by the age of 80[3] and the chance of experiencing a second seizure is between 40% and 50%.[4] Epilepsy affects about 1% of the population currently[5] and affects about 4% of the population at some point in time.[2] Most of affected, nearly 80%, live in developing countries.[5]

Contents

1 Signs and symptoms o 1.1 Focal seizures o 1.2 Generalized seizures o 1.3 Duration o 1.4 Post-ictal 2 Causes o 2.1 Metabolic o 2.2 Mass lesions o 2.3 Medications o 2.4 Infections o 2.5 Other

3 Mechanism 4 Diagnosis o 4.1 Classification o 4.2 Physical examination o 4.3 Labs o 4.4 EEG o 4.5 Imaging o 4.6 Differential diagnosis 5 Prevention 6 Management o 6.1 Medication o 6.2 Other 7 Prognosis 8 Epidemiology 9 History 10 Society and culture o 10.1 Economics o 10.2 Driving 11 Research 12 References 13 External links

Signs and symptoms

Someone who has bitten the tip of their tongue while having a seizure See also: Seizure types The signs and symptoms of seizures vary depending on the type.[6] The most common type of seizures are convulsive (60%).[7] Two-thirds of these begin as focal seizures and become generalized while one third begin as generalized seizures.[7] The remaining 40% of seizures are non-convulsive, an example of which is absence seizures[8]

Focal seizures
Focal seizures are often preceded by certain experiences, known as an aura.[6] These may include: sensory, visual, psychic, autonomic, olfactory or motor phenomena.[9]

In a complex partial seizure a person may appear confused or dazed and will not be able to respond to questions or direction. Focal seizure may become generalized.[9] Jerking activity may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian march.[10] Unusual activities that are not consciously created may occur.[10] These are known as automatisms and include simple activities like smacking of the lips or more complex activities such as attempts to pick something up.[10]

Generalized seizures
There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.[11] They all involve a loss of consciousness and typically happen without warning.[12] Tonic-clonic seizures present with a contraction of the limbs followed by their extension along with arching of the back which lasts 1030 seconds.[12] A cry may be heard due to contraction of the chest muscles.[12] This is then followed by a shaking of the limbs in unison.[12] After the shaking has stopped it may take 1030 minutes for the person to return to normal.[12] Tonic seizures produce constant contractions of the muscles.[12] A person often turns blue as breathing is stopped.[12] In clonic seizures there is shaking of the limbs in unison.[12] Myotonic seizures involved spasms of muscles in either a few areas or all over.[12] Absence seizures can be subtle with only a slight turn of the head or eye blinking.[9] The person does not fall over and returns to normal right after it ends.[9] Atonic seizures involve the loss of muscle activity for greater than one second.[10] This typically occurs on both sides of the body.[10]

Duration
A seizure can last from a few seconds to more than five minutes at which point it is known as status epilepticus.[13] Most tonic-clonic seizures last less than two or three minutes.[13] Absence seizures are usually around 10 seconds in duration.[8]

Post-ictal
After the active portion of a seizure, there is typically a period of confusion referred to as the postictal period before a normal level of consciousness returns.[6] This usually lasts 3 to 15 minutes[14] but may last for hours.[15] Other common symptoms include: feeling tired, headache, difficulty speaking, and abnormal behavior.[15] Psychosis after a seizure is relatively common, occurring in between 6-10% of people.[16] Often people do not remember what occurred during this time.[15]

Causes
Main article: Causes of seizures

Seizures have a number of causes. Of those with seizure about 25% have epilepsy.[17] A number of conditions are associated with seizures but are not epilepsy including: most febrile seizures and those that occur around an acute infection, stroke, or toxicity.[18] These seizures are known as "acute symptomatic" or "provoked" seizures and are part of the seizure-related disorders.[18] In many the cause is unknown. Different causes of seizures are common in certain age groups.

During the neonatal period and early infancy the most common causes include hypoxic ischemic encephalopathy, central nervous system (CNS) infections, trauma, congenital CNS abnormalities, and metabolic disorders. The most frequent cause of seizures in children is febrile seizures which happen in 2-5% of those between the ages of six months and five years.[19] During childhood, well-defined epilepsy syndromes are generally seen. During adulthood, the likely causes are alcohol related, strokes, trauma, CNS infections, and brain tumors.[20] In older adults, cerebrovascular disease is a very common cause. Other causes are CNS tumors, head trauma, and other degenerative diseases that are common in the older age group, such as dementia.[21]

Metabolic
A number of disorders including: low blood sugar, low blood sodium, hyperosmolar nonketotic hyperglycemia, high blood sodium, low blood calcium and high blood urea levels may cause seizures.[12] As may hepatic encephalopathy and the genetic disorder porphyria.[12]

Mass lesions

cavernoma or cavernous malformation is a treatable medical condition that can cause seizures, headaches, and brain hemorrhages. arteriovenous malformation (AVM) is a treatable medical condition that can cause seizures, headaches, and brain hemorrhages. space-occupying lesions in the brain (abscesses, tumours). In people with brain tumours, the frequency of epilepsy depends on the location of the tumor in the cortical region.[22]

Medications
Both medication and drug overdoses can result in seizures,[12] as may certain medication and drug withdrawal.[12] Common drugs involved include: antidepressants, antipsychotics, cocaine, insulin, and the local anaesthetic lidocaine.[12] Difficulties with withdrawal seizures commonly occurs after prolonged alcohol or sedative use.[12]

Infections

parasitic infections such as cerebral malaria infection, such as encephalitis or meningitis

Other
Seizures may occur as a result of high blood pressure, known as hypertensive encephalopathy, or in pregnancy as eclampsia when accompanied by either seizures or a decreased level of consciousness.[12] Very high body temperatures may also be a cause.[12] Typically this requires a temperature greater than 42 C (107.6 F).[12]

head injury may cause non-epileptic post-traumatic seizures or post-traumatic epilepsy seizures in a person with a shunt may indicated failure haemorrhagic stroke can occasionally present with seizures, embolic strokes generally do not (though epilepsy is a common later complication); cerebral venous sinus thrombosis, a rare type of stroke, is more likely to be accompanied by seizures than other types of stroke multiple sclerosis may cause seizures

Electroconvulsive therapy (ECT) deliberately sets out to induce a seizure for the treatment of major depression.

Mechanism
Normally brain electrical activity is non synchronous.[9] In epileptic seizures, due to problems within the brain,[23] a group of neurons begin firing in an abnormal, excessive,[7] and synchronized manner.[9] This results in a wave of depolarization known as a paroxysmal depolarizing shift.[24] Normally after an excitatory neuron fires it becomes more resistant to firing for a period of time.[9] This is due in part from the effect of inhibitory neurons, electrical changes within the excitatory neuron, and the negative effects of adenosine.[9] In epilepsy the resistance of excitatory neuron's to fire during this period is decreased.[9] This may occur due to changes in ion channels or inhibitory neurons not functioning properly.[9] This then results in a specific area from which seizures may develop, known as a "seizure focus".[9] Another cause of epilepsy may be the up regulation of excitatory circuits or down regulation of inhibitory circuits follow an injury to the brain.[9][25] These secondary epilepsies, occur through processes known as epileptogenesis.[9][25] Failure of the bloodbrain barrier may also be a causal mechanism.[26] Focal seizures begin in one hemisphere of the brain while generalized seizures begin in both hemispheres.[11] Some types of seizures may change brain structure, while others appear to have little effect.[27] Gliosis, neuronal loss, and atrophy of specific areas of the brain are linked to epilepsy but it is unclear if epilepsy causes these changes or if these changes result in epilepsy.[27]