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Seizure Disorder

Introduction
Also known as convulsions, epileptic seizures, and if recurrent, epilepsy. It is a sudden alteration in normal
brain activity that cause distinct changes in behavior and body function. They are thought to result from
abnormal, recurrent, uncontrolled electric discharges of neurons in the brain.
Predisposing factors include head or brain trauma, tumors, cranial surgery, metabolic disorders
(hypocalcemia, hypoglycemia or hyperglycemia, hyponatremia, anoxia);central nervous system infection;
circulating disorders; drug toxicity; drug withdrawal states (alcohol, barbiturates); and congenital
neurodegenerative disorders.
There are two basic types of seizures:
Epileptic:These seizures have no apparent cause (or trigger) and occur repeatedly. These seizures are
called a seizure disorder or epilepsy.
Nonepileptic:These seizures are triggered (provoked) by a disorder or another condition that irritates the
brain. In children, a fever can trigger a nonepileptic seizure.









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Signs and Symptoms


In about 20% of people who have a seizure disorder, seizures are preceded
by unusual sensations (called aura), such as the following:
Abnormal smells or tastes
Butterflies in the stomach
A feeling of dj vu
An intense feeling that a seizure is about to begin
Almost all seizures are relatively brief, lasting from a few seconds to a few
minutes. Most seizures last 1 to 2 minutes. When a seizure stops, people
may have a headache, sore muscles, unusual sensations, confusion, and
profound fatigue. These after-effects are called the postictal state. In some
people, one side of the body is weak, and the weakness lasts longer than
the seizure (a disorder called Todd's paralysis). Most people who have a
seizure disorder look and behave normally between seizures. Other possible
symptoms include numbness or tingling in a specific body part, brief
episodes of unresponsiveness, loss of consciousness, confusion, and loss of
muscle or bladder control.

Pathophysiology
Before age 2:High fevers or temporary metabolic
abnormalities, such as abnormal blood levels of sugar (glucose),
calcium, magnesium, vitamin B6, or sodium, can trigger one or
more seizures. Seizures do not occur once the fever or
abnormality resolves. If the seizures recur without such triggers,
the cause is likely to be an injury during birth, a birth defect, or
a hereditary metabolic abnormality or brain disorder.
2 to 14 years:Often, the cause is unknown.
After age 25:A head injury, stroke, or tumor may damage the
brain, causing a seizure. Alcohol withdrawal (caused by
suddenly stopping drinking) is a common cause of seizures.
However, in about half of people in this age group, the cause is
unknown.

Seizures with no identifiable cause are called idiopathic.


Conditions that irritate the brainsuch as injuries, certain drugs,
sleep deprivation, infections, feveror that deprive the brain of
oxygen or fuelsuch as abnormal heart rhythms, a low level of
oxygen in the blood, or a very low level of sugar in the blood
can trigger a single seizure whether a person has a seizure
disorder or not. A single seizure that results from such a
stimulus is called a provoked seizure (and thus is a nonepileptic
seizure). People with a seizure disorder are more likely to have a
seizure when they are under excess physical or emotional stress
or deprived of sleep. Avoiding these conditions can help prevent
seizures.
Rarely, seizures are triggered by repetitive sounds, flashing
lights, video games, or even touching certain parts of the body.
In such cases, the disorder is called reflex epilepsy.

Causes of Seizures
Cause

Examples

High fever

Heatstroke

Infections

Brain infections

Abscess

AIDS

Malaria

Meningitis

Rabies

Syphilis

Tetanus

Toxoplasmosis

Viral encephalitis

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 B6deficiency (in newborns)

Inadequate oxygen supply to the


brain

Abnormal heart rhythms

Carbon monoxide poisoning

Near drowning

Near suffocation

Stroke

Vasculitis

Diagnostic Procedure
EEG, with or without video monitoring, locates epileptic focus,
spread, intensity, and duration, helps classify seizure type.
CT scanning or MRI identifies lesion that may cause of seizure.
Single photon emission CT scanning (SPECT) or positron
emission tomography (PET) identifies seizure foci.
Neuropsychological studies evaluate for behavioral
disturbances.
Serum electrolytes, glucose, and toxicity screen determine the
cause of first seizure.
Lumbar puncture and blood cultures may be necessary if fever
is present.