seizure

{{See also|Seizure types}}

A seizure can last from a few seconds to 5 minutes. Once it reaches and passes 5 minutes, it is known as status epilepticus. Accidental urination (urinary incontinence), stool leaking (fecal incontinence), tongue biting, foaming of the mouth, and turning blue due to inability to breathe commonly are seen in seizures.

A period of confusion typically follows the seizure that lasts from seconds to hours before a person returns to normal. This period is called a postictal period.{{Cite journal |last1=Pottkämper |first1=Julia C. M. |last2=Hofmeijer |first2=Jeannette |last3=van Waarde |first3=Jeroen A. |last4=van Putten |first4=Michel J. A. M. |year=2020 |title=The postictal state-What do we know? |journal=Epilepsia |volume=61 |issue=6 |pages=1045–1061 |doi=10.1111/epi.16519 |issn=1528-1167 |pmc=7317965 |pmid=32396219 }} Other symptoms during this period include drowsiness, headache, difficulty speaking, psychosis, and weakness.{{cite book |url=https://books.google.com/books?id=4W7UI-FPZmoC&pg=PA443 |title=Advanced therapy in epilepsy |publisher=People's Medical Pub. House |year=2009 |isbn=978-1-60795-004-2 |editor=James W. Wheless |location=Shelton, Conn. |page=443}}{{cite book |url=https://books.google.com/books?id=yJQQzPTcbYIC&pg=PA445 |title=A clinical guide to epileptic syndromes and their treatment based on the ILAE classifications and practice parameter guidelines |vauthors=Panayiotopoulos CP |publisher=Springer |year=2010 |isbn=978-1-84628-644-5 |edition=Rev. 2nd |location=[London] |page=445}}

Observable signs and symptoms of seizures vary depending on the type. Seizures can be classified into generalized seizures and focal seizures, depending on what part of the brain is involved.

Focal seizures affect a specific area of the brain, not both sides. It may turn into a generalized seizure if the seizure spreads through the brain. Consciousness may or may not be impaired. The signs and symptoms of these seizures depends on the location of the brain that is affected. Focal seizures usually consist of motor symptoms or sensory symptoms.

• Sensory symptoms: Auras are subjective sensations that occur before focal seizures. Auras include changes in vision, hearing, or smell (an example is smelling rubber).{{Cite journal |last1=Chee |first1=Keanu |last2=Razmara |first2=Ashkaun |last3=Geller |first3=Aaron S. |last4=Harris |first4=William B. |last5=Restrepo |first5=Diego |last6=Thompson |first6=John A. |last7=Kramer |first7=Daniel R. |date=2022 |title=The role of the piriform cortex in temporal lobe epilepsy: A current literature review |journal=Frontiers in Neurology |volume=13 |pages=1042887 |doi=10.3389/fneur.2022.1042887 |doi-access=free |issn=1664-2295 |pmc=9720270 |pmid=36479052 }} Feelings of deja-vu or abdominal discomfort are also examples of auras. A person who experiences focal weakness of a limb may also have just experienced a focal seizure. This is known as Todd's paralysis.{{Cite journal |last1=Xu |first1=Sui-Yi |last2=Li |first2=Ze-Xing |last3=Wu |first3=Xiao-Wei |last4=Li |first4=Ling |last5=Li |first5=Chang-Xin |date=2020-03-05 |title=Frequency and Pathophysiology of Post-Seizure Todd's Paralysis |journal=Medical Science Monitor: International Medical Journal of Experimental and Clinical Research |volume=26 |pages=e920751 |doi=10.12659/MSM.920751 |issn=1643-3750 |pmc=7075081 |pmid=32134903}}
• Motor symptoms: Head turning and eyes moving to one side, with contraction of limbs on one side is a common presentation. Automatisms are also an indicator that a seizure is focal. These are repetitive movements. It can be lip smacking, chewing, swallowing, eyelid fluttering, feet shuffling, or picking movements. Jacksonian March is also a motor presentation of a focal seizure, with contractions spreading from one muscle to the next on one side of the body.

Generalized seizures affect both sides of the brain and typically involve both sides of the body. They all involve a loss of consciousness and usually happen without warning. There are six main types of generalized seizures: tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures.

• Tonic-clonic seizures, also known as Grand Mal seizures, present with continuous stiffening of the body for 10–20 seconds followed by rhythmic jerking. It may be accompanied by an increase in blood pressure, increase in heart rate, or urinary incontinence. The person may turn blue if breathing is impaired. Shoulder dislocation and tongue biting are also possible.
• Tonic seizures produce constant contractions of the muscles. The body stiffens for a prolonged period of time. The muscles most commonly affected are the neck, shoulders, hips, and trunk.
• Clonic seizures involve jerking of the muscles rhythmically.
• Myoclonic seizures involve short contractions of muscles in either a few areas of the body or through the whole body. They are not typically rhythmic.
• Absence seizures last 10–15 seconds usually. It is characterized by a sudden, brief episode where a person is unaware of what is happening and does not respond. The person stops in the middle of activity. The person often does not fall over. They may return to normal right after the seizure ends, with no postictal state. The person is usually unaware of what just happened.
• Atonic seizures involve the loss of muscle activity causing a person to drop abruptly with their muscles limp. This is called a drop attack.

{{Main|Causes of seizures}}

Seizures have a number of causes. Seizures can be classified into provoked or unprovoked. Provoked seizures have a cause that is temporary and reversible. They are also known as Acute Symptomatic Seizures as they occur closely after the injury.{{cite journal |display-authors=6 |vauthors=Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, Hesdorffer DC, Hauser WA, Kazis L, Kobau R, Kroner B, Labiner D, Liow K, Logroscino G, Medina MT, Newton CR, Parko K, Paschal A, Preux PM, Sander JW, Selassie A, Theodore W, Tomson T, Wiebe S |date=September 2011 |title=Standards for epidemiologic studies and surveillance of epilepsy |journal=Epilepsia |volume=52 |issue=Suppl 7 |pages=2–26 |doi=10.1111/j.1528-1167.2011.03121.x |pmid=21899536 |s2cid=8505004 |doi-access=free}} Unprovoked seizures do not have a known cause or the cause is not reversible. Unprovoked seizures are typically considered epilepsy and treated as epilepsy. Of those who have a seizure, about 25% have epilepsy.{{cite journal | vauthors = Stasiukyniene V, Pilvinis V, Reingardiene D, Janauskaite L | title = [Epileptic seizures in critically ill patients] | journal = Medicina | volume = 45 | issue = 6 | pages = 501–507 | year = 2009 | pmid = 19605972 | doi = 10.3390/medicina45060066 | doi-access = free }} Those with epilepsy may have certain triggers that they know cause seizures to occur, including emotional stress, sleep deprivation, and flickering lights.

Dehydration can trigger epileptic seizures by changing electrolyte balances.{{Cite journal |last1=Nardone |first1=Raffaele |last2=Brigo |first2=Francesco |last3=Trinka |first3=Eugen |year=2016 |title=Acute Symptomatic Seizures Caused by Electrolyte Disturbances |journal=Journal of Clinical Neurology |language=en |volume=12 |issue=1 |pages=21–33 |doi=10.3988/jcn.2016.12.1.21 |issn=1738-6586 |pmc=4712283 |pmid=26754778 }} Low blood sugar, low blood sodium, high blood sugar, high blood sodium, low blood calcium, high blood urea, and low blood magnesium levels may cause seizures.

Up to 9% of status epilepticus cases occur due to drug intoxication.{{Cite journal |last1=Chen |first1=Hsien-Yi |last2=Albertson |first2=Timothy E. |last3=Olson |first3=Kent R. |year=2015 |title=Treatment of drug-induced seizures |journal=British Journal of Clinical Pharmacology |language=en |volume=81 |issue=3 |pages=412–419 |doi=10.1111/bcp.12720 |issn=0306-5251 |pmc=4767205 |pmid=26174744 }} Common drugs involved include antidepressants, stimulants (cocaine), and antihistamines. Withdrawal seizures commonly occur after prolonged alcohol or sedative use. In people who are at risk of developing epileptic seizures, common herbal medicines such as ephedra, ginkgo biloba and wormwood can provoke seizures.{{Cite journal |last1=Bauer |first1=Derek |last2=Quigg |first2=Mark |date=April 2019 |title=Optimizing Management of Medically Responsive Epilepsy |url=http://journals.lww.com/00132979-201904000-00006 |journal=CONTINUUM: Lifelong Learning in Neurology |language=en |volume=25 |issue=2 |pages=343–361 |doi=10.1212/CON.0000000000000709 |issn=1080-2371 |pmid=30921013 |s2cid=85563793}}

Systemic infection with high fever is a common cause of seizures, especially in children.{{Citation |last1=Xixis |first1=Kathryn L. |title=Febrile Seizure |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK448123/ |access-date=2024-11-01 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28846243 |last2=Samanta |first2=Debopam |last3=Smith |first3=Travis |last4=Keenaghan |first4=Michael}} These are called febrile seizures and occur in 2–5% of children between the ages of six months and five years.{{cite journal | vauthors = Graves RC, Oehler K, Tingle LE | title = Febrile seizures: risks, evaluation, and prognosis | journal = American Family Physician | volume = 85 | issue = 2 | pages = 149–153 | date = January 2012 | pmid = 22335215 }} Acute infection of the brain, such as encephalitis or meningitis are also causes of seizures.

Acute stroke or brain bleed may lead to seizures. Stroke is the most common cause of seizures in the elderly population.{{Cite journal |last1=Chen |first1=Jiayu |last2=Ye |first2=Haijiao |last3=Zhang |first3=Jie |last4=Li |first4=Aihong |last5=Ni |first5=Yaohui |title=Pathogenesis of seizures and epilepsy after stroke |journal=Acta Epileptologica |publication-date=2022 |volume=4 |issue=1 |pages=2 |doi=10.1186/s42494-021-00068-8 |doi-access=free |issn=2524-4434 }} Post-stroke seizures occur in 5-7% of those with ischemic strokes.{{Cite journal |last1=Zöllner |first1=Johann Philipp |last2=Schmitt |first2=Friedhelm C. |last3=Rosenow |first3=Felix |last4=Kohlhase |first4=Konstantin |last5=Seiler |first5=Alexander |last6=Strzelczyk |first6=Adam |last7=Stefan |first7=Hermann |date=2021-12-06 |title=Seizures and epilepsy in patients with ischaemic stroke |journal=Neurological Research and Practice |publication-date=2021 |volume=3 |issue=1 |pages=63 |doi=10.1186/s42466-021-00161-w |doi-access=free |issn=2524-3489 |pmc=8647498 |pmid=34865660 }} It is higher in those who experienced brain bleeds, with 10-16% risk in those patients. Recent traumatic brain injury may also lead to seizures. 1 to 5 of every 10 people who have had traumatic brain injury have experienced at least one seizure.{{Cite journal |last1=Englander |first1=Jeffrey |last2=Cifu |first2=David X. |last3=Diaz-Arrastia |first3=Ramon |year=2014 |title=Seizures after Traumatic Brain Injury |journal=Archives of Physical Medicine and Rehabilitation |language=en |volume=95 |issue=6 |pages=1223–1224 |doi=10.1016/j.apmr.2013.06.002 |pmc=4516165 |pmid=24862307 }} Seizures may occur within 7 days of the injury (early posttraumatic seizure) or after 7 days have passed (late posttraumatic seizure).

Space-occupying lesions in the brain (abscesses, tumours) are one cause of unprovoked seizures. In people with brain tumours, the frequency of epilepsy depends on the location of the tumor in the cortical region.{{cite journal |vauthors=Hildebrand J |date=July 2004 |title=Management of epileptic seizures |journal=Current Opinion in Oncology |volume=16 |issue=4 |pages=314–317 |doi=10.1097/01.cco.0000127720.17558.38 |pmid=15187884 |s2cid=12828909}} Abnormalities in blood vessels of the brain (Arteriovenous malformation) can also cause epilepsy. In babies and children, congenital brain abnormalities, such as lissencephaly or polymicrogyria, will also result in epilepsy.{{Cite journal |last1=Sanghvi |first1=Jagruti P. |last2=Rajadhyaksha |first2=Surekha B. |last3=Ursekar |first3=Meher |year=2004 |title=Spectrum of congenital CNS malformations in pediatric epilepsy |url=https://pubmed.ncbi.nlm.nih.gov/15347872 |journal=Indian Pediatrics |volume=41 |issue=8 |pages=831–838 |issn=0019-6061 |pmid=15347872 |via=PubMed}} Hypoxic-ischemic encephalopathy in newborns will also predispose the newborn to epilepsy.{{Cite journal |last=Shetty |first=Jayakara |year=2015 |title=Neonatal seizures in hypoxic–ischaemic encephalopathy – risks and benefits of anticonvulsant therapy |url=https://onlinelibrary.wiley.com/doi/10.1111/dmcn.12724 |journal=Developmental Medicine & Child Neurology |language=en |volume=57 |issue=S3 |pages=40–43 |doi=10.1111/dmcn.12724 |pmid=25800491 |issn=0012-1622 |via=PubMed}}

Strokes, brain bleeds, and traumatic brain injury can all also lead to epilepsy if seizures re-occur. If the first seizure occurs more than 7 days following a stroke, there is a higher chance of the person developing epilepsy. Post-stroke epilepsy accounts for 30%-50% of new epilepsy cases. This is also the case for traumatic brain injury, with 80% of people with late posttraumatic seizures having another seizure occur, classifying it as epilepsy.

Infections of newborns that occur while before or during birth, such as herpes simplex virus, rubella, and cytomegalovirus, all carry a risk of causing epilepsy.{{Cite journal |last1=Vezzani |first1=Annamaria |last2=Fujinami |first2=Robert S. |last3=White |first3=H. Steve |last4=Preux |first4=Pierre-Marie |last5=Blümcke |first5=Ingmar |last6=Sander |first6=Josemir W. |last7=Löscher |first7=Wolfgang |year=2015 |title=Infections, inflammation and epilepsy |journal=Acta Neuropathologica |language=en |volume=131 |issue=2 |pages=211–234 |doi=10.1007/s00401-015-1481-5 |issn=0001-6322 |pmc=4867498 |pmid=26423537 }} Infection with the pork tapeworm, which can cause neurocysticercosis, is the cause of up to half of epilepsy cases in areas of the world where the parasite is common.{{cite journal |vauthors=Bhalla D, Godet B, Druet-Cabanac M, Preux PM |date=June 2011 |title=Etiologies of epilepsy: a comprehensive review |journal=Expert Review of Neurotherapeutics |volume=11 |issue=6 |pages=861–876 |doi=10.1586/ern.11.51 |pmid=21651333 |s2cid=21190601}} Meningitis and encephalitis also carry the risk of causing long-term epilepsy as well.

During childhood, well-defined epilepsy syndromes are generally seen. Examples include Dravet syndrome, Lennox–Gastaut syndrome, and juvenile myoclonic epilepsy.

Neurons function by either being excited or inhibited.{{Cite journal |last1=Tatti |first1=Roberta |last2=Haley |first2=Melissa S. |last3=Swanson |first3=Olivia K. |last4=Tselha |first4=Tenzin |last5=Maffei |first5=Arianna |date=2017-05-15 |title=Neurophysiology and Regulation of the Balance Between Excitation and Inhibition in Neocortical Circuits |journal=Biological Psychiatry |volume=81 |issue=10 |pages=821–831 |doi=10.1016/j.biopsych.2016.09.017 |issn=1873-2402 |pmc=5374043 |pmid=27865453}} Excited neurons fire electrical charges while inhibited neurons are prevented from firing. The balance of the two maintains our central nervous system. In those with seizures, neurons are both hyperexcitable and hypersynchronous, where many neurons fire numerously at the same time.{{Citation |last1=Chauhan |first1=Pradip |title=The Anatomical Basis of Seizures |date=2022-04-04 |work=Epilepsy |pages=15–24 |editor-last=Department of Pathophysiology, Medical University of Lublin, Lublin, Poland |url=https://exonpublications.com/index.php/exon/article/view/epilepsy-anatomical-basis |access-date=2024-10-31 |publisher=Exon Publications |doi=10.36255/exon-publications-epilepsy-anatomical-basis |isbn=978-0-6453320-4-9 |last2=Philip |first2=Shalom Elsy |last3=Chauhan |first3=Girish |last4=Mehra |first4=Simmi |pmid=35605083 |editor2-last=J. Czuczwar |editor2-first=Stanislaw|doi-access=free }} This may be due to an imbalance of excitation and inhibition of neurons.{{Cite journal |last=Treiman |first=David M. |title=GABAergic Mechanisms in Epilepsy |url=https://onlinelibrary.wiley.com/doi/10.1046/j.1528-1157.2001.042suppl.3008.x |journal=Epilepsia |language=en |publication-date=2001 |volume=42 |issue=s3 |pages=8–12 |doi=10.1046/j.1528-1157.2001.042suppl.3008.x |pmid=11520315 |issn=0013-9580 |via=Wiley Online Library}}{{Cite journal |last1=Sarlo |first1=Gabrielle L. |last2=Holton |first2=Kathleen F. |year=2021 |title=Brain concentrations of glutamate and GABA in human epilepsy: A review |url=https://linkinghub.elsevier.com/retrieve/pii/S1059131121002168 |journal=Seizure - European Journal of Epilepsy |language=en |volume=91 |pages=213–227 |doi=10.1016/j.seizure.2021.06.028 |pmid=34233236 |via=Elsevier Science Direct}}

γ-aminobutyric acid (GABA) and Glutamate are chemicals called neurotransmitters that work by opening or closing ion channels on neurons to cause inhibition or excitability.{{cite journal |display-authors=6 |vauthors=Wei F, Yan LM, Su T, He N, Lin ZJ, Wang J, Shi YW, Yi YH, Liao WP |date=August 2017 |title=Ion Channel Genes and Epilepsy: Functional Alteration, Pathogenic Potential, and Mechanism of Epilepsy |journal=Neuroscience Bulletin |volume=33 |issue=4 |pages=455–477 |doi=10.1007/s12264-017-0134-1 |pmc=5567559 |pmid=28488083}} GABA serves to inhibit neurons from firing. It has been found to be decreased in epilepsy patients. This may explain the lack of inhibition of neurons resulting in seizures. Glutamate serves to excite neurons into firing when appropriate. It was found to be increased in those with epilepsy. This is a possible mechanism for why there is hyper-excitability of neurons in seizures.

Seizures that occur after brain injury may be due to the brain adapting to injury (neuroplasticity).{{Citation |last1=Bromfield |first1=Edward B. |title=Basic Mechanisms Underlying Seizures and Epilepsy |date=2006 |work=An Introduction to Epilepsy [Internet] |url=https://www.ncbi.nlm.nih.gov/books/NBK2510/ |access-date=2024-10-31 |publisher=American Epilepsy Society |language=en |last2=Cavazos |first2=José E. |last3=Sirven |first3=Joseph I.}} This process is known as epileptogenesis.{{cite journal | vauthors = Goldberg EM, Coulter DA | title = Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction | journal = Nature Reviews. Neuroscience | volume = 14 | issue = 5 | pages = 337–349 | date = May 2013 | pmid = 23595016 | pmc = 3982383 | doi = 10.1038/nrn3482 }} There is loss of inhibitory neurons because they die due to the injury. The brain may also adapt and make new neuron connections that may be hyper-excitatory.

Brief seizures, such as absence seizures lasting 5–10 seconds, do not cause observable brain damage.{{Citation |last1=Dingledine |first1=Ray |title=When and How Do Seizures Kill Neurons, and Is Cell Death Relevant to Epileptogenesis? |date=2014 |work=Issues in Clinical Epileptology: A View from the Bench |volume=813 |pages=109–122 |editor-last=Scharfman |editor-first=Helen E. |place=Dordrecht |publisher=Springer Netherlands |language=en |doi=10.1007/978-94-017-8914-1_9 |isbn=978-94-017-8913-4 |pmc=4624106 |pmid=25012371 |last2=Varvel |first2=Nicholas H. |last3=Dudek |first3=F. Edward |editor2-last=Buckmaster |editor2-first=Paul S.}} More prolonged seizures have a higher risk of neuronal death. Prolonged and recurrent seizures, such as status epilepticus, typically cause brain damage. Scarring of brain tissue (gliosis), neuronal death, and shrinking of areas of the brain (atrophy) are linked to recurrent seizures.{{cite book |url=https://books.google.com/books?id=TwlXrOBkAS8C&pg=PA483 |title=Epilepsy : a comprehensive textbook |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |year=2008 |isbn=978-0-7817-5777-5 |editor1=Jerome Engel Jr. |edition=2nd |location=Philadelphia |page=483 |editor2=Timothy A. Pedley}} These changes may lead to the development of epilepsy.

File:The 2017 ILAE classification of seizure types and the epilepsies what do people with epilepsy and their caregivers need to know?.pdf

Diagnosis of seizures involve gathering history, doing a physical exam, and ordering tests. These are done to classify the seizure and determine if the seizure is provoked or unprovoked.

File:Bittentongue.JPG

Events leading up to the seizure and what movements occurred during the seizure are important in classifying the type of seizure. The person's memory of what happened before and during the seizure is also important. However, since most people that experience seizures do not remember what happened, it is best to get history from a witness when possible.{{Cite journal |last1=Rowland |first1=Kate |last2=Lambert |first2=Carl Earl |date=2022-05-01 |title=Evaluation After a First Seizure in Adults |url=https://pubmed.ncbi.nlm.nih.gov/35559631 |journal=American Family Physician |volume=105 |issue=5 |pages=507–513 |issn=1532-0650 |pmid=35559631}} Video recording of the seizure is also helpful in diagnosis of seizures. Events that occurred after the seizure are also an important part of the history. Past medical history, such as past head trauma, past strokes, past febrile seizures, or past infections, are helpful. In babies and children, information about developmental milestones, birth history, and previous illnesses are important as potential epilepsy risk factors. Family history of seizures is also important in evaluating risk for epilepsy. History regarding medication use, substance use, and alcohol use is important in determining a cause of the seizure.

Most people are in a postictal state (drowsy or confused) following a seizure. A bite mark on the side of the tongue or bleeding from the mouth strongly indicates a seizure happened. But only a third of people who have had a seizure have such a bite.{{cite journal | vauthors = Peeters SY, Hoek AE, Mollink SM, Huff JS | title = Syncope: risk stratification and clinical decision making | journal = Emergency Medicine Practice | volume = 16 | issue = 4 | pages = 1–22; quiz 22–3 | date = April 2014 | pmid = 25105200 }} Weakness of one limb or asymmetric reflexes are also signs a seizure just occurred. Presence of urinary incontinence or fecal incontinence also strongly suggests a seizure occurred. However, most people who have had a seizure will have a normal physical exam.

File:EEG Recording Cap.jpgBlood tests can determine if there are any reversible causes of the seizure (provoked seizures). This includes a complete blood count that may show infection. A comprehensive metabolic panel is ordered to rule out abnormal sugar levels (hypoglycemia or hyperglycemia) or electrolyte abnormalities (such as hyponatremia) as a cause. A lumbar puncture is mainly done if there is reason to believe infection or inflammation of the nervous system is occurring. Toxicology screening is also mainly done if history is suggestive.

Brain imaging by CT scan and MRI is recommended after a first seizure, especially if no provoking factors are discovered. It is done to detect structural problems inside the brain, such as tumors. MRI is generally the better imaging test, but CT scan is preferred when intracranial bleeding is suspected. Imaging may be done at a later point in time in those who return to their normal selves while in the emergency room.

An electroencephalography (EEG) measures the brain's electrical activity.{{Cite journal |last1=Biasiucci |first1=Andrea |last2=Franceschiello |first2=Benedetta |last3=Murray |first3=Micah M. |date=2019-02-04 |title=Electroencephalography |url=https://pubmed.ncbi.nlm.nih.gov/30721678 |journal=Current Biology |volume=29 |issue=3 |pages=R80–R85 |doi=10.1016/j.cub.2018.11.052 |issn=1879-0445 |pmid=30721678|bibcode=2019CBio...29..R80B }} It is used in cases of first seizures that have no provoking factor, normal head imaging, and no prior history of head trauma. It will help determine the type of seizure or epilepsy syndrome present, as well as where the seizures are coming from if focal. It is also used when a person has not returned to baseline after a seizure for a prolonged time.

Other conditions that commonly get mistaken for a seizure include syncope, psychogenic nonepileptic seizures, cardiac arrhythmias, migraine headaches, and stroke/transient ischemic attacks.

There are times when a person has never had a seizure but anti-seizure medications are started to prevent seizures in those at risk. Following traumatic brain injury, anti-seizure medications decrease the risk of early seizures but not late seizures.{{Cite journal |last1=Chang |first1=Bernard S. |last2=Lowenstein |first2=Daniel H. |date=2003-01-14 |title=Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury: Report of the Quality Standards Subcommittee of the American Academy of Neurology |url=https://www.neurology.org/doi/10.1212/01.WNL.0000031432.05543.14 |journal=Neurology |language=en |volume=60 |issue=1 |pages=10–16 |doi=10.1212/01.WNL.0000031432.05543.14 |pmid=12525711 |issn=0028-3878}}{{Cite journal |last1=Torbic |first1=Heather |last2=Forni |first2=Allison A. |last3=Anger |first3=Kevin E. |last4=Degrado |first4=Jeremy R. |last5=Greenwood |first5=Bonnie C. |date=2013-05-01 |title=Use of antiepileptics for seizure prophylaxis after traumatic brain injury |url=https://academic.oup.com/ajhp/article/70/9/759/5112537 |journal=American Journal of Health-System Pharmacy |language=en |volume=70 |issue=9 |pages=759–766 |doi=10.2146/ajhp120203 |pmid=23592358 |issn=1079-2082}} However, there is no clear evidence that anti-seizure medications are effective at preventing seizures following brain surgery (craniotomy), a brain bleed, or after a stroke.{{cite journal |last1=Greenhalgh |first1=Janette |last2=Weston |first2=Jennifer |last3=Dundar |first3=Yenal |last4=Nevitt |first4=Sarah |last5=Marson |first5=Anthony |date=28 April 2020 |title=Antiepileptic drugs as prophylaxis for postcraniotomy seizures |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD007286 |doi=10.1002/14651858.CD007286.pub5 |issn=1469-493X |pmc=7195181 |pmid=32343399}}{{Cite journal |last1=Chang |first1=Richard S. |last2=Leung |first2=William Cy |last3=Vassallo |first3=Michael |last4=Sykes |first4=Lucy |last5=Battersby Wood |first5=Emma |last6=Kwan |first6=Joseph |date=7 February 2022 |title=Antiepileptic drugs for the primary and secondary prevention of seizures after stroke |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=2 |pages=CD005398 |doi=10.1002/14651858.CD005398.pub4 |issn=1469-493X |pmc=8819727 |pmid=35129214}}{{cite journal | vauthors = Marigold R, Günther A, Tiwari D, Kwan J | title = Antiepileptic drugs for the primary and secondary prevention of seizures after subarachnoid haemorrhage | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 6 | pages = CD008710 | date = June 2013 | pmid = 23740537 | pmc = 6885058 | doi = 10.1002/14651858.CD008710.pub2 | hdl = 10722/194540 }}{{cite journal |vauthors=Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG |date=April 2020 |title=Antiepileptic drugs as prophylaxis for postcraniotomy seizures |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD007286 |doi=10.1002/14651858.CD007286.pub5 |pmc=7195181 |pmid=32343399}}{{cite journal |vauthors=Ratilal BO, Pappamikail L, Costa J, Sampaio C |date=June 2013 |title=Anticonvulsants for preventing seizures in patients with chronic subdural haematoma |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=6 |pages=CD004893 |doi=10.1002/14651858.CD004893.pub3 |pmc=7388908 |pmid=23744552}}

Prevention of seizures from re-occurring after a first seizure depends on many factors. If it was an unprovoked seizure with abnormal brain imaging or abnormal EEG, then it is recommended to start anti-seizure medication. If a person has an unprovoked seizure, but physical exam is normal, EEG is normal, and brain imaging is normal, then anti-seizure medication may not be needed. The decision to start anti-seizure medications should be made after a discussion between the patient and doctor.

In children with one simple febrile seizure, starting anti-seizure medications is not recommended.{{cite journal |vauthors=Offringa M, Newton R, Nevitt SJ, Vraka K |date=June 2021 |title=Prophylactic drug management for febrile seizures in children |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=6 |pages=CD003031 |doi=10.1002/14651858.CD003031.pub4 |pmc=8207248 |pmid=34131913}} While both fever medications (antipyretics) and anti-seizure medications reduce reoccurrence, the harmless nature of febrile seizures outweighs the risks of these medications. However, if it was a complex febrile seizure, EEG should be done. If EEG is abnormal, starting prophylactic anti-seizure medications is recommended.

During an active seizure, the person seizing should be slowly laid on the floor.{{Cite journal |last1=Asadi-Pooya |first1=Ali A. |last2=Hosseini |first2=Seyed Ali |last3=Hashemizadeh Fard Haghighi |first3=Leila |last4=Asadi-Pooya |first4=Hanieh |year=2022 |title=Seizure first aid for people with epilepsy: opinions and knowledge of caregivers and healthcare professionals |url=https://pubmed.ncbi.nlm.nih.gov/36130455 |journal=Seizure |volume=102 |pages=1–5 |doi=10.1016/j.seizure.2022.09.007 |issn=1532-2688 |pmid=36130455 |via=PubMed}} Witnesses should not try to stop the convulsions or other movements. Potentially sharp or dangerous objects should be moved from the area around a person experiencing a seizure so that the individual is not hurt. Nothing should be placed in the person's mouth as it is a choking hazard. After the seizure, if the person is not fully conscious and alert, they should be turned to their side to prevent choking. This is called recovery position. Timing of the seizure is also important. If a seizure is longer than five minutes, or there are two or more seizures occurring in five minutes, it is a medical emergency known as status epilepticus.{{cite journal | vauthors = Al-Mufti F, Claassen J | title = Neurocritical care: status epilepticus review | journal = Critical Care Clinics | volume = 30 | issue = 4 | pages = 751–764 | date = October 2014 | pmid = 25257739 | doi = 10.1016/j.ccc.2014.06.006 }} Emergency services should be called.

The first line medication for an actively seizing person is a benzodiazepine, with most guidelines recommending lorazepam.{{cite journal | vauthors = De Waele L, Boon P, Ceulemans B, Dan B, Jansen A, Legros B, Leroy P, Delmelle F, Ossemann M, De Raedt S, Smets K, Van De Voorde P, Verhelst H, Lagae L | display-authors = 6 | title = First line management of prolonged convulsive seizures in children and adults: good practice points | journal = Acta Neurologica Belgica | volume = 113 | issue = 4 | pages = 375–380 | date = December 2013 | pmid = 24019121 | doi = 10.1007/s13760-013-0247-x | hdl-access = free | s2cid = 17641491 | hdl = 1854/LU-4182539 | url = https://biblio.ugent.be/publication/4182539 }} Diazepam and midazolam are alternatives. It may be given in IV if emergency services are present. Rectal and intranasal forms also exist if a child has had seizures previously and was prescribed the rescue medication.{{Cite journal |last1=Chhabra |first1=Ridhi |last2=Gupta |first2=Rachna |last3=Gupta |first3=Lalit K |year=2021 |title=Intranasal midazolam versus intravenous/rectal benzodiazepines for acute seizure control in children: A systematic review and meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S152550502100651X |journal=Epilepsy & Behavior |volume=125 |pages=108390 |doi=10.1016/j.yebeh.2021.108390 |pmid=34740090 |issn=1525-5050 |via=Elsevier Science Direct}} If seizures continue, second-line therapy includes phenytoin, fosphenytoin, and phenobarbital. Levetiracetam or valproate may also be used.

Starting anti-seizure medications is not typically recommended if it was a provoked seizure that can be corrected. Examples of causes of provoked seizures that can be corrected include low blood sugar, low blood sodium, febrile seizures in children, and substance/medication use. Starting anti-seizure medications is usually for those with medium to high risk of seizures re-occurring. This includes people with unprovoked seizures with abnormal brain imaging or abnormal EEG. It also includes those who have had more than one unprovoked seizure more than 24 hours apart.{{Cite journal |last1=Liu |first1=Gerald |last2=Slater |first2=Nicole |last3=Perkins |first3=Allen |date=2017-07-15 |title=Epilepsy: Treatment Options |url=https://pubmed.ncbi.nlm.nih.gov/28762701 |journal=American Family Physician |volume=96 |issue=2 |pages=87–96 |issn=1532-0650 |pmid=28762701}}

It is recommended to start with one anti-seizure medication. Another may be added if one is not enough to control the seizure occurrence. Approximately 70% of people can obtain full control with continuous use of medication.{{cite web |date=October 2012 |title=Epilepsy |url=https://www.who.int/mediacentre/factsheets/fs999/en/ |url-status=live |archive-url=https://web.archive.org/web/20160311001129/http://www.who.int/mediacentre/factsheets/fs999/en/ |archive-date=11 March 2016 |access-date=24 January 2013 |series=Fact Sheets |publisher=World Health Organization}} The type of medication used is based on the type of seizure.

Anti-seizure medications may be slowly stopped after a period of time if a person has just experienced one seizure and has not had any more. The decision to stop anti-seizure medications should be discussed between the doctor and patient, weighing the benefits and risks.

In severe cases where seizures are uncontrolled by at least two anti-seizure medications, brain surgery can be a treatment option. Epilepsy surgery is especially useful for those with focal seizures where the seizures are coming from a specific part of the brain. The amount of brain removed during the surgery depends on the extent of the brain involved in the seizures. It can range from just removing one lobe of the brain (temporal lobectomy) to disconnecting an entire side of the brain (hemispherectomy). The procedure can be curative, where seizures are eliminated. However, if it is not curative, it can be palliative, reducing the frequency of seizures but not eliminating them.{{Cite journal |last=Matern |first=Tyson S. |last2=DeCarlo |first2=Rebecca |last3=Ciliberto |first3=Michael A. |last4=Singh |first4=Rani K. |year=2021 |title=Palliative Epilepsy Surgery Procedures in Children |url=https://pubmed.ncbi.nlm.nih.gov/34620461 |journal=Seminars in Pediatric Neurology |volume=39 |pages=100912 |doi=10.1016/j.spen.2021.100912 |issn=1558-0776 |pmid=34620461 |via=PubMed}}

Helmets may be used to provide protection to the head during a seizure. Some claim that seizure response dogs, a form of service dog, can predict seizures. Evidence for this, however, is poor.{{cite journal | vauthors = Doherty MJ, Haltiner AM | title = Wag the dog: skepticism on seizure alert canines | journal = Neurology | volume = 68 | issue = 4 | pages = 309 | date = January 2007 | pmid = 17242343 | doi = 10.1212/01.wnl.0000252369.82956.a3 | s2cid = 33328776 | citeseerx = 10.1.1.1003.1543 }} Cannabis has also been used for the management of seizures that do not respond to anti-seizure medications. Research on its effectiveness is ongoing, but current research shows that it does reduce seizure frequency.{{Cite journal |last1=Lattanzi |first1=Simona |last2=Trinka |first2=Eugen |last3=Striano |first3=Pasquale |last4=Rocchi |first4=Chiara |last5=Salvemini |first5=Sergio |last6=Silvestrini |first6=Mauro |last7=Brigo |first7=Francesco |year=2021 |title=Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox–Gastaut Syndrome |journal=CNS Drugs |language=en |volume=35 |issue=3 |pages=265–281 |doi=10.1007/s40263-021-00807-y |pmc=8005394 |pmid=33754312 }}{{Cite journal |last1=Elliott |first1=Jesse |last2=DeJean |first2=Deirdre |last3=Clifford |first3=Tammy |last4=Coyle |first4=Doug |last5=Potter |first5=Beth K. |last6=Skidmore |first6=Becky |last7=Alexander |first7=Christine |last8=Repetski |first8=Alexander E. |last9=Shukla |first9=Vijay |last10=McCoy |first10=Bláthnaid |last11=Wells |first11=George A. |year=2020 |title=Cannabis-based products for pediatric epilepsy: An updated systematic review |url=https://pubmed.ncbi.nlm.nih.gov/31865133 |journal=Seizure |volume=75 |pages=18–22 |doi=10.1016/j.seizure.2019.12.006 |issn=1532-2688 |pmid=31865133 |via=PubMed}} A ketogenic diet or modified Atkins diet may help in those who have epilepsy who do not improve following typical treatments, with evidence for its effectiveness growing.{{cite journal |last1=Martin-McGill |first1=Kirsty J. |last2=Bresnahan |first2=Rebecca |last3=Levy |first3=Robert G. |last4=Cooper |first4=Paul N. |title=Ketogenic diets for drug-resistant epilepsy |journal=The Cochrane Database of Systematic Reviews |date=24 June 2020 |volume=2020 |issue=6 |pages=CD001903 |doi=10.1002/14651858.CD001903.pub5 |pmid=32588435 |pmc=7387249 |issn=1469-493X}}{{Cite journal |last1=Devi |first1=Nagita |last2=Madaan |first2=Priyanka |last3=Kandoth |first3=Nidhun |last4=Bansal |first4=Dipika |last5=Sahu |first5=Jitendra Kumar |year=2023 |title=Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis |journal=JAMA Pediatrics |language=en |volume=177 |issue=3 |pages=258–266 |doi=10.1001/jamapediatrics.2022.5648 |pmc=9887534 |pmid=36716045 }}

Following a person's first seizure, they are legally not allowed to drive until they are seizure-free for a period of time. This period of time varies between states, but is usually between 6 and 12 months. They are also cautioned against working at heights and swimming alone in case a seizure occurs.

Following a first unprovoked seizure, the risk of more seizures in the next two years is around 40%.{{Cite journal |last1=Neligan |first1=Aidan |last2=Adan |first2=Guleed |last3=Nevitt |first3=Sarah J |last4=Pullen |first4=Angie |last5=Sander |first5=Josemir W |last6=Bonnett |first6=Laura |last7=Marson |first7=Anthony G |date=2023-01-23 |editor-last=Cochrane Epilepsy Group |title=Prognosis of adults and children following a first unprovoked seizure |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=1 |pages=CD013847 |doi=10.1002/14651858.CD013847.pub2 |pmc=9869434 |pmid=36688481 }} Starting anti-seizure medications reduces recurrence of seizures by 35% within the first two years. The greatest predictors of more seizures are problems either on the EEG or on imaging of the brain. Those with normal EEG and normal physical exam following a first unprovoked seizure had less risk of recurrence in the next two years, with a risk of 25%. In adults, after 6 months of being seizure-free after a first seizure, the risk of a subsequent seizure in the next year is less than 20% regardless of treatment.{{cite journal | vauthors = Bonnett LJ, Tudur-Smith C, Williamson PR, Marson AG | title = Risk of recurrence after a first seizure and implications for driving: further analysis of the Multicentre study of early Epilepsy and Single Seizures | journal = BMJ | volume = 341 | pages = c6477 | date = December 2010 | pmid = 21147743 | pmc = 2998675 | doi = 10.1136/bmj.c6477 }} Those who have a seizure that is provoked have a low risk of re-occurrence, but have a higher risk of death compared to those with epilepsy.{{Cite book| vauthors = Neligan A, Hauser WA, Sander JW |title=Epilepsy |chapter=The epidemiology of the epilepsies |series=Handbook of Clinical Neurology |year=2012|volume=107|pages=113–33|pmid=22938966|doi=10.1016/B978-0-444-52898-8.00006-9|isbn=9780444528988}}; {{cite journal | vauthors = Sander JW, Shorvon SD | title = Epidemiology of the epilepsies | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 61 | issue = 5 | pages = 433–443 | date = November 1996 | pmid = 8965090 | pmc = 1074036 | doi = 10.1136/jnnp.61.5.433 }}

Approximately 8–10% of people will experience an epileptic seizure during their lifetime.{{cite journal | vauthors = Gavvala JR, Schuele SU | title = New-Onset Seizure in Adults and Adolescents: A Review | journal = JAMA | volume = 316 | issue = 24 | pages = 2657–2668 | date = December 2016 | pmid = 28027373 | doi = 10.1001/jama.2016.18625 }} In adults, the risk of seizure recurrence within the five years following a new-onset seizure is 35%; the risk rises to 75% in persons who have had a second seizure. In children, the risk of seizure recurrence within the five years following a single unprovoked seizure is about 50%; the risk rises to about 80% after two unprovoked seizures.{{cite journal | vauthors = Camfield P, Camfield C | title = Incidence, prevalence and aetiology of seizures and epilepsy in children | journal = Epileptic Disorders | volume = 17 | issue = 2 | pages = 117–123 | date = June 2015 | pmid = 25895502 | doi = 10.1684/epd.2015.0736 | s2cid = 20719640 | doi-access = free }} In the United States in 2011, seizures resulted in an estimated 1.6 million emergency department visits; approximately 400,000 of these visits were for new-onset seizures.

Epileptic seizures were first described in an Akkadian text from 2000 B.C.{{cite journal | vauthors = Magiorkinis E, Sidiropoulou K, Diamantis A | title = Hallmarks in the history of epilepsy: epilepsy in antiquity | journal = Epilepsy & Behavior | volume = 17 | issue = 1 | pages = 103–108 | date = January 2010 | pmid = 19963440 | doi = 10.1016/j.yebeh.2009.10.023 | s2cid = 26340115 }} Early reports of epilepsy often saw seizures and convulsions as the work of "evil spirits".{{cite journal | vauthors = Ali R, Connolly ID, Feroze AH, Awad AJ, Choudhri OA, Grant GA | title = Epilepsy: A Disruptive Force in History | journal = World Neurosurgery | volume = 90 | pages = 685–690 | date = June 2016 | pmid = 26709155 | doi = 10.1016/j.wneu.2015.11.060 }} The perception of epilepsy, however, began to change in the time of Ancient Greek medicine. The term "epilepsy" itself is a Greek word, which is derived from the verb "epilambanein", meaning "to seize, possess, or afflict". Although the Ancient Greeks referred to epilepsy as the "sacred disease", this perception of epilepsy as a "spiritual" disease was challenged by Hippocrates in his work On the Sacred Disease, who proposed that the source of epilepsy was from natural causes rather than supernatural ones.

Early surgical treatment of epilepsy was primitive in Ancient Greek, Roman and Egyptian medicine.{{Cite journal| vauthors = Meador KJ, Loring DW, Flanigin HF |date=January 1989|title=History of epilepsy surgery|journal=Journal of Epilepsy|volume=2|issue=1|pages=21–25|doi=10.1016/0896-6974(89)90054-6|issn=0896-6974}} The 19th century saw the rise of targeted surgery for the treatment of epileptic seizures, beginning in 1886 with localized resections performed by Sir Victor Horsley, a neurosurgeon in London. Another advancement was that of the development by the Montreal procedure by Canadian neurosurgeon Wilder Penfield, which involved use of electrical stimulation among conscious patients to more accurately identify and resect the epileptic areas in the brain.

Seizures result in direct economic costs of about one billion dollars in the United States. Epilepsy results in economic costs in Europe of around €15.5 billion in 2004.{{cite book |author=National Institute for Health and Clinical Excellence |title=The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care |date=January 2012 |publisher=National Clinical Guideline Centre |pages=21–28 |chapter=Chapter 1: Introduction |chapter-url=http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |archive-url=https://web.archive.org/web/20131216151008/http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf |archive-date=16 December 2013 |url-status=live}} In India, epilepsy is estimated to result in costs of US$1.7 billion or 0.5% of the GDP. They make up about 1% of emergency department visits (2% for emergency departments for children) in the United States.{{cite journal |vauthors=Martindale JL, Goldstein JN, Pallin DJ |date=February 2011 |title=Emergency department seizure epidemiology |journal=Emergency Medicine Clinics of North America |volume=29 |issue=1 |pages=15–27 |doi=10.1016/j.emc.2010.08.002 |pmid=21109099}}

Scientific work into the prediction of epileptic seizures began in the 1970s. Several techniques and methods have been proposed, but evidence regarding their usefulness is still lacking.{{cite journal | vauthors = Litt B, Echauz J | title = Prediction of epileptic seizures | journal = The Lancet. Neurology | volume = 1 | issue = 1 | pages = 22–30 | date = May 2002 | pmid = 12849542 | doi = 10.1016/S1474-4422(02)00003-0 | s2cid = 10109539 }}

Two promising areas include: (1) gene therapy,{{cite journal | vauthors = Walker MC, Schorge S, Kullmann DM, Wykes RC, Heeroma JH, Mantoan L | title = Gene therapy in status epilepticus | journal = Epilepsia | volume = 54 | issue = Suppl 6 | pages = 43–45 | date = September 2013 | pmid = 24001071 | doi = 10.1111/epi.12275 | s2cid = 13942394 | doi-access = free }} and (2) seizure detection and seizure prediction.{{cite journal | vauthors = Mormann F, Andrzejak RG, Elger CE, Lehnertz K | title = Seizure prediction: the long and winding road | journal = Brain | volume = 130 | issue = Pt 2 | pages = 314–333 | date = February 2007 | pmid = 17008335 | doi = 10.1093/brain/awl241 | doi-access = free }}

Gene therapy for epilepsy consists of employing vectors to deliver pieces of genetic material to areas of the brain involved in seizure onset.

Seizure prediction is a special case of seizure detection in which the developed systems are able to issue a warning before the clinical onset of the epileptic seizure.

Computational neuroscience has been able to bring a new point of view on the seizures by considering the dynamical aspects.{{cite journal |vauthors=Depannemaecker D, Destexhe A, Jirsa V, Bernard C |date=August 2021 |title=Modeling seizures: From single neurons to networks |journal=Seizure |language=English |volume=90 |pages=4–8 |doi=10.1016/j.seizure.2021.06.015 |pmid=34219016 |s2cid=235468072 |doi-access=free}}

{{Reflist}}

{{Wiktionary|seizure}}

{{Commons category|Seizures}}

{{Medical resources

| DiseasesDB = 19011

| ICD11 = {{ICD11|8A63}}–{{ICD11|8A68}}

| ICD10 = {{ICD10|R56}}, {{ICD10|G40.9}}

| ICD9 = {{ICD9|780.3}}, {{ICD9|345.9}}

| ICDO =

| OMIM =

| MedlinePlus = 003200

| eMedicineSubj = neuro

| eMedicineTopic = 415

| eMedicine_mult = {{eMedicine2|neuro|694}}

| MeshID = D012640

}}

{{Seizures and epilepsy}}

{{CNS diseases of the nervous system}}

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{{Authority control}}

{{DEFAULTSORT:Epileptic Seizure}}

Category:Symptoms and signs

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