Seizures (Convulsive Disorders, Epilepsy)
When the brains normal electrical activity is disrupted, seizures, or convulsions, can occur. They are classified as generalized or partial, with variations in each category. Generalized seizures include the following:
Tonic-clonic, or grand mat. The person abruptly halts all activity and loses consciousness briefly. This tonic phase lasts for only a few seconds and is characterized by a sustained contraction of muscles. The subsequent clonic phase may last for five minutes, during which time muscles spontaneously relax and contract, creating convulsive twitching. If only one phase occurs, it is called either clonic or tonic.
Atonic, or drop attach. The person suddenly loses muscle tone, goes limp, and is unconscious for several minutes.
Myoclonic. The person usually remains conscious, but exhibits brief, random contractions and twitching of a muscle.
Absence, or petit mal. The person, usually a child, has a brief episode of altered awareness, in which he stares blankly ahead.
Partial seizures may involve muscles, sensory organs, or menial function, but do not result in generalized convulsions. In some occurrences, muscles may twitch in a specific area, such as a leg, or there may be localized tingling. Others involve brief mental lapses that are similar to absence seizures. A common partial seizure is characterized by repetitive motions that are a continuation of an activity but lacking in purpose. For example, a child might continue a writing motion without actually forming letters.
Epilepsy, the most common seizure disorder, is characterized by recurrent seizures that follow a specific pattern.
Diagnostic Studies and Procedures
Seizures can be diagnosed from symptoms and an eyewitness account of an attack, but determining the cause is often difficult, sometimes impossible. Tests include blood studies, an electroencephalogram (EEG) to measure the brain's electrical activity. X-rays, and perhaps a CT scan or MRI.
Medical Treatments
Medication with anticonvulsant drugs can prevent seizures or reduce their frequency. Commonly used anticonvulsant medications are phenytoin (Dilantin), phenobarbital, primidone (Mysoline), carbamazepine (Tegretol), eihosuximide (Zarontin), clonazepam (Klonopin), and valproic acid (Depakene). The side effects vary, but may include lethargy, drowsiness, dizziness, nausea and vomiting, gait problems, and mental changes.
Finding the right drug or combination of drugs usually involves a period of trial and error. Once a regimen is found to work however, the patient should stay on it. This is one instance in which a generic drug should not be substituted for a brand-name product. Even though the active ingredients may be the same, the two drugs may react differently in the body. Some patients are eventually able to discontinue their medication, while others must remain on it for life.
Surgery may be tried if seizures cannot be controlled by drugs.
Alternative Therapies
Nutrition Therapy. Fasting has been known to eliminate seizures, but this was hardly a feasible treatment for epilepsy until neurologists at Johns Hopkins devised a diet that mimics fasting metabolism. The regimen calls for a high intake of fats, only enough protein for growth, and little or no carbohydrates. This ketogenic diet is recommended mostly for children whose epilepsy cannot be controlled by drugs or who suffer severe side effects from anticonvulsants. It must be tailored individually and followed carefully; after two years, most children can resume a normal diet without recurrence of seizures.
Meditation. This and other relaxation techniques may be helpful for seizures that are triggered by stress.
Self-Treatment
Some people can modify their tendency to have seizures by identifying and then avoiding triggering factors. An orderly, moderate lifestyle, adequate rest, and a nutritious diet help most patients. Others with severe seizures may benefit-from the Johns Hopkins ketogenic diet.
Anyone who has a seizure disorder should wear a medical identification bracelet or necklace that lists the illness and an emergency phone number.
Other Causes of Seizures
A rapidly rising temperature can produce febrile seizures, especially in babies. A brain injury, certain drugs, poisons, lack of oxygen, and either high or low blood sugar can cause seizures.