New Onset Seizures in Adults A Guide to Understanding Seizures What is a seizure? A seizure is the physical response to epilepsy or have experienced a seizure. Risk increased electrical activity in the brain. for new onset of epilepsy increases with age. The result is a synchronized firing of brain Epilepsy is NOT a mental illness. cells. Depending on the area of the brain affected, a person may experience many What if I have never had a seizure different symptoms. Seizures may have a but have been placed on seizure variety of symptoms such as: changes in medication? concentration, muscle contractions, body Many conditions such as brain surgery, tumor, jerking, or sensations such as numbness and or bleeding in the brain can increase the risk tingling. Most seizures last less than three of having a seizure. Prevention of seizures minutes, although confusion afterwards related to acute illness may decrease the risk may last longer. A seizure might be provoked for injury or complications. Your physician by a preceding event such as metabolic may recommend seizure medications disturbances or exposure to toxins. A for a short time to prevent a seizure from provoked seizure will often not reoccur if the happening until the brain has recovered cause of the seizure has been corrected. All from an injury. seizures should be assessed by a physician to determine the best treatment. Treatment How long does a seizure last? may vary based upon the specific cause of Seizures may last from a few seconds to a the seizure. few minutes. However, a person may remain sleepy and confused for a long time after a What is epilepsy? seizure. Epilepsy is a term used to describe a condition correlated with the ongoing risk What if a seizure does not stop? of recurring seizures. This can include having Immediate attention is needed if a seizure is more than one seizure or a single attack longer than 5 minutes. Multiple seizures that with a clear cause that increases the risk recur suddenly without regaining alertness for further seizures. Many people can have between events also requires immediate a seizure without having the syndrome attention. Call 911 if this happens. of epilepsy. Epilepsy is a disorder that affects many people. One percent of the population in the United States have been diagnosed with 1 Causes of Seizures • Idiopathic or unknown cause. No cause clogged, depriving parts of the brain of is identified in 30 percent of all new blood and oxygen. The resulting damage onset seizures. may produce seizures. • Brain Injury from accidents or • Bleeding in the brain, which is another other trauma. form of stroke, may also leave a person with seizures afterward. • Brain Infections like encephalitis or meningitis. • Heart attacks may temporarily cut off oxygen to the brain, with a similar result. • Genetic conditions. • Disease: Alzheimer’s disease, or other • Metabolism changes which prevent neurodegenerative diseases that change important nutrients from getting to the internal structure of the brain, may the brain. cause seizures. Complications of kidney • Electrolyte abnormalities caused by disease, liver disease, alcoholism and even certain medications or illnesses. diabetes may make people more likely to have seizures in later life. • Toxins such as drug overdose, alcohol, or environmental toxins. • Infections of the brain known as meningitis may cause seizures. Many adults have seizures related to physical changes associated with aging such as: • Brain tumors of any kind will increase the risk of seizures. • Stroke is the most frequent cause of seizures that begin in later life. As people • Surgery: An operation on the brain leaves age, arteries may become narrowed or a scar that can cause seizures later on. Types of Seizures There are many different types of seizures. (simple and complex) seizures, and status People may experience only one type of epilepticus. seizure, while others experience multiple types. The kind of seizure a person has Generalized Seizures depends upon which part and how much Generalized seizures affect the entire of the brain is affected by the electrical brain (both hemispheres) with a loss of disturbance. Seizures can be divided into consciousness. Types of generalized categories: generalized seizures, partial seizures include: 2 • Generalized Tonic Clonic often cause • Atonic seizures present with a sudden loss dramatic full body shaking known as tonic- of muscle tone. The person will suddenly clonic movements. The seizure will cause become limp and may fall from a a loss of awareness and the person may standing position. appear unconscious. Usually the person will be confused and sleepy after the shaking • Myoclonic seizures refer to quick (seizure) has stopped. This confusion movements or sudden jerking of the may last for a few minutes to a few hours. muscles. These seizures may occur several Special caution should be used to ensure times a day for several days in a row. a person is on their side and on a stable Partial Seizures surface (such as the floor) after a seizure to prevent breathing problems. In partial seizures, the electrical disturbance is limited to a specific area in the brain. Partial • Absence seizures are characterized by seizures affect different physical, emotional, an altered state of consciousness usually or sensory functions of the brain. The lasting less than 30 seconds. Usually, the symptoms are related to the part of the brain person’s posture is maintained during the that is affected by the seizure. Some people event. After the seizure the person may not have twitching on one part of the body or recall the event and will continue activity as they may feel sensations that seem abnormal though nothing has happened. This to them. type of seizure is often mistaken for a behavioral problem. Partial seizures are classified by the area of the brain that is affected by the seizure and a Postcentral Precentral gyrus gyrus Focal motor. Tonic-clonic movements Somatosensory. of upper (or lower) limb Tingling of contralateral Central limb, face, ssure or side of body Contraversive. Visual. Head and eyes turned Sees ashes of light, to opposite side scotomas, unilateral or bilateral blurring Autonomic. Sweating, ushing or pallor, and/or Auditory. epigastric sensations Hears ringing, hissing or noises 3 person’s state of awareness. Partial All partial seizures have some things seizures include: in common: • Simple Partial Seizures. Consciousness • They end naturally. Except in rare is not lost with this type of seizure. The cases, the brain has its own way of seizure usually does not last longer than bringing the seizure safely to an end one minute. A person may experience after a minute or two. sweating, nausea, visual changes, numbness, tingling, or isolated muscle • You can’t stop them. In an emergency, movement. doctors may use drugs to bring a lengthy, non-stop seizure to an end. However, the • Complex Partial Seizures. This type of average person should wait for the seizure seizure commonly begins in the temporal to run its course and try to protect the lobe of the brain. The temporal lobe person from harm while consciousness controls emotion and memory function. is clouded. There is an alteration in a person’s awareness or state of consciousness during Status Epilepticus a complex partial seizure. Seizures may Most seizures end after a few moments or present as lip smacking, screaming, and a few minutes. Seizures that are prolonged, muscle movements correlated with a state or occur as a series (repeated seizures in the of confusion. After the person regains same day) are called status epilepticus. The consciousness they will usually feel tired term literally means a continuous state of and sleepy for a few hours. seizure. This is always an emergency. Diagnosis and Treatment Options Diagnosis A test commonly used to diagnose epilepsy Doctors take a medical history, do blood is called an electroencephalogram (EEG). This tests and use a variety of medical tests to test records the electrical activity in the brain determine if a person is at risk for recurrent in the form of brain waves. In many patients seizures. If a person is at risk for recurrent the doctor can determine if the brain has seizures (epilepsy), they will often be referred abnormal electrical activity. This may indicate to a neurologist for evaluation and treatment. increased risk for more seizures in the future. A neurologist is a doctor that specializes in During the painless and non-invasive test, diseases of the brain, spine, and nerves. electrodes are placed on the scalp and brain waves are recorded. A brain scan may also 4 be done to see if there are any abnormalities on the type of seizure, age, and other within the brain which may cause seizures. medical conditions. (See section on Seizure Medications below.) Treatment For those at risk for seizure in the future, the When a medication fails to control seizures, doctor usually prescribes a drug that will other treatment options are available. lower the risk of recurrent seizures. More than Patients with seizures or serious side effects 70 percent of patients with epilepsy can have on seizure medication should discuss their seizures controlled with medications. the various treatment options with their Effectiveness of the medication depends neurologist. Seizure Medications What should I know about seizure Will medication cure me from medications? having seizures? For most people, medication will prevent Antiepileptic (anti-seizure) drugs successfully seizures as long as they are taken regularly. prevent seizures in the majority of people Successful drug therapy requires the active who take them regularly and as prescribed. It cooperation of the patient. Medications has been estimated that at least 50 percent do not cure epilepsy and should never be of all patients with epilepsy gain complete stopped without a doctor’s recommendation.