What is seizure and what causes it?

A seizure occurs when there is out-of-control electrical activity in your brain. A seizure can take many forms, ranging anywhere from an involuntary muscle twitch, to “blanking out,” to losing consciousness and convulsing on ground uncontrollably (which most people think of when they hear the word “seizure”). Seizures can take many forms because they have many causes. They can be focal (i.e. propagating from one area of the brain, such as with a brain tumor or a brain bleed), or can be global (seizure activity everywhere in the brain at once, such as with metabolic disturbances).

If you suspect somebody has a seizure, the first diagnostic test to get is an EEG (electroencephalogram), which is essentially an EKG for the brain. It graphs the electrical activity of the brain. A trained neurologist can interpret normal brain wave activity and differentiate it from possible seizure activity. If you are certain that there is seizure activity, you get an MRI to look for any structural abnormalities that can cause seizures (trauma, tumors, AV malformations, etc).

Seizures are treated in many different ways. Ideally, you treat the underlying cause (get rid of the tumor, correct the metabolic abnormality, etc), but sometimes this isn’t possible. You can also treat them with medications called anti-epileptic drugs. There are many AED’s, with different mechanisms of action and different side effects (agitation, suicidal ideations, dizziness, risk of taking when pregnant). Choosing the right AED can be tricky, because you have to know what type of seizure you’re treating, and weigh the risk of side effects with the benefit of hopefully stopping the seizures.

Identifying triggers and avoiding them is a must (avoiding sleep deprivation, bright/flashing lights, etc). Ketogenic diets have also been found to be beneficial in reducing seizure activity in some patients. Also, patients with epilepsy must know how to avoid certain activities in case they have a seizure while doing them (driving, climbing ladders, cooking with gas, stepping into bath tubs).

If you see somebody that you suspect is actively seizing, the best thing to do is give them room, keep others back, and call 911. Do NOT try and hold them down, and do NOT stick anything in their mouth. It is a common misconception that people with seizures will swallow their tongue. This is physically impossible.

Epilepsy is a very common neurologic disorder. Fortunately, we live in a time where we have so many different ways to treat seizures. New medicines are being invented all the time. Vimpat, for example, was just approved by the FDA 8 years ago, and is now used in hospitals all around the United States. We still have a long ways to go, but we’re making great progress in treating epilepsy.

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