Emergency Treatment for Seizures - Causes, Types, and Treatment

Introduction:

The human brain has billions of cells communicating with each other through chemical and electrical signals. These electrical communicating networks formed by brain cells or neurons help the brain function and thus control thoughts, memories, consciousness, behaviors, and muscle movements. Excessive electrical activity in the brain can cause sudden involuntary or out-of-control behavior or consciousness. These uncontrolled sensations, awareness, muscle movements, and behaviors due to sudden electrical bursts in the brain are known as seizures. Unprovoked and spontaneous seizures are commonly seen in a brain disease called epilepsy. Seizure episodes in an epilepsy patient can last from a few seconds to minutes. Repeated seizures and those with a longer duration can cause permanent damage to the brain cells. These can also cause chemical changes in the blood that further damage the brain.

What Are the Causes of Seizures?

About 50 percent of seizures occur without any known cause. However, seizures may occur due to the following reasons:

1. Epilepsy.

2. Head injuries.

3. Lead poisoning.

4. Brain tumors.

5. Infectious disease.

6. Inadequate brain development.

7. Severe fever.

8. Alcohol abuse and alcoholism.

9. Alzheimer's disease and other degenerative diseases of the brain.

10. Kidney failure.

11. Lupus (a disease of the body’s immune system).

12. Stroke.

13. Electrolyte imbalance (the sodium, potassium, calcium, and other electrolytes are not balanced in the blood).

14. Hormonal changes.

What Are the Major Types of Seizures?

The type of seizure depends to some extent on the part of the brain that has sudden electrical outbursts. The major types of seizures include:

1. Generalized Seizures: Abnormal, uncontrolled brain activity on both sides of the brain causes generalized seizures. These are also known as generalized tonic-clonic seizures and have severe symptoms and effects as they involve the entire brain. These are common in epilepsy.

2. Focal Seizures: In focal seizures, uncontrolled electrical outbursts occur on one side of the brain or in one focal region of the brain. Symptoms are seen on one side or a specific part of the body. These partial seizures can progress to generalized seizures.

3. Status Epilepticus: If a seizure occurs for a prolonged duration (lasts for more than five minutes) or if multiple seizures occur subsequently without sufficient time to recover, it can be life-threatening. This type of seizure is known as status epilepticus and can cause disability due to permanent brain damage and death.

What Happens During a Seizure?

The patients often pass out during seizures. As a result, there is an increased risk of falls and injuries. Most cases do not require calling for emergency care. However, it is essential to take care of the patient, keep them safe from harmful sharp objects, and ensure that the person is breathing and has a clear airway. The symptoms of a seizure episode include the following:

1. A warning sign or a preceding aura.

2. A convulsion with rhythmic jerks (complex partial seizure).

3. Unresponsiveness (usually eyes remain open).

4. Breathing is barely detectable during a seizure (and deep breaths during recovery).

5. Unable to control urination.

6. Abnormal movements of limbs (arms and legs).

7. Periods of staring.

8. Abnormal stiffening of the muscles.

9. A transition phase (post-ictal period) back to normal.

What to Do in Case a Person Has a Seizure?

When a person experiences a seizure, one can take the following steps:

1. First, ease the patient to the floor and cushion the patient’s head.

2. Prevent the patient from falling.

3. Remove the patient’s eyeglasses, if any.

4. Remove objects that can harm the patient (sharp objects).

5. Loosen tight clothing such as ties, neckwear, and scarves.

6. Check if the patient is breathing and if the airway is clear. If the patient is not breathing, immediately call for emergency care and start rescue breaths.

7. Refrain from putting anything (such as food or drink) in the patient’s mouth. The patient cannot swallow during a seizure. This can cause injury or choking.

8. Do not try to restrain the seizure convulsions and movements.

9. If the patient vomits after a seizure, ensure to roll the patient to their left. This helps drain the vomit or other secretions from the mouth, clear the airway (passage of airflow to the lungs), and allows them to breathe.

10. Note the length of the seizure episode, the head direction, the type of body movements, eye movements, and the time taken to get back to normal consciousness. Report the details of the seizure episode to the emergency personnel or doctor.

11. Check for medical tags such as bracelets with important medical information.

12. Stay with the patient till the episode of seizure ends.

13. After the seizure, make the patient sit in a safe place and communicate with them to ensure they are awake and back to normal. Inform them that they experienced a seizure calmly.

14. Comfort the patient after a seizure and ensure the patient’s safety.

When Should We Call for Emergency Medical Care if a Person Has a Seizure?

It is not necessary to call for emergency medical services for all seizure episodes. However, quickly call for emergency medical help in the following conditions:

1. The patient has seizures for more than five minutes.

2. The patient has multiple repeated seizures with no time to recover between them.

3. The patient has persistent difficulty in breathing or has stopped breathing.

4. The patient remains unconscious after the seizure.

5. The patient remains confused and not alert after the episode.

6. The patient has other co-morbidities, such as diabetes, or is pregnant.

7. The patient has other life-threatening medical conditions.

8. The patient has experienced a seizure for the first time.

9. In patients with known epilepsy, any significant change in the duration or type of the seizure.

How Can We Treat Seizures?

If the seizures are due to any underlying cause, such as high fever, alcohol, and low blood sugar, treating the cause can help the patients. The doctor may recommend certain diagnostic blood tests to check blood chemistry imbalances, metabolic and immune system problems, toxins and poisons. Other diagnostic tests and imaging, such as an electroencephalogram to check brain activity, computed tomography, and magnetic resonance imaging, are performed to look for the cause or suspected injury. Treating the cause often resolves the problem and prevents seizures. If the condition causing the seizures cannot be cured, the doctor might recommend medicines to decrease the seizure severity and episodes. The following can be used to treat seizures and prevent recurrence:

1. Medications: Intravenous medications can help the person having a seizure episode. Various medications are prescribed to reduce the frequency and severity of the seizure episodes.

2. Surgery: Surgeries to treat conditions such as epilepsy are performed if the medications do not work.

3. Dietary Changes: Changes in diet, such as a no-carb diet, can help patients.

4. Brain Stimulation: A medical device implanted into the patient’s brain can produce a mild electric current and interfere with uncontrolled electrical activity during a seizure.

5. Electrical Stimulation of Nerve: Stimulation of an important nerve (vagus nerve) helps to reduce the frequency of seizures.

Conclusion:

Seizures are caused by excessive electrical activity in the brain. These result in sudden involuntary or out-of-control behavior or consciousness, uncontrolled sensations, awareness, muscle movements, and behaviors. These are common in epilepsy. Seizure episodes in an epilepsy patient can last from a few seconds to a few minutes. However, repeated seizures and those with a longer duration (greater than five minutes) can cause permanent damage to the brain cells. Such severe seizure episodes require immediate emergency medical care.