Seizures Emergencies

Seizures can cause symptoms, such as mild loss of attention, violent muscular contractions, and even death.

What is the medical definition of a seizure?

Seizures are uncontrolled electrical activity in the brain that may lead to symptoms that may range from mild loss of attention to violent muscular contractions that can lead to death. Everyone has the potential to have seizures. Some people have them frequently. Seizure disorders vary tremendously. Some people have only an occasional seizure, and other people have daily or more frequent seizures. Another term frequently used in the place of seizure is convulsion.

• There are many different types of seizures. Seizure activity may range from simple blank staring to loss of consciousness with spasticity or muscle jerking.

When should you go to the ER for a seizure?

• Generally, a seizure should be considered an emergency in these situations:
  • Seizures that do not stop within a few minutes.
  • Prolonged confusion remains after the seizure (more than 10-15 minutes).
  • The person is not responsive after a seizure.
  • The person has trouble breathing.
  • The person is injured during the seizure.
  • The seizure is a first-time seizure.
  • There is a significant change in the type or character of the seizure from that person's usual seizure pattern.

Many people have seizures for reasons that are unknown. Other people have seizures from some condition that affects normal brain functioning. These may include brain tumor, infections, fever, birth injuries, injury, or trauma.

• Other problems that might affect the functioning of the brain and lead to seizures include drugs or medications, alcohol, low blood sugar, or other chemical abnormalities.
• Rapidly flashing lights, high stress, or lack of sleep may induce seizures in certain people.

Seizures in children are a special category of seizures that are addressed a bit differently. 

Childhood seizure disorders mostly have an underlying genetic cause, but some are not easily classifiable. Some childhood epilepsy syndromes are as follows:

• Doose syndrome (myoclonic-atonic epilepsy),
• Lennox-Gastaut syndrome,
• Dravet syndrome (severe myoclonic epilepsy of infancy)
  • Progressive spasticity is frequently seen in older children and adolescents with Dravet syndrome, often associated with the development of crouched gait or walk.
  • Causes may include brain malformation and mutations that cause neurons to malfunction, such as SCN1A mutations.
• Benign neonatal myoclonic epilepsy,
• Familial myoclonic epilepsy, and
• Autosomal dominant cortical myoclonus and epilepsies,
• Unverricht-Lundborg disease,
• Lafora body disease,
• myoclonic epilepsy with ragged red fibers (MERRF),
• the neuronal ceroid lipofuscinosis, sialidosis, and dentate-rubral-pallidoluysian atrophy (DRPLA).

• Common generalized seizures often begin when the person cries out or makes some sound. This may be followed by several seconds of abnormal stiffening, progressing to abnormal rhythmic jerking of the arms and legs.
  • The eyes are generally open, but the person is not responsive or alert.
  • The person may not appear to be breathing. They are, however, actually usually breathing adequately for the brief duration of the seizure. The person often breathes deeply for a while after an episode.
  • He or she will return to consciousness gradually over several minutes.
  • Incontinence, or loss of urine, is common.
  • Often people will be combative briefly after a generalized seizure (a seizure that involves the entire brain).
• Many other seizure types exist, including isolated abnormal movements of a single limb, staring spells, or abnormal stiffening without the rhythmic jerking.

A first seizure is a reason to visit the doctor or a hospital's emergency department. For a person with a seizure disorder, a change in seizure patterns or more frequent seizures are reasons to seek medical care.

Many people with recurrent seizures may have a seizure and awaken fully. Immediate medical attention is not often needed if the person is fully awake and has not suffered injury and is known to have recurrent seizures.

Other conditions, however, call for immediate medical attention.

• A seizure that continues more than 5 minutes or a series of seizures without full recovery between them
• Persistent breathing difficulty (Often the person may appear to stop breathing briefly during the seizure, but breathing should resume quickly; if it does not, call 911, check for a pulse and if necessary, begin CPR.)
• Injuries sustained during a seizure
• Persistent confusion or unconsciousness
• A first seizure
• A significant change from that person's usual seizure pattern in terms of seizure type, seizure length, or associated symptoms

A doctor should evaluate any questionable seizure.

Not all of the following diagnostic tests are necessary for every seizure type, and many are not necessary upon first evaluation in the emergency department. Some may be arranged with a primary care doctor later as an outpatient.

The evaluation and treatments needed may include these procedures:

• Blood tests
• Imaging (head CT scan or MRI)
• Spinal tap
• EEG (electroencephalogram or a brain wave tracing)
• Medications to stop or prevent seizures

Emergency treatment usually involves IV (or oral medication in some people) medication such as lorazepam; other drugs may also be utilized with this drug type (phenytoin or fosphenytoin). Treatment is needed to begin soon as continual seizures lasting 20-30 min. may result in damage to the brain. Once seizures are controlled, the underlying cause is sought. Additional medications depend on the underlying causes and the recommendations from a neurologist.

Home care is appropriate when a person is known to have seizures, if the seizure is brief, and if the person recovers uneventfully. Usually, the patient is being treated by a neurologist and that doctor may need to be notified. However, there are some suggestions that may help prevent injuries associated with seizures as follows:

• Prevent injuries.
• Cushion the head.
• Loosen any tight neckwear.
• Turn the person on his or her side after the convulsion ceases. This may help drain any moisture or secretions from the person's mouth and prevent chocking or aspiration.
• Do not attempt to hold down or restrain the person.
• Do not place anything in the person's mouth or try to pry the teeth apart.
• Observe these items: length of seizure, type of movements, direction of any head or eye turning, amount of time to return to alertness and full consciousness.

Seizures are often continuing concerns. It is important to keep any follow-up appointments or tests. Most patients are referred to a neurologist for follow-up

• Until the seizures are well controlled, it is important to avoid driving or engaging in any other potentially dangerous activity that may cause you harm or harm to others if a seizure suddenly occurs.
• Many states require mandatory reporting of seizures to state drivers' license bureaus and other regulatory agencies.
• Many patients on seizure medications do very well and at some point in time decide to quit taking their antiseizure medication. This decision may be dangerous for themselves and others. Patients should not discontinue medications unless advised to do so by their physician.

For many people with recurrent seizures, one key to prevention is taking prescribed medication on a regular basis.

• Failure to take antiseizure medications as prescribed is a common cause of recurrent seizures. Certain medical conditions or interaction with other medication can lead to temporary failure of the antiseizure medicine even if taken properly.
• If the cause of the seizure is discovered, it is important to treat that condition and address whatever caused the seizure.

The outlook for someone with seizures usually depends on the cause of the seizure. Investigation by a doctor is usually needed to discover the cause or at least exclude some causes.

• Most seizures related to medications, drugs, or minor head injury, for example, resolve without specific treatments and do not indicate an ongoing seizure disorder or epilepsy.
• Most other seizure disorders can be effectively managed with proper medications given under the guidance of your doctor or a specialist known as a neurologist.
• Some seizure disorders are difficult to control despite medications and other therapies. This situation is rare.
• A subclass of seizures is known as nonepileptic seizures or pseudoseizures. These are not truly epileptic seizures at all, but rather represent a condition in which someone has realistic-appearing seizures because of an underlying stress or psychological disorder. Prognosis for these is very good and is related entirely to resolving the person's underlying disorder with counseling, not antiseizure medications. This possibility should be considered in these cases:
  • When no cause of seizures can be found
  • If the seizures cannot be verified despite appropriate evaluation
  • If the seizures are resistant to appropriate medical therapies