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Seizure (Convulsions)

Seizure (Convulsions) Treatment in Delhi, India

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Overview

A convulsion, also termed a seizure, is defined as a sudden occurrence of abnormal electrical activity in the brain. As a result of this, an individual undergoes specific behavioural changes and an altered level of consciousness. They can occur among any age group and involve either a particular muscle group or the entire body as a whole. During convulsions, the various muscle groups of an individual tend to contract in an unconstrained manner. These take place after an individual undergoes either an episode of stroke or after a closed head injury due to any road traffic accident or even due to an infection of the brain, i.e. Meningitis. These last from a few seconds to 2 -3 minutes. If the seizures last for more than 5 minutes, then the patient needs to be shifted to a nearby hospital on an emergency basis.

Types of Convulsions

Based on the site of origin, the seizures may be classified as follows:

1 Partial/focal seizures

2 Generalised seizures

  1. Partial/Focal Seizures: These occur due to abnormal electrical activity taking place in one part of the brain. At times, these are associated with loss of consciousness as well. These are categorised into the following types:  
  • Simple Partial Seizures:  These take place when a specific part of the body gets involved, like arms or legs. The consciousness is intact
  • Complex Partial Seizures:  These originate in one hemisphere of the brain and are associated with impairment of consciousness
  • Status Epilepticus: It refers to a condition where a patient tends to have repetitive partial or generalised seizures without regaining consciousness between the seizure attacks. In status epilepticus, the seizures last more than 5 minutes and it’s a medical emergency
  1. Generalised seizures: These result when both sides of the brain get affected and are frequently associated with loss of consciousness. It involves the entire body of an individual.

Types of Generalised Seizures

  • Tonic/Clonic Convulsions: The patient has a strong feeling about something unpleasant happening inside the body, which is followed by spasms and stiffness in the extremities during the tonic phase. It is followed by the clonic phase characterised by shaking and trembling. The patient is restless during this phase. Loss of consciousness followed by lack of bladder and bowel control is present during the seizure
  • Absence Seizures: There is a sudden lapse in consciousness that begins all of a sudden. It is mostly seen in children. They are unaware of their surroundings, resulting in a temporary blackout that lasts for a very short duration
  • Atonic Seizures: This type of seizure is characterised by a decrease in the strength of the muscles, which takes place suddenly and most likely, the person may fall down to the ground. These are also called akinetic seizures
  • Myoclonic Seizures: These are generally unnoticed as they tend to last for a few seconds only. These are characterised by the shaking of legs, arms, head, or entire body as soon as the patient wakes up from sleep. These occur in conjunction with atonic seizures

Symptoms of Seizures

The symptoms of seizures vary from patient to patient, and they mainly depend on the type of seizure, location in the brain, and age. The most commonly seen symptoms are as follows:

  • Loss of consciousness
  • Anxiety
  • Restlessness
  • Shaking of extremities
  • Disorientation
  • Continuous staring

Causes of Seizures (Convulsions)

Convulsions or seizures may be caused due to a variety of factors, the most common being epilepsy. However, there are cases where the cause remains unknown and cannot be detected in spite of undergoing all recommended tests. The following are the chief causes of convulsions:

  • Brain Infections: This can be due to either bacterial infection, i.e. meningitis or viral infection like encephalitis
  • High-grade fever: Most commonly found in children and aggravated by high grades of fever
  • Brain tumour: Mainly, middle-aged and older people are at risk of developing convulsions because of the tumour
  • Metabolic disorders: Conditions like diabetes and kidney problems can lead to altered blood sugar levels, thereby causing seizures
  • Alcohol withdrawal: Sudden withdrawal of alcohol results in convulsions or seizures
  • Other disorders: Conditions like stroke or heart disease result in decreased oxygen supply to the brain, resulting in seizures
  • Degenerative diseases of the brain: Alzheimer's disease is responsible for convulsions in older individuals
  • Eclampsia: Most commonly seen in pregnant females with high blood pressure levels
  • Inadequate sleep
  • Decreased blood sodium levels

Diagnosis of Seizures (Convulsions)

The doctor thoroughly examines the patient after going through the medical history and looks for all the symptoms present in the patient. These help the doctors make the proper diagnosis as well as select appropriate investigation protocols.

Various diagnostic tests include:

  • Blood investigations: Primarily done to find any infection or electrolyte imbalance, as well as for the presence of any toxic materials
  • Neurological Examination: Evaluation of brain and spinal cord by assessment of fine motor skills along with mental function and behaviour
  • Electroencephalogram: With the help of this method, the electrical activity of the brain is recorded. Doctors are able to predict the likely possibility of seizures in the near future as well
  • Lumbar puncture: Examination of cerebrospinal fluid is being done in order to find out if the cause of the seizure is because of infection or not
  • Imaging tests: Various imaging tests are as follows:

    •   MRI: The presence of lesions in the brain leads to seizures

    •  CT-Scan: Various tumours or even cysts, which are responsible for seizures or convulsions, are detected.

    •  PET scan: A dye is being injected into the vein, which helps to distinguish between the active and affected areas of the brain.  

Treatment of Seizures (Convulsions)

The main aim of convulsion management is to plan the best possible treatment approach for the patient with an emphasis on the least possible side effects. Therefore, various treatment approaches are as follows:

Medications: Anti-convulsant drugs are given to control seizures. However, the doctor decides on the best possible combination which gives optimal benefits with the least side effects

Surgery: Following is the list of surgeries being performed for seizures

  • Lesionectomy: It is performed to remove the lesion present in the area of the brain where seizures initially began. These lesions include tumours, infections and haematomas
  • Multiple subpial transections: Multiple incisions are being made in the brain to prevent the further onset of seizures
  • Corpus callosotomy: A surgical procedure is performed to treat those seizures, which start in one half of the brain and shift to the other half. Mainly used to treat epileptic seizures when anti-convulsant drugs don't benefit at all.
  • Hemispherectomy: This procedure involves the removal of half of the outer layer of the brain from the remaining half. Side effects of this procedure include loss of several routine functional abilities.

Electrical Stimulation: These include

Complications of Seizures (Convulsions)

Convulsions often lead to life-threatening scenarios. Commonly seen complications during an attack or seizure include:

  • Injury: Head injuries and fractures are very common complications encountered during seizures
  • Accidental immersion: If the attack or seizure comes at the time of swimming, then the chances of drowning are vastly increased
  • Accidents: Accidents are bound to happen while driving as patients are bound to lose control of the vehicle, resulting in fatal injuries

Prognosis of Seizures (Convulsions)

In various cases, convulsions occur just once, and patients may never know about the cause or have any ill effects. The prognosis for frequent convulsions or convulsions with seizures depends on the cause and may require short or long-term treatment. Epilepsy can be effectively managed.

Review

Reviewed by Dr. Mohit Goel - Associate Director- Neurology, Max Smart Hospital, Saket, Neurology, Neurosciences.


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