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Seizures

A temporary series of uncontrollable muscle spasms brought on by unusual electrical activity in the brain.

Also known as convulsion, clonic seizure, or tonic-clonic seizure.

A seizure is characterized by a sudden episode of un- controllable brain activity. The intense, involuntary muscular contractions that often accompany seizures are referred to as convulsions. Seizures normally last three to five minutes, with a period of unconsciousness that may last for up to 30 minutes.

Seizures can result from a chronic condition, such as epilepsy. Alternatively, convulsions may be related to an acute condition, such as a high fever, adverse reaction to medication, or infection. In childhood, the most common cause of convulsion, or seizure, is high fever. Seizures triggered by fever are referred to as febrile seizures. Seizures can also result from encephalitis, meningitis, otitis media (middle ear infection), or from the ingestion of large doses of drugs, such as antidepressants or stimulants.

There are two types of seizures: grand mal and petit mal. Grand mal seizures involve intense contractions of the muscles of the trunk and limbs. Immediately prior to the seizure, the patient may have some indication that it is imminent. During the seizure the patient becomes un- conscious and experiences generalized muscle contractions, known as clonic seizures, that may distort the body. Thrashing movements of the limbs follow, caused by opposing sets of muscles alternating in contractions (hence, the other name for grand mal seizures: tonic- clonic seizures). The patient may also lose bladder control. When the seizure ceases, usually after three to five minutes, the patient may remain unconscious for up to half an hour. Upon waking, he or she may not remember having had a seizure and may be confused.

Petit mal seizures last approximately 30 seconds, during which the patient may experience subtle signs of irregular brain activity before returning to normal activity. Signs of petit mal seizures include blinking, staring into space, or pausing in conversation. Petit mal seizures are hereditary, and only occur only in children and adolescents under age 20. The seizures may occur several times a day, usually when the patient is quiet. After puberty, petit mal seizures usually disappear or are replaced by grand mal seizures.

Status epilepticus is a very rare but potentially lifethreatening condition in which grand mal seizures occur in rapid succession with no period of recovery between them. The patient may have difficulty breathing and experience a dangerous rise in blood pressure. Status epilepticus can be triggered by abruptly discontinuing medication prescribed for epilepsy, or by alcohol withdrawal.

Although observing a child experiencing a seizure can be alarming, the incident itself rarely leads to serious injury or complications. People of all ages who experience seizures are more adversely affected by misconceptions and stigma attached to seizures than by the seizure itself. For many individuals, the unpredictableness and loss of control over one's body are the most difficult aspects of seizure. Adolescents, particularly susceptible to seizure associated with epilepsy, may find the loss of control and dependence on others especially disturbing. Adolescents (and adults) with epilepsy are restricted from participating in certain activities, such as driving a car or riding a motorcycle, scuba diving, and gymnastics.

Seizures associated with epilepsy can usually be controlled with anticonvulsant medication. Education and consistent medication will help the patient adjust to seizure activity and carry on a normal life, with some restrictions. Occasionally, an adolescent who does not respond to medication may find relief in a surgical procedure to remove brain tissues.

Children who experience even one episode of febrile seizure (associated with high fever) were formerly treated with anticonvulsant medication as a preventive measure. The National Institutes of Health issued a recommendation in the 1980s that this practice be discontinued, except in cases where there is some indication that seizures are likely to recur, such as with a child with a family history of epilepsy or a nervous system impairment.

Pseudoseizures resemble seizures but are not caused by a physical disorder of the brain. The physical process of a pseudoseizure may be identical to a real seizure, including staring unresponsively, stiffening, and rhythmic jerking. If brain activity were monitored during a pseudoseizure, the brain wave tracing would not show the changes that are characteristic of epileptic seizures. Researchers believe that, in some cases, pseudoseizures may be related to dissociative disorders. Although there are many causes for pseudoseizures, many studies indicate that physical or sexual abuse may be one of the most common causes. In fact, patients with dissociative disorders often report experiencing pseudoseizures, which may be the symptom that led them to seek treatment.

For Further Study

Books

Freeman, John Mark, Eileen P. G. Vining, and Diana J. Pillas. Seizures and Epilepsy in Childhood: A Guide for Parents. Baltimore: The John Hopkins University Press, 1990.

Tuttle, Heather. Living with Seizures. Rootstown, OH: Tuttle Press, 1995. [juvenile]

Organizations

American Epilepsy Foundation
Address: 638 Prospect Avenue
Hartford, CT 06105-2498
Telephone: (203) 232-4825

Epilepsy Foundation of America
Address: 4351 Garden City Drive
Landover, MD 20785
Telephone: toll-free (800) 332-1000