seizure

[Random]

Wise,
I wonder if when you have a chance you might make a thread explaining seizure, or point us toward a good source of information on it.

I'm eager to understand what seizure actually is, what causes it, what physically happens, what the common course/result is, how common it is for them to leave no radiographic signs, how definitive a diagnosis is without radiographic signs, if there are other potential explanations for someone just losing a week or so…

I'm curious for reasons you may remember and also because I learned a woman I know with MS had a seizure that left her in a coma. It's heartbreaking and I'm wondering how that happens, if it is common and if there is any way to predict the prognosis for her.

Thanks if you have time.
Randy

[Wise Young]

Wise,
I wonder if when you have a chance you might make a thread explaining seizure, or point us toward a good source of information on it.

I'm eager to understand what seizure actually is, what causes it, what physically happens, what the common course/result is, how common it is for them to leave no radiographic signs, how definitive a diagnosis is without radiographic signs, if there are other potential explanations for someone just losing a week or so…

I'm curious for reasons you may remember and also because I learned a woman I know with MS had a seizure that left her in a coma. It's heartbreaking and I'm wondering how that happens, if it is common and if there is any way to predict the prognosis for her.

Thanks if you have time.
Randy

Randy,

There are several kinds of seizures. One kind, the most common, is called "gran mal". I guess in French, it means "big bad". This is a seizure that starts in the cerebral cortex, involves the motor cortex, and causes a person to fall to the ground and go through all sorts of movements and twitching.

A second kind is called "petit mal", which are seizures in deeper brain structures and does not necessarily manifest in motor movements but causes transient loss of consciousness, sometimes associated with emotional changes. When brain recordings are made, it appears that these types of seizures are occurring in deeper and older cortical structures.

Multiple sclerosis is associated with increased risk of seizures. About 5% of people with multiple sclerosis have seizures. The reason is not clear but it may be because multiple sclerosis is associated with plaques which are areas of demyelination and inflammation in the brain and spinal cord. Inflammation is frequently associated with pro-inflammatory cytokines and neurotrophins. The latter causes sprouting and abnormal connections that can cause seizures.

Brain injury is also associated with increased risks of seizures. The risk of seizures depends on injury severity and location but about 5% of people with brain injuries develop seizures. They typically occur relatively early after injury and the risk decreases with time. The mechanisms are not well understood but the seizures are likely to be relate to injury and inflammation of the brain. Drugs such as 4-aminopyridine (Fampridine) increases excitability and the likelihood of seizures in people.

Seizures often occur without any evidence of brain injury on MRI or CT scans. Seizures disrupts activity of the brain where they occur. While gran mal seizures typically exhibit motor "fits", seizures may involve the hippocampus or deeper structures that affect memory and even emotions. There is a condition called status epilepticus, where the brain undergoing repeated seizures that lead to ischemia or cessation of breathing. These may cause damage to the brain and even coma. Prognosis varies but, in my experience, prolonged coma after a seizure is rare.

Wise.

[Wise Young]

http://www.nejm.org/doi/full/10.1056...99801013380104

In 1998, Annegers, et al. reported an incredible study where they identified 4541 children and adults who had suffered brain injury in Olmsted County, Minnesota, during the period from 1935 through 1984. They classified the patients as having mild (<30 minutes loss of consciousness or amnesia), moderate (30 minute to 24 hours loss of consciousness or amnesia), and severe (loss of consciousness or amnesia for >24 hours). They then compared the rate of unprovoked seizures in these patients, compared to non-injured populations.

The incidence of seizures is expressed relative to the uninjured population (controls). Mild head-injured patients had 1.5 times more seizures than ccontrol. Moderate head-injured patients had 2.9 times more seizures than controls. Severe head-injured patients had 17 times more seizures than controls. Significant risk factors include subdural hematoma, skull fractures, and loss of consciousness or amnesia greater than 24 hours.

Wise.

[Wise Young]

This is from the National MS Society web site:

http://www.nationalmssociety.org/abo...res/index.aspx

Seizures, which are the result of abnormal electrical discharges in an injured or scarred area of the brain, are fairly uncommon among people with MS. Their incidence has been estimated at 2% to 5%, compared to the estimated 3% incidence of seizures in the general population.

Seizures may take several forms:

Generalized tonic-clonic seizures are brief episodes of unconsciousness with uncontrollable jerking movements of the extremities.
Generalized absence seizures are momentary lapses of consciousness without abnormal movements.
Partial complex seizures are periods of stereotyped repetitive activity. The person appears to be awake but does not respond to external stimuli.
Paroxysmal Symptoms of MS Differ from Seizures

Paroxysmal symptoms in MS are brief sudden attacks of abnormal posturing of the extremities, loss of tone in the legs ("drop attacks") or other manifestations that may appear similar to an epileptic seizure but are of different origin. Examples of paroxysmal symptoms include: paroxysmal pain (e.g., trigeminal neuralgia); tonic spasms of an arm or leg; Lhermitte's sign (electric shock-like sensation down the spine when the neck is flexed); Uhthoff's symptoms (transient blurring of vision associate with exertion and elevated body temperature).

Most Seizure Disorders Can Be Controlled by Medication

Seizures are usually diagnosed by the clinical history and an electroencephalogram (EEG), which is a recording of electrical activity in the brain. Most seizure disorders can be well controlled by use of the appropriate anticonvulsant medication, such as carbamazepine (Tegretol®) or phenytoin (Dilantin®), and continuing medical supervision.

[Random]

Thanks so much, Wise, especially for this:

... Prognosis varies but, in my experience, prolonged coma after a seizure is rare.
Wise.

I'm curious what qualifies as amnesia. Is that when you have incorrect memory of who you are or were you are in life, some kind of long-term disorientation, or is it also just prolonged short-on term memory loss?

Randy

[Wise Young]

Thanks so much, Wise, especially for this:



I'm curious what qualifies as amnesia. Is that when you have incorrect memory of who you are or were you are in life, some kind of long-term disorientation, or is it also just prolonged short-on term memory loss?

Randy

Randy,

You are of course welcome. You are welcome to pick over my brain any time that you want.

Amnesia refers to loss of memory. There are two kinds of losses and of course everything in between. One is retrograde, i.e. you lose memories that you have accumulated. So, most people who have had brain injury and any period of unconsciousness, they usually have loss of memories that go back hours, days, weeks, or months and years before the injury.

The other form of amnesia is sometimes called anterograde but really is an inability to form memory. There is a woman who comes to the Open House all the time and she has a son who had both brain and spinal cord injury in a motorcycle accident. Her son lost his ability to form new memories and woke up every morning to discover that he has spinal cord injury.

The last is really not amnesia but is mistakenly called short-term memory loss. It is really inability to form short term memory. The first and most recognizable sign is when a person will ask the same question over and over again, even though you had supplied the answer multiple times. It is amazing that the brain can behave almost like a tape-recorder.

I was really impressed but of course saddened to hear about Pat Summit, the coach of the Tennessee Voles [source]http://www.pbs.org/newshour/bb/sports/july-dec11/summitt_08-25.html[/source], announcing that she has been diagnosed with early stage Alzheimer's disease. It is likely that her first symptoms were loss of short term memory.

Wise.

[IsMaisin]

This thread hasn't been active for awhile, but I hope what I have to add is helpful.

Terminology is confusing. Not just for us but for the doctors too. I have had the exact same condition described several different ways either medically or medical-administratively.

My background:
•TBI with ~45 minutes of unconsciousness at age 17. One week inpatient for the other injuries.
•TBI with ~1 hour of unconsciousness, ICU for 2 days due to blood clotting, appeared functional but had a period of six weeks without forming memories.
•TBI with ~30 minutes of unconsciousness.
•TBI with ~1 hour of unconsciousness. Began to exhibit signs of seizures.
•TBI with over 12 hours of unconsciousness, bleeding from nose, ears, and eyes, unable to speak clearly, see, stand. Seizures multiple times a shift according to medical records. Over a year of hospitalizations and rehab followed.

I know that I have (at least) three completely different types of seizures. I know what most of my triggers are, and I know how to recognize an aura. I am lucky enough to have had a seizure while attached to an EEG on three occasions.

I want to list the different ways some of my seizures have been described.

The administrative description used by the Army and the VA for rating purposes divides all seizures into two categories:
•Major - involving thrashing of the limbs
•Minor - involving twitching or no limb movement.

These correspond almost exactly with the Grand Mal and Petit Mal descriptions that were used by neurology when I was younger.

Currently, I am aware of the following as the list of descriptions my neurologist uses:
I Partial seizures (Older term: focal seizures)
A Simple partial seizures - consciousness is not impaired
1 With motor signs
2 With sensory symptoms
3 With autonomic symptoms or signs
4 With psychic symptoms
B Complex partial seizures - consciousness is impaired (Older terms: temporal lobe or psychomotor seizures)
1 Simple partial onset, followed by impairment of consciousness
2 With impairment of consciousness at onset
C Partial seizures evolving to secondarily generalized seizures
1 Simple partial seizures evolving to generalized seizures
2 Complex partial seizures evolving to generalized seizures
3 Simple partial seizures evolving to complex partial seizures evolving to generalized seizures
II Generalized seizures
A Absence seizures (Older term: petit mal)
1 Typical absence seizures
2 Atypical absence seizures
B Myoclonic seizures
C Clonic seizures
D Tonic seizures
E Tonic–clonic seizures (Older term: grand mal)
F Atonic seizures
III Unclassified epileptic seizures
(ref: International League Against Epilepsy 1981 standards. Currently a revision is in progress)

Seems a bit overwhelming, doesn't it?

But what does it feel like to me?

Sometimes I see things that aren't there (simple partial seizure with psychic symptoms) but it is impossible to tell unless I am interacting with someone who can tell me that what I see isn't real.

Sometimes someone interacting with me notices that I'm not really hearing and their might be some twitching. I don't remember any part of it, but I'm not exhausted afterwards. I get these "are you ok?" type of seizures up to a couple of times an hour. It's hard to tell because I have to be interacting to notice them.

The big ones are easy to notice. I usually have an aura (I've learned to get on the ground fast) followed by major thrashing (I've broken a bone in my foot when it became trapped) and sometimes incontinence. I'm currently down to about 3 a month, it varies with medication.

Medication is a trade-off. It is easy to medicate all symptoms away, but that leaves me a vegetable drooling in a corner. And it does not help that seizure control drugs and depression control drugs usually (but not in all cases) exacerbate the other problem. I have chosen a regime that gives me the most mental stability and resiliency at the cost of significantly increasing my gross and fine motor control problems (which are already bad).

One thing a lot of people fail to realize is that it takes time to recover from a seizure. Sometimes I sleep the rest of the day away, others I may be fuzzyheaded for a couple of weeks. And a series of really bad seizures close together can take months to recover from - months in which I continue to have more seizures.

On a final note, it really doesn't help that the witnesses never seem to give the same information. I once had a major seizure in a meeting room with eight other people, one of whom was a nurse. Accounts range from 15 seconds to 5 minutes and no one agreed on exactly what I did. Until the first time I had a seizure while hooked to an EEG, I was diagnosed as having conversion disorder, not epilepsy.

[Wise Young]

IsMaisin,

Thank you for your description. Many of the best descriptions of neurological conditions have come from people who have them. You have the additional insight of experiencing seizures from the inside. You are very insightful. I also hope that other people who have seizures can learn from your experience and attitude towards the seizures.

Wise.

[rlmtrhmiles]

Seizures. Interesting. I have had them from my auto accident. Probably stuck on Dilantin and Levitiracetam rest of my life. Have been under control quite a long time. However, I had gotten to a point where I was able to notice "something strange" beginning to happen. Most of time I immediately stopped all activity. More often than not this prevented anything drastic from occurring. If I did not stop, I usually was in trouble. Whoever though, when I was in trouble I think I was totally aware of all that was happening and continually fought against it. Fighting was grab something rigid and hold. Pretty much I knew entire time what was going on. Just had to wait. My 1st description took a long time t learn. 2nd description, I did not even know what was happening. Now these things have been under control for quite a long time. Am even attempting to reobtain my driver license.