Epileptic seizures (colloquially a fit) are brief episodes of "abnormal excessive or synchronous neuronal [1] activity in the brain".

The outward effect can vary from wild thrashing movement (tonic-clonic seizure) to as mild as a brief loss of awareness (absence seizure). The syndrome of recurrent, unprovoked seizures is termed epilepsy, but seizures can occur in people who do not have epilepsy. Additionally there are a number of conditions that look like seizures but are not. After a first seizure, treatment is generally not needed unless specific problems are found on [2] either electroencephalogram or imaging of the brain. About 5-10% of all people will have an unprovoked seizure by the age of 80 and the chance of [4] experiencing a second seizure is between 40% and 50%. Epilepsy affects about 1% of the population [5] [2] currently and affects about 4% of the population at some point in time. Most of affected, nearly 80%, [5] live in developing countries.
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Signs and symptoms[edit]

Someone who has bitten the tip of their tongue while having a seizure

See also: Seizure types The signs and symptoms of seizures vary depending on the type. The most common type of seizures [7] are convulsive (60%). Two-thirds of these begin as focal seizures and become generalized while one [7] third begin as generalized seizures. The remaining 40% of seizures are non-convulsive, an example of [8] which is absence seizures
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Partial seizures[edit]
Main article: Partial seizure Partial seizures may be further subdivided into both simple and complex seizures. This refers to the effect of such a seizure on consciousness; simple seizures cause no interruption to consciousness (although they may cause sensory distortions or other sensations), whereas complex seizures interrupt consciousness to varying degrees. This does not necessarily mean that the person experiencing this sort of seizure will fall unconscious (like fainting). For example, a complex partial seizure may involve the unconscious repetition of simple actions, gestures or verbal utterances, or simply a blank stare and apparent unawareness of the occurrence of the seizure, followed by no memory of the seizure. Other patients may report a feeling of tunnel vision or dissociation, which represents a diminishment of

awareness without full loss of consciousness. Still other patients can perform complicated actions, such as travel or shopping, while in the midst of a complex partial seizure. The effects of partial seizures can be quite dependent on the area of the brain in which they are active. For example, a partial seizure in areas involved in perception may cause a particular sensory experience (for example, the perception of a scent, music or flashes of light) whereas, when centred in the motor cortex, a partial seizure might cause movement in particular groups ofmuscles. This type of seizure may also produce particular thoughts or internal visual images or even experiences which may be distinct but not easily described. Seizures centered on thetemporal lobes are known to produce mystical or ecstatic experiences in some people, they are also known as ecstatic seizures. [citation needed] These may result in a misdiagnosis of psychosis or evenschizophrenia, if other symptoms of seizure are disregarded and other tests are not performed. Unfortunately for those with epilepsy, antipsychotic medications prescribed withoutanticonvulsants in this case can actually lower the seizure threshold further and worsen the symptoms. When the effects of a partial seizure appear as a 'warning sign' before a larger seizure, they are known as an aura: it is frequently the case that a partial seizure will spread to other parts of the brain and eventually become generalized, resulting in a tonic-clonic convulsion. The subjective experience of an aura, like other partial seizures, will tend to reflect the function of the affected part of the brain.

Generalized seizures[edit]
Primarily generalized seizures can be sub-classified into a number of categories, depending on their behavioural effects: Absence seizures involve an interruption to consciousness where the person experiencing the seizure seems to become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight muscle twitching may occur. Myoclonic seizures involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky movements of muscles or muscle groups. Clonic seizures are myoclonus that are regularly repeating at a rate typically of 2-3 per second. in some cases, the length varies. Tonicclonic seizures involve an initial contraction of the muscles (tonic phase) which may involve tongue biting, urinary incontinence and the absence of breathing. This is followed by rhythmic muscle contractions (clonic phase). This type of seizure is usually what is referred to when the term 'epileptic fit' is used colloquially. Atonic seizures involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes called 'drop attacks' but should be distinguished from similar looking attacks that may occur in cataplexy.

Continuous seizures[edit]
Status epilepticus refers to continuous seizure activity with no recovery between successive seizures. A tonic-clonic seizure lasting longer than 5 minutes (or two minutes longer than a given person's usual seizures) is usually considered grounds for calling the emergency services.Medications are available for this type, ranging from benzodiazepines to lesser known medication. Epilepsia partialis continua is a rare type of focal motor seizure (hands and face) which recurs every few seconds or minutes for extended periods (days or years). It is usually due to strokes in adults and focal

cortical inflammatory processes in children (Rasmussen's encephalitis), possibly caused by chronic viral infections or autoimmune processes.

Causes[edit]
Main article: Causes of seizures Seizures have a number of causes. Of those with seizure about 25% have epilepsy. A number of conditions are associated with seizures but are not epilepsy including: most febrile seizuresand those that [18] occur around an acute infection, stroke, or toxicity. These seizures are known as "acute symptomatic" [18] or "provoked" seizures and are part of the seizure-related disorders. In many the cause is unknown. Different causes of seizures are common in certain age groups. During the neonatal period and early infancy the most common causes include hypoxic ischemic encephalopathy, central nervous system (CNS) infections, trauma, congenital CNS abnormalities, and metabolic disorders. The most frequent cause of seizures in children is febrile seizures which happen in 2-5% of those [19] between the ages of six months and five years. During childhood, well-defined epilepsy syndromes are generally seen. During adulthood, the likely causes are alcohol related, strokes, trauma, CNS infections, and brain [20] tumors. In older adults, cerebrovascular disease is a very common cause. Other causes are CNS tumors, head trauma, and other degenerative diseases that are common in the older age group, such [21] as dementia.
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Diagnosis[edit]

An EEG can aid in locating the focus of the epileptic seizure.

It is important to distinguish primary seizures from secondary causes. Depending on the presumed [2] cause blood tests and/or lumbar puncture may be useful. Hypoglycemia may cause seizures and should be ruled out. An electroencephalogram and brain imaging with CT scan or MRI scan is recommended in [2][28] the work-up of seizures not associated with a fever.

Prevention[edit]
A number of measures have been attempted to prevention seizures in those at risk. Following traumatic [37] brain injury anticonvulsants decrease the risk of early seizures but not late seizures. In those with a history of febrile seizures medications (both antipyretics and anticonvulsants) have not [38] been found effective for prevention; however, some appear to be associated with harm. In those without a history of seizures and a subdural hematoma the evidence is unclear regarding a benefit versus [39] [40] harm from using anticonvulsants. This is also true following a craniotomy as well as [41] [42] after stroke, intracranial venous thrombosis, and subarachnoid haemorrhage both in those who have [43] and have not had seizures.

Management[edit]
Potentially sharp or dangerous objects should also be moved from the vicinity, so that the individual is not hurt. After the seizure if the person is not fully conscious and alert, they should be placed in the recovery [13] position. A seizure longer than five minutes is a medical emergency known as status epilepticus.

Medication[edit]
The first line treatment of choice for someone who is actively seizing is a benzodiazepine, most [28] [28] guidelines recommend lorazepam. This may be repeated if there is no effect after 10 minutes. If [28] there is no effect after two doses, barbiturates or propofol may be used. Ongoing medication is not typically needed after a first seizure and is generally only recommended after a [28] second one has occurred or in those with structural lesions in the brain. After a second seizure antiepileptic medications are recommended. Approximately 70% of the people are able to get full control with [5] continuous use of medication. Typically one type of anticonvulsant is preferred.

Management

Seizures - Home Treatment

If you witness a seizure, your account of the seizure will help a doctor diagnose and treat the person. Try to stay calm. Pay close attention to what happens during and after the seizure. o During a seizure: Protect the person from injury. Keep him or her from falling if you can, or try to guide the person gently to the floor. Try to move furniture or other objects that might injure the person during the seizure. If the person is having a seizure and is on the ground when you arrive, put something soft under his or her head.

Tegretol or Carbatrol (carbamazepine) First choice for partial, generalized tonic-clonic and mixed seizures Common adverse effects include fatigue, vision changes, nausea, dizziness, rash. Zarontin (ethosuximide) Used to treat absence seizures Adverse effects include nausea, vomiting, decreased appetite, and weight loss. Felbatol (felbamate) Treats partial and some generalized seizures Side effects include decreased appetite, weight loss, inability to sleep, headache, and depression. Although rare, the drug may cause bone marrow or liver failure. Therefore, the use of the drug is limited and patients taking it must have blood cell counts and liver tests regularly during therapy. Gabitril (tiagabine) Used with other epilepsy drugs to treat partial and some generalized seizures Common side effects include dizziness, fatigue, weakness, irritability, anxiety, and confusion. Keppra (levetiracetam) Used with other epilepsy drugs to treat partial seizures Side effects include tiredness, weakness, and behavioral changes. Lamictal (lamotrigine) Treats partial and some generalized seizures Has few side effects, but rarely people report dizziness, insomnia, or rash. Lyrica (pregabalin) Used to treat partial seizures Side effects include dizziness, sleepiness (somnolence), dry mouth, peripheral edema, blurred vision, weight gain, and difficulty with concentration/attention. Neurontin (Gabapentin) Used with other epilepsy drugs to treat partial and some generalized seizures Few lasting side effects; during the first weeks of treatment you may experience tiredness and dizziness. Dilantin (Phenytoin) Controls partial seizures and generalized tonic-clonic seizures; also can be given by vein (intravenously) in the hospital to rapidly control active seizures, although if the drug is being delivered by IV, Cerebyx (fosphenytoin) is usually used. Side effects include dizziness, fatigue, slurred speech, acne, rash, and increased hair (hirsutism). Over the long term, the drug can cause bone thinning.