A seizure is a sudden change in brain function due to a massive electrical discharge in a group of nerve cells. The increased electrical activity will typically cause an altered level of consciousness and various changes in behavior, such as convulsions, automatisms, or a blank stare.
Types of Seizures
- Generalized Tonic-Clonic (Grand Mal): This is the most common type of seizure. The patient will experience a loss of consciousness followed by muscle rigidity and convulsions.
- Simple Partial: This seizure is sometimes referred to as a focal motor or Jacksonian motor seizure. The patient will remain conscious and have uncontrolled muscle spasms in one area of the body. The seizure activity might spread to another area of the body and it’s important to document the progression. This information is useful for identifying the cause and will help with long-term treatment.
- Complex Partial: This seizure is sometimes referred to as a psychomotor or temporal lobe seizure. The seizure usually starts with a blank stare, followed by an automatism such as lip smacking, chewing, rolling of the fingers, fidgeting or some other repetitive movement. The patient will appear dazed and will not to respond to any commands.
- Absence (Petit Mal): This seizure is most commonly seen in children where they experience an abrupt interruption of activity and stare blankly. The seizures only last a few seconds and can occur several times a day.
- Febrile: This seizure is most commonly seen in children, typically 6 months to 6 years of age, and is caused by a high fever. Approximately 5% of children with a fever will have a febrile seizure. The patient will experience a loss of consciousness followed by muscle rigidity and convulsions.
Stages of Seizures
- Aura: A sensation the patient experiences which serves as a warning that a seizure is about to occur. For example, this could be a sound, a feeling of anxiousness or dizziness, an odor, an odd taste, or an uneasy feeling in the stomach.
- Tonic Phase: The patient becomes unresponsive and their muscles tense up (muscle rigidity). This phase lasts approximately 15-20 seconds.
- Hypertonic Phase: The patient has extreme muscular rigidity with hyperextension of the back. This phase lasts approximately 5-15 seconds.
- Clonic Phase: The patient has convulsions and might suffer from oral trauma or incontinence. Their breathing might be shallow or absent. This phase lasts approximately 30 seconds to 5 minutes.
- Postictal State: This is known as the recovery phase. The patient is initially altered, confused or disoriented and their mental status improves over time. The patient typically feels exhausted and weak from the convulsions and might complain of a headache. This phase lasts approximately 5-30 minutes (sometimes several hours).
Common Causes of Seizures
- Hypoglycemia / Hyperglycemia
- Head injury
- Drug or alcohol withdrawal
- Electrolyte imbalance
A patient who experiences seizures lasting longer than 10 minutes or has consecutive seizures without a period of responsiveness between them is considered to be in status epilepticus. This is a severe medical emergency and will require proper airway management, positive pressure ventilation and immediate transport.