Causes of seizures

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Generally, seizures are observed in patients who do not have epilepsy. [1] There are many causes of seizures. Organ failure, medication and medication withdrawal, cancer, imbalance of electrolytes, hypertensive encephalopathy, may be some of its potential causes. [2] The factors that lead to a seizure are often complex and it may not be possible to determine what causes a particular seizure, what causes it to happen at a particular time, or how often seizures occur. [3]

Contents

Diet

Malnutrition and overnutrition may increase the risk of seizures. [4] Examples include the following:

Folic acid in large amounts was considered to potentially counteract the antiseizure effects of antiepileptic drugs and increase the seizure frequency in some children, although that concern is no longer held by epileptologists. [13]

Medical conditions

Brain tumors are among many medical conditions in which seizures can be a symptom Hirnmetastase MRT-T1 KM.jpg
Brain tumors are among many medical conditions in which seizures can be a symptom

Those with various medical conditions may experience seizures as one of their symptoms. These include:[ citation needed ]

Other conditions have been associated with lower seizure thresholds and/or increased likelihood of seizure comorbidity (but not necessarily with seizure induction). Examples include depression, psychosis, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and autism, among many others.

Drugs

Adverse effect

Seizures may occur as an adverse effect of certain drugs. These include:[ medical citation needed ]

Use of certain recreational drugs may lead to seizures in some, especially when used in high doses or for extended periods. These include amphetamines (such as amphetamine, methamphetamine, MDMA ("ecstasy"), and mephedrone), cocaine, methylphenidate, psilocybin, psilocin, and GHB.

If treated with the wrong kind of antiepileptic drugs (AED), seizures may increase, as most AEDs are developed to treat a particular type of seizure.

Convulsant drugs (the functional opposites of anticonvulsants) will always induce seizures at sufficient doses. Examples of such agents — some of which are used or have been used clinically and others of which are naturally occurring toxins — include strychnine, bemegride, flumazenil, cyclothiazide, flurothyl, pentylenetetrazol, bicuculline, cicutoxin, and picrotoxin.

Alcohol

There are varying opinions on the likelihood of alcoholic beverages triggering a seizure. Consuming alcohol may temporarily reduce the likelihood of a seizure immediately following consumption. But, after the blood alcohol content has dropped, chances may increase. This may occur, even in non-epileptics. [15]

Heavy drinking in particular has been shown to possibly have some effect on seizures in epileptics. But studies have not found light drinking to increase the likelihood of having a seizure at all.[ citation needed ] EEGs taken of patients immediately following light alcohol consumption have not revealed any increase in seizure activity. [16]

Consuming alcohol with food is less likely to trigger a seizure than consuming it without. [17]

Consuming alcohol while using many anticonvulsants may reduce the likelihood of the medication working properly. In some cases, it may trigger a seizure. Depending on the medication, the effects vary. [18]

Drug withdrawal

Some medicinal and recreational drugs can dose-dependently precipitate seizures in withdrawal, especially when withdrawing from high doses and/or chronic use. Examples include drugs that affect GABAergic and/or glutamatergic systems, such as alcohol (see alcohol withdrawal), [19] benzodiazepines, barbiturates, and anesthetics, among others.

Sudden withdrawal from anticonvulsants may lead to seizures. It is for this reason that if a patient's medication is changed, the patient will be weaned from the medication being discontinued following the start of a new medication.

Missed anticonvulsants

A missed dose or incorrectly timed dose of an anticonvulsant may be responsible for a breakthrough seizure, even if the person often missed doses in the past, and has not had a seizure as a result. [20] Missed doses are one of the most common reasons for a breakthrough seizure. A single missed dose is capable of triggering a seizure in some patients. [21]

Fever

In children between the ages of 6 months and 5 years, a fever of 38 °C (100.4 °F) or higher may lead to a febrile seizure. [25] About 2-5% of all children will experience such a seizure during their childhood. [26] In most cases, a febrile seizure will not indicate epilepsy. [26] Approximately 40% of children who experience a febrile seizure will have another one. [26]

In those with epilepsy, fever can trigger a seizure. Additionally, in some, gastroenteritis, which causes vomiting and diarrhea, can lead to diminished absorption of anticonvulsants, thereby reducing protection against seizures. [27]

Vision

Flashing light, such as that from a disco ball, can cause seizures in some people Disco ball.jpg
Flashing light, such as that from a disco ball, can cause seizures in some people

In some epileptics, flickering or flashing lights, such as strobe lights, can be responsible for the onset of a tonic clonic, absence, or myoclonic seizure. [28] This condition is known as photosensitive epilepsy and, in some cases, the seizures can be triggered by activities that are harmless to others, such as watching television or playing video games, or by driving or riding during daylight along a road with spaced trees, thereby simulating the "flashing light" effect. Some people can have a seizure as a result of blinking one's own eyes. [29] Contrary to popular belief, this form of epilepsy is relatively uncommon, accounting for just 3% of all cases. [30]

A routine part of the EEG test involves exposing the patient to flickering lights to attempt to induce a seizure, to determine if such lights may be triggering a seizure in the patient, and to be able to read the wavelengths when such a seizure occurs. [29]

Unlike photosensitive epilepsies – where epileptic activity only appears for few seconds after eye-closure – in some non-photosensitive epilepsies seizures may be triggered by the loss of central vision during eye-closure in an epileptic phenomenon called fixation-off sensitivity (FOS) where the epileptic activity persists for the total duration of eye-closure, though unrelated phenomena they can both coexist in some patients. [31] [32] [33]

Head injury

A severe head injury, such as one sustained in a motor vehicle accident, fall, assault, or sports injury, can result in one or more seizures that can occur immediately after the fact or up to a significant amount of time later. [34] This could be hours, days, or even years following the injury.

A brain injury can cause seizure(s) because of the unusual amount of energy that is discharged across of the brain when the injury occurs and thereafter. When there is damage to the temporal lobe of the brain, there is a disruption of the supply of oxygen. [35]

The risk of seizure(s) from a closed head injury is about 15%. [36] In some cases, a patient who has had a head injury is given anticonvulsants, even if no seizures have occurred, as a precaution to prevent them in the future. [37]

Hyperglycemia and hypoglycemia

Hyperglycemia, or high blood sugar, can increase frequency of seizure. The probable mechanism is that elevated extracellular glucose level increases neuronal excitability. [38]

Curiously, hypoglycemia, or low blood sugar, can also trigger seizures. [39] The mechanism is also increased cortical excitability. [40]

Menstrual cycle

In catamenial epilepsy, seizures become more common during a specific period of the menstrual cycle.

Sleep deprivation

Sleep deprivation is the second most common trigger of seizures. [15] In some cases, it has been responsible for the only seizure a person ever has. [41] However, the reason for which sleep deprivation can trigger a seizure is unknown. One possible thought is that the amount of sleep one gets affects the amount of electrical activity in one's brain. [42]

Patients who are scheduled for an EEG test are asked to deprive themselves of some sleep the night before to be able to determine if sleep deprivation may be responsible for seizures. [43]

In some cases, patients with epilepsy are advised to sleep 6-7 consecutive hours as opposed to broken-up sleep (e.g., 6 hours at night and a 2-hour nap) and to avoid caffeine and sleeping pills in order to prevent seizures. [44]

Parasites and stings

In some cases, certain parasites can cause seizures. The Schistosoma sp. flukes cause Schistosomiasis. Pork tapeworm and beef tapeworm cause seizures when the parasite creates cysts at the brain. Echinococcosis, malaria, toxoplasmosis, African trypanosomiasis, and many other parasitic diseases can cause seizures.

Seizures have been associated with insect stings. Reports suggest that patients stung by red imported fire ants (Solenopsis invicta) and Polistes wasps had seizures because of the venom. [45] [46]

In endemic areas, neurocysticercosis is the main cause behind focal epilepsy in early adulthood. All growth phases of cysticerci (viable, transitional and calcified) are associated with epileptic seizures. Thus, anti-cysticercus treatment helps by getting rid of it thus lowers the risk of recurrence of seizures in patients with viable cysts. Symptomatic epilepsy can be the first manifestation of neuroschistosomiasis in patients without any systemic symptoms. The pseudotumoral form can trigger seizures secondary to the presence of granulomas and oedemas in the cerebral cortex. [47]

Stress

Stress can induce seizures in people with epilepsy, and is a risk factor for developing epilepsy. Severity, duration, and time at which stress occurs during development all contribute to frequency and susceptibility to developing epilepsy. It is one of the most frequently self-reported triggers in patients with epilepsy. [48] [49]

Stress exposure results in hormone release that mediates its effects in the brain. These hormones act on both excitatory and inhibitory neural synapses, resulting in hyper-excitability of neurons in the brain. The hippocampus is known to be a region that is highly sensitive to stress and prone to seizures. This is where mediators of stress interact with their target receptors to produce effects. [50]

"Epileptic fits" as a result of stress are common in literature and frequently appear in Elizabethan texts, where they are referred to as the "falling sickness". [51]

Breakthrough seizure

A breakthrough seizure is an epileptic seizure that occurs despite the use of anticonvulsants that have otherwise successfully prevented seizures in the patient. [52] : 456  Breakthrough seizures may be more dangerous than non-breakthrough seizures because they are unexpected by the patient, who may have considered themselves free from seizures and, therefore, not take any precautions. [53] Breakthrough seizures are more likely with a number of triggers. [54] : 57  Often when a breakthrough seizure occurs in a person whose seizures have always been well controlled, there is a new underlying cause to the seizure. [55]

Breakthrough seizures vary. Studies have shown the rates of breakthrough seizures ranging from 11 to 37%. [56] Treatment involves measuring the level of the anticonvulsant in the patient's system and may include increasing the dosage of the existing medication, adding another medication to the existing one, or altogether switching medications. [57] A person with a breakthrough seizure may require hospitalization for observation. [52] : 498 

Other

Music (as in musicogenic epilepsy) [59] [60] [61]

Diagnosis and management

In the case of patients with seizures associated with medical illness, the patients are firstly stabilized. They are attended to their circulation, airway, and breathing. Next vital signs are assessed through a monitor, intravenous access is obtained, and concerning laboratory tests are performed. Phenytoin or fosphenytoin supplemented with benzodiazepines are administered as the first line of therapy if the seizure persists for more than 5 –10 minutes. Through neuroimaging, clinical assessments, and spinal-fluid examination the patients are screened for intrinsic neurological anomalies. The patients are analyzed for non-epileptic seizures. Early electroencephalography is recommended if there is a possibility of non-convulsive or subtle status epilepticus. They are examined for disorders such as sarcoidosis, porphyria, and other unusual systemic disorders. Information is gathered on the drug, medication history, and its withdrawal. For seizures associated with alcohol, intravenous pyridoxine and other specific antidotes are prescribed. The patient is checked for proconvulsant exposure. All underlying potential causes are considered. For instance, in a patient with an end-stage renal disease where there is a probability of hypertensive encephalopathy, blood pressure is analyzed. [2]

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures tend to recur and may have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. Most of the time these episodes last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term convulsion is sometimes used as a synonym for seizure. However, not all epileptic seizures produce convulsions, and not all convulsions are caused by epileptic seizures. Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.

Anticonvulsants are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder and borderline personality disorder, since many seem to act as mood stabilizers, and for the treatment of neuropathic pain. Anticonvulsants suppress the excessive rapid firing of neurons during seizures. Anticonvulsants also prevent the spread of the seizure within the brain.

<span class="mw-page-title-main">Myoclonus</span> Involuntary, irregular muscle twitch

Myoclonus is a brief, involuntary, irregular twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus describes a medical sign and, generally, is not a diagnosis of a disease. These myoclonic twitches, jerks, or seizures are usually caused by sudden muscle contractions or brief lapses of contraction. The most common circumstance under which they occur is while falling asleep. Myoclonic jerks occur in healthy people and are experienced occasionally by everyone. However, when they appear with more persistence and become more widespread they can be a sign of various neurological disorders. Hiccups are a kind of myoclonic jerk specifically affecting the diaphragm. When a spasm is caused by another person it is known as a provoked spasm. Shuddering attacks in babies fall in this category.

<span class="mw-page-title-main">Status epilepticus</span> Medical condition

Status epilepticus (SE), or status seizure, is a medical condition consisting of a single seizure lasting more than 5 minutes, or 2 or more seizures within a 5-minute period without the person returning to normal between them. Previous definitions used a 30-minute time limit. The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures. Status epilepticus is a life-threatening medical emergency, particularly if treatment is delayed.

<span class="mw-page-title-main">Primidone</span> Barbiturate medication used to treat seizures and tremors

Primidone, sold under various brand names, is a barbiturate medication that is used to treat partial and generalized seizures, as well as essential tremors. It is taken by mouth.

<span class="mw-page-title-main">Lennox–Gastaut syndrome</span> Medical condition

Lennox–Gastaut syndrome (LGS) is a complex, rare, and severe childhood-onset epilepsy. It is characterized by multiple and concurrent seizure types, cognitive dysfunction, and slow spike waves on electroencephalogram (EEG). Typically, it presents in children aged 3–5 years and can persist into adulthood. It has been associated with several gene mutations, perinatal injuries, congenital infections, brain tumors/malformations, and genetic disorders such as tuberous sclerosis and West syndrome. The prognosis for LGS is poor with a 5% mortality in childhood and persistent seizures into adulthood (80%–90%).

Psychogenic non-epileptic seizures (PNES) are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND), also known as conversion disorders. A more recent term to describe these events is dissociative non-epileptic seizures. These are typically treated by psychologists or psychiatrists. PNES has previously been called pseudoseizures, psychogenic seizures, and hysterical seizures, but these terms have fallen out of favor.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system which is characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. TLE is the most common form of epilepsy with focal seizures. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure.

Frontal lobe epilepsy (FLE) is a neurological disorder which is a subtype of the larger group of epilepsy and then focal epilepsy is characterized by brief, recurring seizures that arise in the frontal lobes of the brain, often while the patient is sleeping. It is the second most common type of focal epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form by the fact that both forms are characterized by the occurrence of partial (focal) seizures. Partial seizures occurring in the frontal lobes can occur in one of two different forms: either “focal aware”, the old term was simple partial seizures “focal unaware” the old term was complex partial seizures. The symptoms and clinical manifestations of frontal lobe epilepsy can differ depending on which specific area of the frontal lobe is affected.

<span class="mw-page-title-main">Generalized epilepsy</span> Epilepsy syndrome that is characterised by generalised seizures with no apparent cause

Generalized epilepsy is a form of epilepsy characterised by generalised seizures with no apparent cause. Generalized seizures, as opposed to focal seizures, are a type of seizure that impairs consciousness and distorts the electrical activity of the whole or a larger portion of the brain. Generalized seizure occurs due to abnormalities in both hemispheres.

Geschwind syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some people with temporal lobe epilepsy. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984. There is controversy surrounding whether it is a true neuropsychiatric disorder. Temporal lobe epilepsy causes chronic, mild, interictal changes in personality, which slowly intensify over time. Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, and intensified mental life. Not all symptoms must be present for a diagnosis. Only some people with epilepsy or temporal lobe epilepsy show features of Geschwind syndrome.

Post-traumatic seizures (PTS) are seizures that result from traumatic brain injury (TBI), brain damage caused by physical trauma. PTS may be a risk factor for post-traumatic epilepsy (PTE), but a person having a seizure or seizures due to traumatic brain injury does not necessarily have PTE, which is a form of epilepsy, a chronic condition in which seizures occur repeatedly. However, "PTS" and "PTE" may be used interchangeably in medical literature.

Epilepsy and driving is a personal and safety issue. A person with a seizure disorder that causes lapses in consciousness may be putting the public at risk from their operation of a motor vehicle. Not only can a seizure itself cause an accident, but anticonvulsants often have side effects that include drowsiness. People with epilepsy are more likely to be involved in a traffic accident than people who do not have the condition, although reports range from minimally more likely up to seven times more likely.

<span class="mw-page-title-main">Pyridoxine-dependent epilepsy</span> Medical condition

Pyridoxine-dependent epilepsy (PDE) is a rare genetic disorder characterized by intractable seizures in the prenatal and neonatal period. The disorder was first recognized in the 1950s, with the first description provided by Hunt et al. in 1954. More recently, pathogenic variants within the ALDH7A1 gene have been identified to cause PDE.

An epileptologist is a neurologist who specializes in the treatment of epilepsy. Epileptologists are experts in epileptic seizures and seizure disorders, anticonvulsants, and special situations involving seizures, such as cases in which all treatment intended to stop seizures has failed and epilepsy in pregnant women. Some epileptologists specialize in treatment of epilepsy in children.

Epilepsy is a disorder in which nerve cell activity in the brain is disturbed, causing seizures.During a seizure, a person experiences abnormal behavior, symptoms, and sensations, sometimes including loss of consciousness. There are few symptoms between seizures. A seizure is a single occurrence, whereas epilepsy is a neurological condition characterized by two or more unprovoked seizures. Epilepsy is the most common childhood brain disorder in the United States. Nearly 3 million people have been diagnosed with this disease, while 450,000 of them are under the age of 17. Two thirds of the child population will overcome the side effects, including seizures, through treatment during adolescence. Some treatments include surgery, medication and therapy, surgery however is only done if the child has drug resistant epilepsy.

People with epilepsy may be classified into different syndromes based on specific clinical features. These features include the age at which seizures begin, the seizure types, and EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as deciding what anti-seizure medication should be tried. Epilepsy syndromes are more commonly diagnosed in infants and children. Some examples of epilepsy syndromes include benign rolandic epilepsy, childhood absence epilepsy and juvenile myoclonic epilepsy. Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and severe cognitive dysfunction, for instance Lennox-Gastaut syndrome and West syndrome.

<span class="mw-page-title-main">Cerebral folate deficiency</span> Medical condition

Cerebral folate deficiency is a condition in which concentrations of 5-methyltetrahydrofolate are low in the brain as measured in the cerebral spinal fluid despite being normal in the blood. Symptoms typically appear at about 5 to 24 months of age. Without treatment there may be poor muscle tone, trouble with coordination, trouble talking, and seizures.

References

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