Conditions

Seizure Disorders

Seizures are a temporary neurologic event. Seizures can be variously characterized according to behavioral and electroencephalographic (EEG) changes. Recurrent seizures from one of many chronic processes are considered epilepsy; however, a single seizure or recurrent seizures from a correctable cause (e.g., febrile seizures) are not considered epilepsy.

An epileptic seizure is a temporary malfunction of the brain caused by uncontrolled electrical activity from the nerve cells in the cerebral cortex. The seizures rarely damage the brain.

The underlying cause of epilepsy is relatively unknown. Seizures may occur for no apparent reason or may be triggered by a wide range of things, including exposure to an allergen, drug or alcohol withdrawal, fever, flashing light, hunger, hypoglycemia, infection, lack of sleep, metabolic or nutritional imbalances, or trauma, especially head injury.

Seizures are the most common neurological problem affecting children. One third of people with seizure disorders are children. Iodiopathic epilepsy (seizures of unknown cause) or febrile seizures (nonepileptic seizures induced by fever) affect about 3 percent of children. Angelman syndrome is associated with seizures or tremors. Lennx-Gastaut syndrome is a severe seizure disorder that usually develops in children between the ages of one and eight.

Signs and Symptoms:

• Prodrome of generalized seizures (aura), including lethargy, depression, irritability, myoclonic jerks of limbs, abdominal pains, pale complexion, headache, constipation, or diarrhea
• Loss of consciousness
• Total or partial body muscle spasm (tonic contractions)
• Apnea (cessation of breathing)
• Cyanosis (bluish coloring) of skin and mucous membranes
• Dilated pupils that are unreactive to light
• Bowel or bladder incontinence
• Increased pulse and blood pressure
• Increased salivation and sweating
• Deep coma, postictal confusion, and deep sleep

Repeated seizures over a long period of time may result in:

• Absentmindedness
• Automatisms (e.g., lip smacking, chewing, fumbling)
• Declining school or work performance
• Loss of postural muscle tone

Diagnosis:

Initially, providers must attend to the seizure patient's respiratory and cardiovascular status and vital signs. After the patient is stable, a detailed history must be taken from family members, witnesses, and the patient (if possible) to determine definitively whether the patient actually experienced a seizure. Precipitating events (e.g., head trauma) and risk factors (e.g. family history of seizures) must be considered. The presence or absence of "auras," which are experienced by up to 60% of seizure patients, automatisms, myoclonus, postures (i.e., whether or not the patient fell), continence (loss of bowel function), and postictal confusion must be noted. These signs can help to differentiate the type of seizure experienced.

Your doctor may also order any of the following imaging procedures to rule out underlying medical conditions and help classify the type of seizure.

Treatment Options:

Treating the seizure patient can be challenging. It includes diagnosing and treating any underlying condition that may be causing the seizure activity. Precipitating events (e.g., lack of sleep, alcohol ingestion) should be identified and then avoided. The goal of therapy is to stop the seizure without adverse side effects, to prevent recurrences, and to help patients readjust to their home life and work environment.

Traditional Treatments:

Ideally, patients should take only one medication. However, many patients need several medications for complete seizure control. The following types of medications may be prescribed:

• Carbamazepine (Tegretol), 600 to 1,800 mg/day for tonic-clonic and focal-onset seizures
• Phenytoin (Dilantin), 300 to 500 mg/day for tonic-clonic and focal-onset seizures
• Valproic acid (Depakote), 750 to 2,000 mg/day for tonic-clonic, absence, myoclonic, and focal-onset seizures
• Phenobarbital (Luminal), 60 to 180 mg/day for tonic-clonic and focal-onset seizures
• Primidone (Mysoline), 750 to 1,250 mg/day for tonic-clonic and focal-onset seizures
• Lamotrigine (Lamictal), 150 to 500 mg/day for focal-onset seizures and Lennox-Gastaut syndrome
• Gabapentin (Neurontin), 900 to 2,400 mg/day for focal-onset seizures
• Ethosuximide (Zarontin), 750 to 1,500 mg/day for absence seizures
• Clonazepam (Klonopin), 1 to 12 mg/day for absence and myoclonal seizures
• Felbamate (Felbatol), 2400 to 3,600 mg/day for focal-onset seizures and Lennox-Gastaut syndrome

Complementary and Alternative Therapies:

Some mild cases of seizures may be controlled by alternative therapies, specifically nutrition. Herbal treatment may be helpful if low blood sugar and/or stress are initiating factors.

Nutritional Supplementation:

• Taurine: 500 mg twice a day, neuroinhibitory amino acid that may inhibit seizures.
• Folic acid: 400 mcg/day, depleted during seizures and in some persons with seizures, although higher doses than 400 mcg may actually precipitate some seizures. Should take with B12
• B12: 100 to 200 mcg/day
• B6: 20 to 50 mg/kg, especially in children may help control seizures; depleted in phenytoin therapy. However, B6 may inhibit phenytoin's effects.
• Magnesium: 500 to 750 mg/day (should be in a 1:1 ratio in persons taking calcium) for normal muscle and neuronal function
• Manganese: 5 to 15 mg/day, depleted in epileptics, especially in children
• Zinc: 30 mg/day, may be depleted by some medications, some concern that excess zinc may disrupt zinc/copper ratios and increase seizures, especially without sufficient taurine
• Dimethylglycine: 100 mg three times a day, anecdotal evidence for decreasing medication requirements

Alternative Therapies:

• Passionflower both prevents and treats seizures. It may be effective without side effects, especially where stress is a precipitating factor.
• Skullcap is an antispasmodic and calmative herb, with historic use for epilepsy.
• Valerian is a spasmolytic, sedative, and historical treatment used for epilepsy. Large doses may cause lethargy or gastrointestinal upset that resolve with discontinuation
• Milk thistle protects the liver from ill effects of some medications.

General Recommendations:

• Follow the course of treatment recommended by your doctor.
• Be aware of those things that seem to have set off seizures in the past and avoid them.
• If you have a history of seizures, it is wise to obtain a Medic Alert bracelet or necklace and war it at all times.