Seizures come in all different shapes and forms, from absence seizures where the person seems to just lose focus to grand mal seizures, which involve loss of consciousness, loss of bladder or bowel control, and generalized jerky body movements. For the purposes of today’s article I will focus on grand mal seizures. Seizures are caused by a sort of electrical short circuit of the brain. Abnormal brain wave activity may be seen on electroencephalogram (EEG). Seizures need to be differentiated from other conditions that may look similar including syncope (sudden loss of consciousness), movement disorders, and other brain conditions. Hallmark seizure symptoms include tongue biting, incontinence, and a post-ictal phase. The post-ictal phase, which immediately follows a seizure, is characterized by an altered level of consciousness where the patient may seem awake but unresponsive or confused and disoriented. This phase may last at least 30 to 60 minutes. It is caused by the brain sort of resetting itself, or restoring default settings to use a computer analogy.
Seizures can cause serious physical, psychological, and social consequences including anxiety, loss of driving privileges, limitations on employment, and occasionally even death. There is disagreement in the medical community about how to treat and manage a first unprovoked seizure. Unprovoked seizures, also known as idiopathic seizures, have no known cause, meaning all brain scans, EEGs, and other tests are normal. Some physicians will treat a first unprovoked seizure with anti-seizure medication and some will choose to observe the patient off medication. One large study showed that the two-year risk of a second unprovoked seizure was 23 percent in those treated with medication and 43 percent in those just observed. Like most medications, anti-seizure drugs can have adverse side effects including sedation, dizziness, wobbly gait, weight gain, rash, hair loss, and gastrointestinal symptoms. One study found that the two-year quality-of-life scores in those treated vs. untreated were the same due to medication side effects.
New guidelines published by the American Academy of Neurology and the American Epilepsy Society emphasize that the risk of recurrent seizures should be weighed against the risk of adverse effects from medication. They note that the risk of seizure recurrence in someone with normal brain scans and EEG is 25 percent over two years. Some patients may accept the 25 percent risk while others may not. Also patients need to know that immediate treatment after a seizure may not reduce the long-term risk for seizure remission but will reduce the risk of another seizure over the next two years. There is great variation from state to state on driving restrictions for those who have had a seizure and seizure reporting requirements for physicians.
For more information go to www.aesnet.org or www.aan.com
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