Seizure

Disease Description (Causes and Symptoms)

• Definition: A condition in which the brain’s normal electrical activity changes abruptly, causing localized or generalized abnormal electrical discharges and resulting in temporary changes in consciousness, movement, sensation, or behavior (seizure). If seizures occur repeatedly, epilepsy is diagnosed.
• Main pathophysiology: Seizures may be caused by neuronal hyperexcitability, an imbalance in inhibitory circuits, structural abnormalities of the brain (tumors, malformations, scars), metabolic or toxic causes, and genetic diseases.
• Common symptoms:
  • Generalized tonic-clonic seizure (grand mal seizure): loss of consciousness, generalized convulsions, possible urination or defecation, postictal confusion
  • Absence seizure (petit mal seizure): brief loss of consciousness, staring, and eye blinking (mainly in children)
  • Partial (focal) seizure: involuntary movements in a specific part of the body, abnormal sensations, unusual smells or hallucinations, and emotional changes (such as fear). In simple partial seizures, consciousness is maintained; in complex partial seizures, consciousness is impaired and automatisms may occur (staring blankly, lip smacking, etc.)
  • Status epilepticus: an emergency condition in which a seizure lasts for 5–20 minutes or longer, or recurs without recovery

Treatment Methods

• General principles after diagnosis: If a cause (electrolyte imbalance, infection, medication, etc.) is identified, treating that cause takes priority. If the cause is unknown or seizures recur, anticonvulsants (antiepileptic drugs) are used.
• Drug treatment (main drugs)
  • Traditional drugs: phenytoin, carbamazepine, valproate, phenobarbital, etc.
  • Newer drugs: lamotrigine, levetiracetam, topiramate, gabapentin, etc.
  • Absence seizures (petit mal seizures): ethosuximide, valproate, etc.
  • Infusion therapy (emergency): intravenous (IV) benzodiazepines (e.g., lorazepam), followed by phenytoin/fosphenytoin, valproate, or levetiracetam
• Emergency treatment for status epilepticus: Prompt airway and breathing support, IV benzodiazepines (initially), followed by intravenous anticonvulsants and, if necessary, anesthesia and intensive care treatment
• Surgical treatment: For patients with focal (partial) seizures that cannot be controlled with medication, removal of the seizure focus (such as temporal lobectomy) or functional surgery may be considered. Before surgery, functional areas and the seizure origin must be identified (video-EEG, MRI, PET, SPECT, etc.)
• Neuromodulation treatment: Vagus nerve stimulation (VNS), and more recently, deep brain stimulation (DBS), etc. These may help reduce seizure frequency in some patients.
• Dietary therapy: Ketogenic diet (with some effectiveness, particularly for intractable partial or generalized seizures in children)
• Lifestyle management and precautions:
  • Take anticonvulsants regularly; do not stop them arbitrarily
  • Pay attention to sleep, stress, alcohol, medications, and drug interactions
  • Follow safety rules for bathing, swimming, driving, etc. (a seizure-free period may be required according to local regulations)
  • Consult a specialist when planning a pregnancy (particularly due to the risk of birth defects with valproate; folic acid supplementation is recommended)
• Common drug side effects: Drowsiness, dizziness, weight changes, elevated liver enzyme levels, hematologic abnormalities (such as decreased white blood cell count), effects on memory and cognition, and skin rash (in severe cases, Stevens-Johnson syndrome)
• Risk of complications: Trauma, aspiration pneumonia, status epilepticus, SUDEP (sudden unexpected death in epilepsy), etc.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and information to prepare
  • A list of all medications currently being taken (including prescription drugs, over-the-counter drugs, and herbal medicines) and the times they are taken
  • Copies of or dates of previous test results (MRI/CT, EEG, blood tests)
  • A recent seizure record: date, time, duration, seizure characteristics, triggers, and recovery status
  • If possible, a video of the seizure (recorded with a smartphone), either as a file or on a device for playback
  • A summary of medical history (birth history, trauma, infections, surgeries, and family history)
• Tests that may be performed during the outpatient visit
  • Blood tests (electrolytes, liver enzyme levels, and drug levels if necessary)
  • Brain imaging (MRI recommended) or CT
  • Electroencephalography (EEG)
• Information to report during the visit (examples)
  • "When was your most recent seizure? What signs did you have?"
  • "What medications are you currently taking, and when do you take them?"
  • "Have there been any changes in your sleep pattern, alcohol use, or stress?"

Examples of General Questions to Ask the Doctor

• "What are the expected side effects of this medication, and when should I contact you immediately?"
• "If my seizures are completely controlled, can I stop taking the medication? What are the criteria for stopping it?"
• "What lifestyle restrictions apply to driving, work, pregnancy, and other activities?"
• "What emergency first-aid measures should I take when I have signs of a seizure (for oral protection, vomiting, or difficulty breathing)?"

Examples of Condition-Specific Questions

• "Based on my EEG and MRI results, how can it be determined whether my seizure is a partial seizure or a generalized seizure? How likely is it that I will meet the criteria for surgery?"
• "I am planning a pregnancy. Do I need to change the anticonvulsant I am currently taking? What prescription is recommended to reduce the risk of fetal birth defects?"