02/08/2025
TYPES OF SEIZURES
A seizure is a sudden, uncontrolled burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings, or levels of consciousness. Seizures are broadly classified into two major types:
---
CLASSIFICATION OF SEIZURES
1. Generalized Seizures
Involve both hemispheres of the brain from the onset.
Can be motor (with movement) or non-motor (absence-type).
2. Focal (Partial) Seizures
Originate from one part of the brain.
May be:
Aware (Simple Partial): No loss of consciousness
Unaware (Complex Partial): Impaired consciousness
Can evolve into secondary generalized seizures (spreads to both hemispheres)
---
CAUSES OF SEIZURES (Provoked or Unprovoked)
Mnemonic: VITAMINS
Category Example Causes
V – Vascular Stroke, hypertension, eclampsia
I – Infections Meningitis, encephalitis
T – Toxins Alcohol withdrawal, drug overdose (e.g., tramadol, co***ne), medications
A – AV Malformation Arteriovenous malformation in the brain
M – Metabolic Hypoglycemia, hyperglycemia, hyponatremia, hypernatremia, hypocalcemia
I – Idiopathic No identifiable cause (often genetic)
N – Neoplasms Brain tumors
S – Stress Emotional or physical stress can trigger seizures in some individuals
---
PATHOPHYSIOLOGY
Seizures result from abnormal, excessive, and synchronous neuronal activity in the brain. The imbalance between excitatory neurotransmitters (like glutamate) and inhibitory neurotransmitters (like GABA) leads to a hyper-excitable state. Depending on the area of the brain affected, the clinical features vary.
---
TYPES OF GENERALIZED SEIZURES
1. Absence Seizure (Petit Mal)
Brief loss of awareness
Staring into space, blank facial expression
Sudden return to normal with no memory of the event
2. Tonic-Clonic Seizure (Grand Mal)
Tonic phase: Muscle stiffening, loss of consciousness, fall
Clonic phase: Rhythmic jerking of limbs
May include: tongue biting, incontinence, postictal confusion
3. Tonic Seizure
Sudden stiffening of muscles, often in the back and limbs
4. Atonic Seizure
Sudden loss of muscle tone → patient may collapse (“drop attacks”)
5. Clonic Seizure
Repetitive, rhythmic jerking of muscle groups
6. Myoclonic Seizure
Sudden, brief involuntary twitching of a specific muscle group (e.g., shoulder or arm)
---
FOCAL (PARTIAL) SEIZURES
1. Simple Focal Seizures (Aware)
No loss of consciousness
May present with:
Muscle twitching
Tingling, numbness
Visual, auditory, or olfactory hallucinations
Deja vu or emotional changes
2. Complex Focal Seizures (Unaware)
Impaired consciousness
Automatisms: lip-smacking, hand-wringing, chewing
Confused, dazed, may not respond appropriately
3. Secondary Generalized Seizures
Start as focal and spread to both hemispheres
Often become tonic-clonic seizures
---
STATUS EPILEPTICUS 🚨
Definition:
A medical emergency where a seizure lasts more than 5 minutes, or 2 or more seizures occur back-to-back without regaining consciousness.
Why It’s Dangerous:
Risk of permanent brain damage
Hypoxia, acidosis, metabolic disturbances
Can lead to death if untreated
---
TREATMENT & CARE
(🔰 Step-by-step guide for first responders & beginners)
Acute Seizure First Aid
1. Stay Calm
Do not panic; note the time the seizure starts.
2. Protect the Patient
Gently ease them to the floor if standing.
Move nearby harmful objects out of the way.
3. Positioning
Turn the patient to their side (recovery position) to keep the airway clear.
Loosen tight clothing, especially around the neck.
4. Do NOT:
❌ Do not put anything in their mouth.
❌ Do not restrain or hold them down.
❌ Do not give food, drink, or medicine during the seizure.
5. Protect the Head
Place a folded cloth or soft item under the head.
6. Pad Side Rails (if in bed)
Especially for known seizure patients.
7. Time the Seizure
If it lasts >5 minutes, call for emergency help.
8. Observe & Document
Note:
Type of movements
Duration
Level of consciousness after seizure
Eye deviation, incontinence, tongue bite, etc.
9. After Seizure (Postictal Phase)
Reassure and orient the patient.
Allow them to rest and stay in the side-lying position.
Stay with them until full recovery.
---
Medications (Acute Management & Long-term)
Benzodiazepines (for acute seizures):
Lorazepam (IV)
Diazepam (IV or re**al)
Barbiturates: Phenobarbital
Antiepileptic drugs (long-term):
Phenytoin, valproate, carbamazepine, levetiracetam, lamotrigine, etc.
---
WHEN TO CALL FOR EMERGENCY HELP
First-time seizure
Seizure > 5 minutes
Multiple seizures without recovery
Patient is injured
Trouble breathing
Diabetic or pregnant patient
Seizure occurred in water
---
SUMMARY
Seizures arise from abnormal electrical activity in the brain.
They may be generalized or focal, with a variety of presentations.
Status epilepticus is life-threatening and requires urgent intervention.
Proper first aid and medication can prevent complications and improve outcomes.
