Cochin Cardiac Club

Health Blog by Dr.Uday Nair


The brain consists of millions of nerve cells, or neurones, and their supporting structure. Each neurone maintains itself in an electrically charged state. It receives electrical signals from other neurones, and passes them on to others. What actually happens is that a tiny quantity of a special neurotransmitter substance is released from the terminals of one neurone. This chemical excites an electrical response in the nuerone next in the chain, and so the signal moves onward.

All the functions of the brain, including feeling, seeing, thinking and moving muscles depend on electrical signals being passed from one neurone to the next, the message being modified as required. The normal brain is constantly generating electrical rhythms in an orderly way.

One must remember that different parts of the brain control different parts of our body and functions.
Left side of the body is controlled by right half of the brain and the right side The left half of the brain controls the right side of the body. In such a scenario, if a seizure starts from the right side of the brain, a person may jerk off the left hand or thumb or the left side of the body may be affected.

In epilepsy this order is disrupted by some neurone discharging signals inappropriately. There may be a kind of brief electrical "storm" arising from nuerones that are inherently unstable because of a genetic defect (as in the various types of inherited epilepsy), or from neurones made unstable by metabolic abnormalities such as low blood glucose, or alcohol. Alternatively, the abnormal discharge may come from a localised area of the brain (this is the situation in patients with epilepsy caused by head injury, or brain tumour).A seizure is not a disease in itself but it is a symptom of neurological conditions such as epilepsy.

A seizure may vary from staring at something for a few seconds to serious convulsions. These are caused by a sudden surge of an electrical activity in a particular area of the brain or the whole brain.

It does not mean that if a person has had a single seizure, he is sure to get epilepsy. Sometimes, children who have high fever can also suffer with a seizure. Sometimes one may also get a seizure caused by an imbalance of body fluids or chemicals, or also by drug or alcohol withdrawal.

A person who has missed his/her medication, or has been unable to sleep well for long, or has been severely ill with high fever or even without it can get a seizure. People, who are under a severe psychological stress, drink excessive alcohol, or even take to drugs such as ecstasy are prone to get a seizure. Seizures can also be provoked by nutritional deficiencies in people or during a menstrual cycle.

A doctor may be able to predict whether you will have more seizures by a test called as an EEG, electroencephalogram, in which wires are attached to your scalp to record your brain waves. Some patterns that appear on the test are very typical to epileptic conditions. If such patterns appear on your test, you are more likely to develop epilepsy.


People who are otherwise healthy but suffer with epilepsy live as long as any normal person does. However, if epilepsy is caused by strokes or a brain tumor, the life expectancy of such people is less than an average person.

However, certain type of long-lasting convulsive seizure called as tonic-clonic status epilepticus is a life-threatening condition and is a medical emergency, which may last for more than 30 minutes. However, if not controlled within that time frame, it may cause a permanent injury or even death.

If not stopped within about 30 minutes, it may cause permanent injury or death.

Accidents during a seizure can become dangerous. People who suffer with epilepsy must be careful of going to the water as drowning is common. Showers must be preferred as tubs may also be dangerous. Safety on roads, railway platforms and busy streets must be doubly-assured.

Types of seizures

There are many different types of epilepsy, partially in infancy, childhood and adolescence. Epilepsy can be regarded in terms of--
  • Generalized and partial epilepsy - the site of seizure origin in the brain
  • Primary epilepsy - the underlying cause of seizures idiopathic where epilepsy occurs in a normal person. It can be traced to a hereditary predisposition to seizures.
  • Secondary or symptomatic epilepsy - seizures are due to the inherent abnormality of brain structure and sometimes related with the neurological problems.
Sometimes brain damage is caused by a complicated birth and a hard blow to the head; a stroke that hampers oxygen to the brain, or the infection of brain like meningitis


Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce:
  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.
Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one part of the brain, they're called focal or partial seizures. These seizures fall into two categories.
  • Simple focal seizures. These seizures don't result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of part of the body, such as an arm or leg, and spontaneous sensory symptoms such as tingling, vertigo and flashing lights.
  • Complex focal seizures. These seizures alter consciousness or awareness, causing you to lose awareness for a period of time. Complex focal seizures often result in staring and nonpurposeful movements — such as hand rubbing, chewing, swallowing or walking in circles.
Generalized seizures

Seizures that seem to involve all of the brain are called generalized seizures. Six types of generalized seizures exist.
  • Absence seizures (also called petit mal). These seizures are characterized by staring and subtle body movement, and can cause a brief loss of awareness.
  • Tonic seizures. These seizures cause stiffening of the muscles, generally those in your back, arms and legs and may cause you to fall to the ground.
  • Clonic seizures. These types of seizures are associated with rhythmic, jerking muscle contractions, usually affecting the arms, neck and face.
  • Myoclonic seizures. These seizures usually appear as sudden brief jerks or twitches of your arms and legs.
  • Atonic seizures. Also known as drop attacks, these seizures cause you to lose normal muscle tone and suddenly collapse or fall down.
  • Tonic-clonic seizures (also called grand mal). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

The Causes of Epilepsy

An inherited instability in the functioning of neurones seems to be responsible for the common forms of generalised epilepsy, especially absence attacks, and tonic-clonic seizures where there is a family history of similar disorder. How this genetic defect operates has yet to be established - perhaps the abnormality lies in the structure of the neurone's outer membrane, leading to electrical instability.
Injury to the brain may certainly cause epilepsy. This includes deprivation of oxygen at birth, trauma to the head at any time of life, and stroke (injury to part of the brain caused by blockage or haemorrhage of one of its blood vessels).
Metabolic disturbance can produce generalised seizures through disturbing the normal functioning of neurones. This may occur when there is severe lowering of blood glucose levels, and when there is severe malfunctioning of the liver or kidneys.
Alcohol and drug abuse may cause seizures during intoxication, or when the offending substance is being withdrawn. Withdrawal of certain medications, such as barbiturates and other sedatives, can cause epileptic seizures in those who have taken them for long periods.
Brain tumour is, fortunately, a relatively uncommon cause of epilepsy, but it must be excluded in all patients who develop epilepsy for the first time during adult life. Tumour should also be excluded in children and adolescents in whom the appearances of the EEG test are not typical of genetic epilepsy, or where these does not seem to be an adequate alternative explanation (such as birth injury).

Diagnosis of Epilepsy

Epilepsy is essentially a clinical diagnosis i.e. from history and physical examination. Detailed account of the attack from patient and the eyewitness is more important than the results of all the investigations as regards confirmation of the diagnosis. It often gives clues to the basic cause as well. Thus every effort must be made to obtain this.

Investigations are done to confirm the diagnosis and determine the cause. Depending on the age of the onset of the first seizures and associated symptoms and signs, the doctor decides the number and priority of the investigations. They include:
  • Plain X–rays of skull and chest.
  • Blood count and haemoglobin concentration.
  • Electroencephalogram (EEG).
  • Cerebrospinal Fluid Examination obtained through lumbar puncture.
  • CT Scans and MRI Scans of the brain.
  • Angiography.
  • IQ test and personality tests.
Diagnosing a case of epilepsy

A patient’s detailed medical history is of utmost importance in diagnosing epilepsy. Many times family members who witness the seizure activity might be asked to keep a record of the time of the seizures, how long each seizure lasts, any aggravating factors like emotional stress, certain foods, smells or sounds etc.. This information can be crucial in the diagnosis of the type of epilepsy.

Usually, a neurologist would look into a case of epilepsy, although general physicians can also treat a person with seizures. The laboratory that would be required for epilepsy are:
  • Primary care investigations
    Chest X–ray to rule out malignancy. Blood tests (eg. full blood count, erythrocyte sedimentation rate, electrolytes, renal function, liver function, calcium, and glucose) could show an underlying disorder or metabolic disturbance.
  • Secondary care investigations
    Such as electroencephalography, neuroimaging, and metabolic screening in children, may aid seizure classification and help to determine the aetiology but they have limitations.
  • Magnetic resonance imaging (MRI)
    Can better define the structures of the brain in three dimensions and can look at discrete areas of brain activation.
  • Computed axial tomography (CAT)
    Has a role in the urgent assessment of seizures or when MRI is contraindicated, but it is less effective in detecting lesions.
  • Electroencephalography (EEG)
    The EEG is not foolproof. It can only measure abnormal electrical activity that occurs during the test period and should not be performed to ‘Exclude’ a diagnosis of epilepsy but should be used to support the classification of epileptic seizures and epilepsy syndromes when there is clinical doubt.
  • Positron emission tomography (PET)
    Scanning is a highly specialized, expensive and largely unavailable technique that detects cerebral blood flow and metabolism.
  • Single proton emission computerized tomography (SPECT)
    scanning is much cheaper and technically simpler than PET scanning it shows the areas where blood flows through your brain.

Risk factors

There are some people who are prone to get epilepsy especially if one has a family history of seizures.

Here are the following people who could be at an increased risk of getting a seizure disorder or may suffer with epilepsy.

  • Babies who suffer with a seizure in the first month
  • Some babies have a poorly developed brain or an abnormal brain structure.
  • People who suffer with a head injury and suffer with internal bleeding.
  • Strokes may also trigger epilepsy. Many vascular diseases can also cause epilepsy.
  • People who do not get enough oxygen for the brain.
  • Sometime people who get high fever can also get febrile seizures and may cause epilepsy if continues.
  • Excessive alcohol intake and a poor nutritional diet can cause epilepsy.
  • Use of illegal drugs such as cocaine and taking ecstasy pills can also trigger an epilepsy attack.

Related risks

Most people lead an active and a healthy life even while suffering with epilepsy. However, their life could be at great risk.

Status Epilepticus: This is a serious condition in which a person may either have an abnormally prolonged seizure or may be slightly unconscious even in between a seizure. This could be life threatening and for all safety measures, any seizure that lasts more than five minutes must be brought to the doctors notice.

Such people do not necessarily get long convulsive seizures or severe symptoms but may experience several small episodes.

Sudden Unexplained Death: People who suffer with epilepsy may die suddenly without any reason. Although researchers are still unsure as to what causes the death, experts suggest that an increased dose of drugs or taking more than one or two types of anti-convulsant drugs at a time may cause the death.

Other risks: Head injury is common in people suffering with a seizure. People may also drown if a seizure occurs in water. Even minimal water in a bath tub can cause a person to drown. Drugs or pills taken to control epilepsy may cause drowsiness and may also cause accidents while driving and so on. Pregnant ladies are at risk along with their babies during an epilepsy attack. And epilepsy medications do not ease the problem. In fact they may cause birth defects.

How can epilepsy be treated?

There are different ways of treating epilepsy. Doctors who treat epilepsy come from different backgrounds of medicine. Doctors who specialize on treating epilepsy are called epileptologists. 

Once epilepsy is diagnosed it is important to treat it as soon as possible. According to reports medications and other treatments to treat epilepsy may not be successful once the seizures and their consequences become conventional.

People with can use antiepileptic drugs to avoid and cure seizures. Children with medication-controlled epilepsy can lead a seizure free life by discontinuing medications.

It’s a difficult task to find the right dosage and medication for treating epilepsy. Initially you will be prescribed a low dose, which may be increased if the seizures still remain uncontrolled.

The side-effects caused by anti-seizure medications are:

  • Mild fatigue
  • Dizziness
  • Gain in weight

Severe side-effects include:

  • Skin rashes
  • Depression
  • Loss of coordination
  • Extreme fatigue
  • Speech problems

Consult your doctor before changing your medications and taking up prescription medicines or over-the-counter drugs.

You may be suggested other treatment options such as surgery, vagus nerve stimulation or a ketogenic diet. New medications such as Tegretol and Epilim are known to suppress epilepsy in most patients without any serious side-effects.

Emergency measures for a seizure case

If you see a person having an epileptic seizure, please do not turn away and do try and help him/her… The following measures are to be employed in case you see a person suffering from a seizure.

Do’s in Epilepsy

To aid someone having a seizure, take these steps:
  • Keep calm.
  • Prevent the patient from injuring himself.
  • Block the fall of the person onto the ground.
  • Loosen their belt, necktie, or other tight clothing, remove the spectacles.
  • Cushion their head.
  • Clear away any sharp or hard objects.
  • When the seizure is over, turn them on their side to prevent choking.
  • After the seizures stops turn the patient to a side and wipe the froth from his mouth.

Don’ts in Epilepsy

  • Do not panic and do not be afraid!!!
  • Do not insert spoon or any such articles into the mouth.
  • Do not restrict convulsive movements as it may cause fracture.
  • Do not try to insert a gag in the mouth it may cause difficulty in breathing and also hurt the helpers fingers.
  • Do not crowd around the patient.
  • Do not give water or any other liquid till he is fully consciousness.
  • Do not try and physically hold the person, this may injure both the person and the helper.
  • Medical aid is usually not required except in case of the person being in water and drowning is a danger then mouth to mouth resuscitation maybe required. The duration of the seizure is usually not more than 2 minutes after which the person enters a state of deep sleep.

    Lifestyle restrictions

    It is important for people with epilepsy to try to get over any fear of seizures and live their lives as normally as possible. However, there are a number of restrictions such as those outlined below.
    • To hold a civilian driving licence in the UK you need to have been seizure-free for 12 months, or only had seizures at night while asleep.
    • Activities such as climbing and diving are best avoided if you are still having seizures.
    • If you decide to go swimming it is best to go with a friend who can keep an eye on you, and help out if necessary. Inform the lifeguard when swimming in a public pool.
    • Flickering lights, such as strobe lights in nightclubs, can trigger seizures in some people. If this is the case, clubs with strobes are best avoided. It is also sensible to avoid playing computer games for long periods of time as the flickering screen has been associated with seizures in some susceptible people with epilepsy.
    • Some people's seizures can be brought on by lack of sleep, or by drinking alcohol the night before. This calls for a more moderate lifestyle, which can be particularly difficult for teenagers for whom this is more commonly a problem.
    Rigid guidelines are impossible as each person's epilepsy is different. For example, it makes a big difference whether the fits are unpredictable or whether they always occur at the same time.


    • Difficulty learning
    • Inhaling fluid into the lungs, which can cause aspiration pneumonia
    • Injury from falls, bumps, or self-inflicted bites during a seizure
    • Injury from having a seizure while driving or operating machinery
    • Many epilepsy medications cause birth defects -- women wishing to become pregnant should alert their doctor in advance in order to adjust medications
    • Permanent brain damage (stroke or other damage)
    • Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
    • Side effects of medications


      Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.
      Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.
      Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

      Please Note

      Call your local emergency number or doctor if this is the first time a person has had a seizure .

      In the case of someone who has had seizures before, call emergency for any of these following situations:

      • This is a longer seizure than the person normally has, or an unusual number of seizures for the person
      • Repeated seizures over a few minutes
      • Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

      Call your doctor if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

      Some people with certain types of seizures may be able to reduce or completely stop their seizure medicines after having no seizures for several years. Certain types of childhood epilepsy goes away or improves with age -- usually in the late teens or 20s.

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