Seizure

What is a seizure?

The brain has millions of nerve cells that pass signals back and forth to help the brain and body work normally. Seizures happen when the signals in the brain do not pass back and forth like they should. A seizure is a symptom, not a disease. There are different types of seizures, depending on the cause and the area of the brain that is affected. The types of seizures look and feel very different, such as:

• A seizure that starts with a loss of consciousness and falling down, followed by body stiffening, shaking, or jerking. The seizure may last a few minutes. Then you go into a deep sleep for a few minutes. When you wake up, you will probably not remember the seizure. You may be drowsy for hours after the seizure. This is called a grand mal or tonic-clonic seizure.
• A seizure that involves a short loss of consciousness, of staring, fluttering eyelids, or twitching in your face. You are awake but not aware of what is going on around you. You will probably not remember the seizure. Each seizure may last only 10 to 30 seconds, but hundreds may happen each day. This is called an absence or petit mal seizure.
• A seizure that causes numbness or jerking of the limbs. You may be awake and remember what happened, or you may lose consciousness for a short time. This is called a focal or partial seizure.

Having one seizure right after another or one very long seizure is a medical emergency because it can keep you from getting enough oxygen.

If you have had several seizures and no cause can be found, your healthcare provider may diagnose a seizure disorder, which is also called epilepsy. People with epilepsy may have a seizure every day, but most have them less often and some people only have a seizure once every few years. If you have epilepsy, there are many medicines to help prevent seizures and allow you to work, drive a car, and be active.

What can I expect in the hospital?

Generally, new seizures require hospitalization to determine the cause and treat the condition. If you have a history of seizures, you may need to stay in the hospital because:

• You have a medical condition which is making your seizures worse or happen more often
• You have seizures that need immediate treatment or an adjustment to your treatment
• You need surgery to treat seizures

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• A heart (cardiac) monitor may be used to keep track of your heartbeat.
• Your strength, range of motion, and ability to feel pain may be checked regularly.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.

Testing

Testing may include:

• Blood tests to check your blood sugar level and oxygen level, or for dehydration, infections, drugs, or alcohol
• Blood tests to check how anti-seizure medicine is working
• EEG (electroencephalogram), which uses small wires pasted or taped to your head to measure and record the electrical activity of your brain
• Magnetic resonance imaging (MRI), which uses a powerful magnetic field and radio waves to take pictures from different angles to show thin cross sections of the brain
• Computed tomography (CT) scan, which is a series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the brain
• Lumbar puncture, also called a spinal tap, which uses a needle to get a sample of fluid from the area around your spinal cord to check for infection

Treatment

The treatment for a seizure depends on its cause.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs to help you breathe.
• Depending on the cause of your seizure, your provider may prescribe medicines to:
  • Prevent seizures
  • Treat or prevent an infection
  • Reduce fever
  • Control your blood sugar
  • Decrease swelling in the brain and around the spinal cord
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• Rarely, you may need surgery to treat seizures if all other treatments have failed. Surgery may include:
  • Vagus nerve stimulation (VNS): A procedure in which a very thin wire (electrode) is placed on the vagus nerve in the neck and attached by a wire that runs under the skin to a very small machine (neurostimulator) placed under the skin in your upper chest. The neurostimulator sends small electrical signals to the electrode to block nerve signals that cause seizures.
  • Resection: Surgery to remove the area of the brain that is causing the seizures. Resection surgeries are named based on the part of the brain that is being removed. For example, a temporal lobectomy involves removing the temporal lobe of the brain.
  • Nerve transection: Surgery to cut nerves or brain tissue so that seizure signals cannot be sent to other nerves
• Your provider may prescribe a special diet, called a ketogenic diet, to help stop seizures.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Severe headache
  • Trouble breathing
  • Seizure after a head injury
  • Slurred speech
  • Loss of bladder or bowel control
  • Side effects from your medicine, such as nausea, dizziness, and mental changes, such as hallucinations
  • Seizures that are different, such as happening more often or lasting longer
  • Hallucinations, which may be visual or involve other senses such as hearing, touching, tasting or seeing something that is not really there
  • Intense feelings of fear or déjà vu (the feeling that what you are experiencing has happened before even though you know it hasn't)
  • Loss of consciousness
  • Confusion
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, why you are in the hospital, the treatment you need, and how well you recover. This is often between 3 to 4 days. Talk with your provider about how long your stay may be.