If you have a seizure, does it mean that you have epilepsy?

       

A seizure is a change in behavioral state which results from abnormal electrical activity in the brain. Given the right set of circumstances (e.g. - blow to the head intoxication, high fever) anyone can experience a seizure. When seizures reoccur without any obvious cause, then a person may be considered to have epilepsy.

           

Types of Seizures and their symptoms

       

Grand Mal

     
   Tonic-Clonic Seizures

           

The true generalized seizure is characterized by sudden loss of consciousness, usually without warning. At onset there is usually a general stiffening of the body, often with forceful expiration of air. If the person having the seizure is upright when this happens, there can be a hard fall to ground or floor. This "tonic" phase of the seizure has a short duration, but is often frighten witnesses. Virtually all skeletal muscles in the body are forcefully contracting at the same time, there may be biting of the tongue, passage of urine, infrequently defecation or vomiting, and sometimes a change in color to a purplish-blue The "tonic" phase generally lasts aproximately 30 seconds.    

Immediately following the 'tonic' phase of a seizure, convulsing begins {forceful, rhythmic jerking of arms, legs, head and neck) Convulsing can range in both its intensity and its duration, and can last a couple of minutes, with peaks in intensity and then fading out. Skin/lip/nail bed color generally returns to normal during this period.          

When the convulsing stops, there is a state of sleepiness when all the muscles that were convulsing are deeply relaxed. If a person in this state is in a position which makes it hard for them to breathe, they may NOT change their own position (see following section). The folklore about people with seizures "swallowing their tongue" actually relates to the possible airways being blocked    

As the sleepiness lightens, a person recovering from seizure may be confused. The confusion more often passes over minutes, desire to sleep for a while sometimes lasts for a while.    

If a generalized convulsion is prolonged (5 minutes or more) or if it is followed by a second seizure before complete recovery (person is awake and interactive), it is time to seek medical assistance.            

Temporal Lobe Epilepsy

- Complex Partial Seizures (often misslabeled petit mal)                      

The second most common form of seizure in adults is partialcomplex(i.e.- disturbance of consciousness). Usually the area of brain involved in the seizure activity is the temporal lobe. But other parts of the brain can give rise to seizures which fall under this heading. What most of these seizures have in common is:

  • Some form of warning or aura with an awareness that something is about to happen. This may take the form of a mental picture, a noxious odor, an unusual sensation in the stomach, the perception of a voice or music, even a particular recollection;
  • Loss of awareness without collapse/unconsciousness as if auto-pilot takes over);
  • Duration of minutes during which there may be automatisms -- repetitive, non-purposeful acts -- (eg.- lip smacking, swallowing, picking at things, garbled or semi-random speech, aimless walking or manipulation of objects);
  • A period of confusion lasting minutes after the episode, possibly with sleepiness (but not the profound somnolence that generally follows a major convulsion). The person in this state may walk around, as if with purpose. Rarely, aggression may be manifest during this phase - especially if someone is attempting to passively restrain/direct movement. This aggression, when manifest, is not well-focused, not 'thought-out' and can often be avoided by leaving the person alone for a few minutes.
   

There is actually quite a bit of variety in the behavior individuals with this type of seizure exhibit. But once a seizure of this type has expressed itself in an individual, any subsequent episode generally has the same aura and outward behavioral appearance as the first one.    

There is total amnesia for the period of the seizure and variable amnesia for events just preceding and following it. Sometimes, in some persons, this type of seizure precedes a generalized convulsion (see above) as the electrical signal spreads out from one part of the brain to the entire brain.           

Focal Fits -Simple Partial Seizures

       

Seizures which involve only part of the brain ("partial" without alteration of awareness can occur in persons who have had injury to the brain (as from trauma, stroke, hemorrhage,malformation, tumor). Most commonly, they involve rhythmic (2-3 cycles/second) twitching of face, hand/arm, and/or leg on the side of the body opposite to the side of brain from which the seizure emanates. Generally, this type of seizure lasts minutes. In some individuals, it forms the prelude to a generalized convulsion. Occasionally, it can go on for a very long time (hours-days). The longer it lasts, the greater the associated fatigue. Extremely prolonged versions of this seizure type can interfere with sleep, cause muscle pain and lead to exhaustion.           

Other Seizure Types

   

The true petit mal seizure type (also known as absent seizures)

       

Absence seizures are characterized by abrupt and brief interruption of consciousness without convulsion. During the typical, seconds-long episode there is "loss of contact", "spacing out" rarely with chewing, swallowing, or blinking automatisms.Sometimes an individual continues doing whatever they were doing at seizure onset, though in an automatic way. During the episode, interactionis not possible. These episodes can be very brief, subtle and easily missed by a nearby observer. Normally, whatever activity a child was engaged in before the seizure is continued following it. Sometimes children with these seizure types are misdiagnosed with learning or behavioral problems.              

Habits which can have a bearing upon seizure risk.

       
  • Caffeine lowers seizure threshold. all persons with or at risk for seizures should use caffeine in moderation, especially if prevention of recurrent seizure is proving difficult.
  • Alcohol makes it easier to have a seizure. It does so both as its level rises in the blood stream and as it later falls. It also tends to interact with just about every drug used to treat or prevent epilepsy. Because of its complex effects upon metabolism, body water and mineral balance, sugar metabolism and even sleep, alcohol use should be avoided in anyone who has had or is at special risk of seizure.
  • Sleep-deprivation does much to lower seizure threshold.
                

Clinical Studies on Autism And Seizure disorders

       

Rossi PG, Parmeggiani A, Bach V, Santucci M, Visconti

Department of Child Neurology and Psychiatry, University of Bologna, Italy.

Epileptic seizures are frequently reported (4-32%) in autism. These values are higher than in the normal population of children and adolescents (0.5%). In the literature there is no uniform description of epilepsy in autism. We examined 106 patients with autistic disorder divided into three groups on the basis of presence or absence of EEG paroxysmal abnormalities (PA) and / or epilepsy including febrile convulsions (FG). Our patients presented an autistic syndrome unrelated to clear congenital or acquired encephalopathy. The prevalence of epilepsy and EEG PA was 23.6% and 18.9%, respectively. Significant differences between the three groups appeared for (i) familial antecedents for epilepsy / FC and neurologic and psychiatric diseases (P < 0.004), (ii) a different proportion between the three groups for mental retardation (P < 0.03), (iii) and EEG fast activity (P < 0.04). Our patients showed several types of epilepsy, including idiopathic forms with seizure onset after the age of 10 in 45% of cases. Seizures were mainly partial, not frequent and controllable by anti-epileptic drugs. PA were mostly focal and multifocal and in 45% of cases were typical of benign childhood partial epilepsy with centro-temporal spikes. The higher incidence of epilepsy and EEG PA is apparently not related to organic pre-, peri- and postnatal antecedents or cerebral lesions. On the contrary, genetic factors responsible for autism and epilepsy seem important in the genesis of these two disorders.

             

Clinical-radiological evaluation of infantile autism and epileptic syndromes associated with autism

Carod FJ, Prats JM, Garaizar C, Zuazo E Servicio de Neuropediatria, Hospital de Cruces, Barakaldo, Vizcaya.

        With the aim of ascertaining the existence of medical conditions associated with autism, the presence of pre- and perinatal factors, family antecedents as well as the prevalence rate of different epileptic syndromes in the juvenile autistic population, we carried out a retrospective observational study and looked at the medical history of 62 autistic children so diagnosed in the neuropaediatric service at Barakaldo Hospital Cruces in the past twenty years. All of them were diagnosed by a child neurologist following DSM-III-R criteria, having been by the same physician on at least one occasion. From the etiologic point of view, eight children (13%) presented specific syndromes, fifteen (23%) presented encephalopathies acquired pre-or perinatally, two (3.2%) had brain tumours and the remaining thirty-seven (61%) presented critogenetic autism. 47% of autistic children were seen to have some kind of epileptic syndrome: six had idiopathic epilepsy (juvenile myoclonic epilepsy 1: partial benign epilepsy with Rolandic point 2 ; petit mal 1; generalised primary epilepsy grand mal type 1); eleven had cryptogenic epilepsy (myoclonic epilepsy 1 ; focal 7; grand mal 1; Lennox 2) and secondary epilepsy in eleven other cases (West 4; focal 6; grand mal). In the literature an epileptic frequency among autistic subjects is quoted as being between 16% and 35% dropping to 6% in slight cryptogenic autistic cases. Our frequency rate among autistic children is much higher, reaching 47% of the total and affecting 46% of cryptogenic autistic cases. There were no cases of polymorphic nursing epilepsy in our series. Idiopathic and cryptogenic epilepsy were more frequent in cryptogenic autism.

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Excerps from the above link to research on Autism:

"...hearing deficits are common in people with autism, with as many as 30% to 50% of people with autism showing evidence of a hearing deficit according to one study." "...in all likelihood researchers, clinicians, and parents alike probably overlooked the data concerning eye and ear anomalies in autism simply because they were too busy dealing with the far more obvious problems with which an individual with autism struggles...."(To read this study in full click on the words the ears the eyes an the autism)

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