Table of ContentsView AllTable of ContentsWhat Are Seizures?Status EpilepticusSUDEPAssociated RisksTreatment
Table of ContentsView All
View All
Table of Contents
What Are Seizures?
Status Epilepticus
SUDEP
Associated Risks
Treatment
Seizures are sudden, uncontrollable electrical disturbances in the brain. When pathways of communication between neurons (nerve cells) in the brain are disrupted, the opportunity for seizures arises.
Seizures can cause changes in:
There are differenttypes of seizureswhich vary in severity, symptoms, duration, and place of origin in the brain. A typical seizure will last from 30 seconds to two minutes.A prolonged, uncontrollable seizure may indicate a greater health risk.
From case to case, symptoms of seizures vary. Some symptoms include:
When Seizures Don’t Stop
Prolonged seizures lasting over five minutes should be potentially considered and treated asstatus epilepticus, a form of prolonged seizures significantly associated with disease (morbidity) and death (mortality).
Verywell / Emily Roberts
Status epilepticus is characterized as a prolonged seizure or series of multiple or continuous seizures without full recovery of consciousness between them. This condition can last over 30 minutes and is considered a medical emergency.
About 200,000 cases of status epilepticus occur annually in the United States. It tends to be most common in older populations.Additionally, one study found that more than 50% of reported incidents occur in patients with undiagnosedepilepsy.
A prolonged episode of status epilepticus can result in a variety of conditions, including:
Identifying and treating a status epilepticus episode immediately is very important, although it may be initially difficult to recognize.
An even more serious type of status epilepticus is refractory status epilepticus (RSE). This occurs when the seizures last longer than 60 minutes despite treatment with a standard anticonvulsant. RSE is common among elderly patients and leads to death in approximately 76% of reported cases.
Alcohol or Drug Withdrawal
Withdrawal from alcohol or sedating drugs can take a toll on a person’s body and can cause a variety of related health problems. It is common for a person to have withdrawal seizures, also known as “rum fits,” during the abrupt end of alcohol intake after a long period of heavy drinking.
Seizures during alcohol or drug withdrawal are generally self-limited, although they can be very serious and have been associated with status epilepticus. About one-third of patients experiencing withdrawal seizures may progress todelirium tremens(DT).
Sudden Unexpected Death in Epilepsy (SUDEP)
Sudden unexpected death in epilepsy (SUDEP)occurs in about 1 in every 1,000 people with epilepsy.It is a leading cause of death for people with this condition and most commonly occurs in people with poorly controlled epilepsy.
SUDEP is diagnosed after a complete autopsy and toxicology report. When the cause of death of a person with epilepsy cannot be identified, it is considered an SUDEP.
In the few reported witnessed cases, SUDEP follows episodes ofgeneral tonic-clonic seizures, also known as grand mal seizures, during which the whole body experiences muscle contractions and the person loses consciousness. Unfortunately, in most cases, SUDEP occurs unwitnessed.
Tonic-clonic seizures and nocturnal (nighttime) seizures are clinical risk factors that may be associated with SUDEP.
SUDEP is also common among those with an early age of epilepsy onset, men, and those who have a long duration of epilepsy.Pregnant women with epilepsy are also at risk for SUDEP.
If you or someone you know is dealing with epilepsy, gaining the right education and counseling to avoid seizure-provoking factors, like alcohol or sleep deprivation, is important. It may also be beneficial to begin documenting nocturnal seizures.
Lack of supervisionduring the nightcan be a risk and may delay potential resuscitation.Discussing with your healthcare provider how to manage nocturnal seizures and prevent seizure clusters may help lower the risk of SUDEP.
Risks Associated With Seizures
Those with seizures that result in an alteration or loss of consciousness, like duringatonic seizuresor tonic-clonic seizures, are at the highest risk of injury. Notably, most such injuries are not fatal. The type of injuries associated with seizures depends on the type of seizure and severity.
Broken Bones
Fractures are a common injury in people with epilepsy. Fractures can occur due to the inability to activate protective reflexes during seizures, resulting in falls.
The muscle contractions of seizures themselves can also pose a great load on the skeleton. Additionally, some anti-epileptic medications are known to reduce bone mass density.
Burns
Burns are more common among people with epilepsy than the general population. Most reported burns happen during daily activities like cooking or ironing.
Shoulder Dislocations
Posterior shoulder dislocations are described as seizure-related injuries but are fairly rare events.
In the case of someone who is experiencing a seizure, ensuring that the person is not lying on their side during the episode may lower the risk of a shoulder dislocation.
After the seizure, the person can be turned to their side to help avoid aspiration.
Car Accidents
Driving is often a common concern for those dealing with epilepsy due to the possibility of unprovoked seizures occurring while the individual is behind the wheel. It is important to recognize that the likelihood of an accident occurring while driving does increase if you are dealing with a seizure disorder.
Legislation regardinglicensing people dealing with epilepsy to drivevaries from state to state and country to country.
Aspiration
Aspiration is the inhalation of a substance or object. During a seizure, food, digestive fluid, vomit, or other material may get into the airways or lungs.
Aspiration is rare but normal and even happens in healthy individuals during sleep. The body’s reflexes usually keep the substances out.
Activating these reflexes during and after a seizure is difficult. In some cases, aspiration can lead to respiratory disease, such asaspiration pneumonia.
During the middle of a seizure (the ictal phase), there is a low risk of aspiration. After a seizure (the postictal phase), the risk of oral secretions accidentally entering the airways increases.
It is recommended that a person be turned to their side after a seizure in order to avoid aspiration.
Treatment for Seizures
In the case that potentially dangerous seizures arise, emergency evaluation is necessary. These include first time, withdrawal-based, unexplained and/or increased seizures. and persistent seizures. Contact your local emergency service via telephone and summon an ambulance.
It is important to ensure that vital functions, especially normal breathing and heart function, are preserved. If someone is experiencing an ongoing seizure, providing respiratory support and monitoring their airway is most important. After the seizure, you can turn the person to their side to avoid aspiration.
Medical help should be sought during or immediately after a dangerous episode of persistent seizures.
During the seizure, blood sugar levels decrease drastically, and temperature, the electrical activity of the heart (ECG), and blood pressure must be monitored in order to minimize the risk of another seizure.
In an emergency, abenzodiazepine medicationcan be administered rectally for fast-acting effects.
Long-Term Epilepsy Prognosis
Summary
Many individuals live with seizure disorders that cause events regularly despite optimal treatment. When these events are well characterized and proper precautions are taken, individuals will not need hospitalization or significant changes to their healthcare plan.
However, new/unexplained or changing seizure patterns can result in severe health consequences and even death. If you or someone you know might be at risk of status epilepticus, SUDEP, or other injuries associated with seizures, talk to your healthcare provider to learn more about how you can reduce these potential risks
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