Seizure: What is a Seizure?

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Seizure:  What is a Seizure?




Guest:  Dr. Jonathan Edwards - Neurosciences

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Jonathan Edwards who is Associate Professor of Neurology and Medical Director of the Comprehensive Epilepsy Program here at the Medical University of South Carolina.  Dr. Edwards, let’s start by talking about what a seizure is.  Can you explain that, please?


Dr. Jonathan Edwards:  A seizure is a change in sensation, behavior or activity that’s caused by a burst of abnormal electrical activity in the brain.  The way the brain works is very complex.  The bottom line on how it works is the brain cells give off electrical discharges.  In someone who has a seizure, you get an extra wave of those electrical discharges.  Here’s an analogy.  In a way, the brain works like a big symphony orchestra.  If you ever see a symphony orchestra play, you’ll notice that not all of the musicians are doing the same thing at the same time.  The violinist may be playing one thing and the piano soloist may be playing something else. 


The brain works the same way.  The different parts of the brain give off electrical discharges at different times and not all the brain cells are firing at the same time.  What happens with a seizure is that one of the musicians starts playing excessively and at the wrong time.  Sometimes that extra playing stays with just that musician and sometimes it spreads across the whole orchestra, depending on how strong that abnormality is.  With a seizure, a part of the brain is irritable and gives off extra rhythms of electrical discharges.  The discharges may stay in that vicinity or they may spread across the brain.  Depending how much they spread determines what type of seizure you have.


Dr. Linda Austin:  So, give some examples, then.  I would imagine that depending on which of those musicians or which area of the brain is going haywire to begin with, the seizure might present differently.  What are some examples of how a seizure might look?


Dr. Jonathan Edwards:  Well, for example, if the seizure starts in the inside part of the temporal lobe, which a part of the side of the brain, it may begin with an unusual sensation, an overwhelming sense of familiarity or a sudden sense of fear, or even a sudden inability to understand language that could last a few seconds.  If the seizure activity starts back in the visual part of the brain, what we call the occipital lobe, the patient may see sparkles, flashes, colors or shapes.  Seizures that start out of the motor area, or the frontal lobes, may begin with focal twitching, jerking or stiffening up of a particular part of the body, such as one arm that may spread to the face and the rest of the body on that side.


Dr. Linda Austin:  I would think that the form of seizure that people may be most familiar with is the seizure that babies can get from high fevers.  Is that right?


Dr. Jonathan Edwards:  The most familiar seizure type, that you see in the movies and you always hear about, is what we refer to as generalized convulsion or a grand mal seizure, which is a convulsion that involves the whole body.  But there are many other kings of seizures.  There are some seizures that are so mild that only the patient knows that he’s having one.  And there are other types that may involve staring spells in which someone may not be able to respond for several seconds or a minute or so.  Then, there are some that may involve jerking, but only in part of the body.  So, there’s a whole spectrum of severity.


Dr. Linda Austin:  How common is it that a person might have just one seizure at some time in their life and never be troubled by another one?


Dr. Jonathan Edwards:  Seizures are very common.  One out of ten people will have a seizure at some time in his or her life.


Dr. Linda Austin:  Does that include infantile seizures?


Dr. Jonathan Edwards:  Yes.  If you include all types of seizures, 1 out of 10 people will have a seizure at some time in their life. 


Dr. Linda Austin:  For those who have only one seizure, what are some of the causes?


Dr. Jonathan Edwards:  It’s very common that people can have what we refer to as a provoked seizure.  For example, if a patient who has diabetes takes too much insulin, their blood glucose may drop in a very dramatic fashion.  The brain cells don’t like that.  If they don’t get the glucose, they get kind of cranky and can get a whole rhythm of electrical discharges due to that low glucose.  That’s a seizure, but it’s caused by something else.


Dr. Linda Austin:  I guess another example might be alcohol withdrawal, correct?


Dr. Jonathan Edwards:  Yes.


Dr. Linda Austin:  So, delirium tremens, for example, could be associated with a seizure?


Dr. Jonathan Edwards:  Yes.


Dr. Linda Austin:  How about other common causes of those provoked seizures?


Dr. Jonathan Edwards:  Well, seizures can be caused by other metabolic problems, such as abnormalities in the electrolytes, a really low sodium or a really high, or low, calcium.  There are many other causes.  Sometimes seizures are caused by meningitis or encephalitis.  And some children will have seizures with a high fever, but they may never have a seizure again. 


Dr. Linda Austin:  Is it fair to say, though, that if you have had one seizure, one seizure alone is a good reason to call the doctor and get it checked out?


Dr. Jonathan Edwards:  Oh, certainly.  I think any patient who has a seizure should be seen by their doctor.  But many patients who have a seizure may never have one again.


Dr. Linda Austin:  Dr. Edwards, I want to talk some more about how you make a diagnosis, not just of a seizure, but of epilepsy.  But let’s save that for another podcast.


Dr. Jonathan Edwards:  Okay.


Dr. Linda Austin:  Thank you very much.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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