Seizure:
What is a Seizure?
Transcript:
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.
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