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Q?: "... My mother recently had a seizure for the first time in her life. She is otherwise a healthy woman, does not use medications and does not suffer from any medical conditions? Her EEG was normal and nothing was detected on MRI. Could you please let me know what causes seizures?..."

Dr. Keti:
28 December, 2002

In seizures or seizure-like episodes the cause cannot always be identified. There are many different conditions that can cause seizures and some doctors group the causes of seizures into four main categories: neurological, cardiovascular, psychological, and of other causes. Visit this site to find more: The Causes of Seizures and Seizure-like Episodes

Epilepsy is a neurological disorder,a physical condition which causes sudden bursts of electrical energy in the brain. Epilepsy typically involves generalized seizures, that affect all or most of the brain. Often the cause of the seizure correlates with the age of onset. There are many factors that may trigger seizures, for e.g. hormone changes, as in pregnancy or menstruation; illness or sensory stimuli, like lights, sounds, and touch. Unfortunately, in many cases no trigger is found for the seizures.


Causes
Seizures are due to a chemical imbalance in brain cells involving factors that either suppress or promote excess electrical discharges. Some people with epilepsy have an area of brain damage which has caused this activity, while in others the problem is due to an occasional malfunction. Different seizures are caused by different chemical processes.
In up to 70% of cases, the cause of a person's seizures remains unknown. (Source: The Epilepsy Foundation)

Epilepsy is a condition not an illness; Some of the more common causes of seizures include: developmental or genetic conditions present at birth; metabolic abnormalities, like diabetes; usage of or intoxication from alcohol or drugs; head/brain injury; tumors and brain lesions; disorders affecting the blood vessels (like stroke); degenerative disorders (like senile dementia, or Alzheimer disease, or infections.
If your mum's seizure-like episodes return it would be helpful to determine if these are epileptic seizures or non-epileptic psychological episodes as non-epileptic seizures are psychological in origin. Therefore it is important to get an accurate diagnosis because the treatments are different. Continuous EEG monitoring which records one of her episodes, can help diagnose her condition. (Source: The Epilepsy Org. UK)
Also, according to many doctors it is important for people to recognize that depression is frequently associated with epilepsy.
New research, presented to the annual meeting of the American Epilepsy Society, suggests a link between women taking oestrogen-containing compounds, such as oral contraceptives, and worsening or more frequent seizures, possibly having implications on what types of contraceptives doctors prescribe for women with ref 4

According to Dileep R. Nair, MD: "Epilepsy can present itself at any age; however, the incidence and prevalence is highest in the very young and the elderly. Depending on age of manifestation, the causes for epilepsy can differ widely. In the United States, there are approximately 1.6 million people who have epilepsy." ref.(2)

Symptoms of Epilepsy
Epilepsy is characterized by seizures that occur on a chronic, recurrent basis. In addition to seizures, there may be other symptoms or signs, such as headache, changes in mood or energy level, dizziness, fainting, confusion, and memory loss (5)
Seizures may manifest themselves with minimal or no movements, brief sudden loss of awareness or conscious activity, or in so called tonic-clonic (previously referred as grand mal) seizures: violent muscle contractions affecting the whole body, or a major portion of the body, loss of consciousness, temporarily stopage of breathing, incontinence of urine, tongue or cheek biting and then following the seizures confusion and weakness.

Some disorders that can be confused with epilepsy include migraine, syncope, transient ischemic attacks, nonepileptic events (pseudoseizures), movement disorders, Meniere's disease and rage attacks.

Diagnostic Procedures
Tests may include procedures such as physical examination, Computed Tomography scan(CT scan) of the head; an electroencephalograph (EEG),which is a reading of the electrical activity in the brain; various blood tests (e.g.blood sugar); or tests for infectious diseases, kidneys or liver disorders. EEG is an actual recording and reading of the electrical activity in the brain, as the information in the brain is transmitted from one nerve cell to another by an electrochemical process, this process can be detected as electrical activity by an electroencephalograph (EEG).

Although seizures are associated with abnormal patterns of electrical activity, it is important to note that a normal EEG does not rule out a seizure disorder.ref(3,6).

Treatment
Most doctors will not start treatment with Anti-Epileptic Drugs (AED) until more than one seizure has occurred. However, if the seizure is unprovoked (by illness, other drugs etc), or it's witnessed by a relative, or other person, or if epilepsy runs strongly in the family and there is an abnormality on the EEG a doctor may start a patient on AED straight away. On the whole, and because of the side effects, doctors try to avoid prescribing more than two drugs.

Another therapy may include the Vagus Nerve Stimulation (VNS), which is mainly reserved for those patients with intractable epilepsy and who are not candidates for surgery (7). VNS involves periodic mild electrical stimulation of the vagus nerve in the neck by a surgically implanted device similar to a heart pacemaker. Although VNS maybe as effective as a typical AED, usually it does not provide a seizure-free state.

A high fat diet or Ketogenic Diet
This is supervised diet and is prescribed for children who are motivated and have a strong support by their family. The diet is high in fat and low in carbohydrates and proteins. It is prescribed when seizures are deemed out of control or the side effects of medication and/or surgery are considered unacceptable. Seizures are brought under control in many of the children who try the diet, and maybe completely eliminated in half of the children who rigidly stick to the diet. (8)

In patients who do not respond to medication, and when the injured brain tissue causing the seizures can be identified and safely removed without causing any psychological or functional damage, surgery may be considered as a treatment.
With certain types of seizures that begin in just one part of the brain, an operation to remove a small amount of tissue in the area involved or by interrupting the nerve pathways along which seizure spreads, may help controlling seizures.(1)


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