A seizure is a sudden, uncontrolled burst of electrical activity in the brain that can cause a wide range of symptoms, from muscle spasms and confusion to changes in sensation and loss of consciousness. Seizures are not a disease themselves but rather a symptom of various underlying conditions, including epilepsy. With an estimated 2.2 to 41 out of every 1,000 people experiencing a seizure at some point in life, understanding this neurological phenomenon is crucial for early detection, management, and prevention.

Types of Seizures

Seizures are categorized based on where they originate in the brain and how they affect bodily functions. The two main classifications are focal seizures and generalized seizures.

Focal Seizures

These start in a specific area on one side of the brain. They can be further divided into:

  • Focal aware seizures: Consciousness is maintained; symptoms may include twitching, unusual sensations, or emotional changes.

  • Focal impaired awareness seizures: Consciousness is altered or lost; often includes confusion, repetitive behaviors, or unresponsiveness.

  • Secondary generalized seizures: Start as focal and spread across both brain hemispheres, resulting in more intense symptoms.

Generalized Seizures

These affect both sides of the brain from the onset. Types include:

  • Absence seizures: Characterized by blank stares and subtle body movements.

  • Tonic seizures: Sudden muscle stiffening, often leading to falls.

  • Clonic seizures: Repeated rhythmic jerking movements.

  • Myoclonic seizures: Brief muscle twitches in upper limbs.

  • Atonic seizures: Loss of muscle control, causing collapses.

  • Tonic-clonic seizures: The most dramatic form; involves muscle stiffening, jerking, and loss of consciousness.

Recognizing the Symptoms

Seizure symptoms vary widely depending on type, severity, and affected brain region. Most seizures last from a few seconds to several minutes.

Focal Seizure Symptoms

  • Involuntary twitching

  • Changes in vision, smell, or taste

  • Sudden emotional shifts

  • Confusion or altered awareness

  • Repetitive motions like chewing or blinking

Generalized Seizure Symptoms

  • Sudden collapse or falling

  • Jerking of arms and legs

  • Loss of awareness

  • Staring spells

  • Uncontrolled muscle movements

Note: Status epilepticus—seizures lasting 30 minutes or recurring quickly without recovery—is a medical emergency.

What Causes Seizures?

Seizures are caused by abnormal electrical discharges in the brain. These discharges result from imbalances between excitatory (glutamate) and inhibitory (GABA) neurotransmitters. Known causes include:

  • Epilepsy: Chronic condition characterized by recurring seizures

  • Genetic mutations (e.g., SCN1A gene)

  • Brain infections: Meningitis, encephalitis, HIV

  • Brain injury: Trauma, stroke, hemorrhage

  • Neurodegenerative diseases: Alzheimer’s

  • Structural abnormalities

Provoked seizures, not related to epilepsy, can result from:

  • Alcohol or drug withdrawal

  • Sleep deprivation

  • Stress or hormonal changes

  • Dehydration or missed meals

Risk Factors

Individuals may be more susceptible to seizures if they:

  • Are under 10 or over 50 years old

  • Have a family history of seizures

  • Have a history of stroke or brain injury

  • Live with dementia or neurovascular issues

  • Have experienced febrile seizures as a child

Diagnosis

Diagnosing seizures involves:

  • Medical history review

  • Neurological exam

  • Blood tests for infections, electrolytes, or metabolic issues

  • EEG (Electroencephalogram): Measures brain wave patterns

  • MRI or CT scans: Identifies tumors, cysts, or injuries

  • PET scans: Assesses brain metabolism

  • MEG scans: Detects surface-level brain activity

These tests help differentiate seizures from similar conditions like syncope or cardiac arrhythmias.

Treatment Options

Seizure management aims to reduce frequency and severity using a combination of approaches:

Medications

  • Common AEDs: Carbamazepine (Tegretol), Lamotrigine (Lamictal), Levetiracetam (Spritam), Valproate, Topiramate (Topamax)

  • Benzodiazepines: Diazepam (Valium), Lorazepam (Ativan)

Side effects may include fatigue, dizziness, and coordination issues. Medication must be tailored to the seizure type and individual response.

Dietary Therapy

  • Ketogenic Diet: High-fat, low-carb diet helpful in drug-resistant epilepsy

  • Should be done under medical supervision

Surgical Intervention

  • Lobectomy or lesionectomy: Removes seizure-origin brain tissue

  • Corpus callosotomy: Prevents seizure spread between hemispheres

  • Thermal ablation: Destroys tissue with targeted heat

Neurostimulation Devices

  • Vagus Nerve Stimulation (VNS)

  • Deep Brain Stimulation (DBS)

  • Responsive Neurostimulation (RNS)

These devices detect abnormal activity and apply corrective impulses.

Prevention Tips

While not all seizures can be prevented, certain measures reduce risk:

  • Wear helmets to prevent head injury

  • Manage chronic conditions like hypertension and diabetes

  • Get vaccinated against infections like meningitis

  • Practice prenatal care to avoid developmental risks

  • Avoid seizure triggers like alcohol, stress, and sleep deprivation

Comorbid Conditions

Seizures may co-occur with:

  • Bone fractures from falls during seizures

  • ADHD: Shares overlapping neurological pathways

  • Depression: Linked to living with chronic neurological issues

  • Hypertension: Bi-directional risk with epilepsy

  • Diabetes: Blood sugar imbalances may provoke seizures

Living With Seizures

Many people with seizures, especially those with epilepsy, can lead normal lives with proper care. Support strategies include:

  • Consistent medication use

  • Avoiding known triggers

  • Routine neurological follow-ups

  • Emotional and psychological support

  • Connecting with advocacy organizations

With treatment, 70–80% of individuals with epilepsy can achieve significant seizure control. However, conditions like status epilepticus or SUDEP (Sudden Unexpected Death in Epilepsy) underscore the importance of ongoing care and monitoring.