Overview
Diagnosis
After a seizure, it is important to see a healthcare professional to review your symptoms and medical history. Several tests may help determine the cause and assess the likelihood of future seizures.
Tests may include:
Neurological exam
A healthcare professional may assess your behavior, muscle control, and cognitive abilities to determine if there is an issue with your brain or nervous system.
Blood tests
Blood samples can detect infections, blood sugar levels, or electrolyte imbalances that may contribute to seizures.
Lumbar puncture
Also known as a spinal tap, this procedure collects cerebrospinal fluid to check for infections that may have caused the seizure.
Electroencephalogram (EEG)
Electrodes placed on the scalp record electrical activity in the brain. EEG patterns can help predict seizure recurrence and rule out other conditions.
CT scan
A CT scan produces cross-sectional images of the brain to detect tumors, bleeding, or cysts that could trigger seizures.
MRI
Magnetic resonance imaging provides detailed images of brain structures to identify potential causes of seizures.
Positron emission tomography (PET)
A PET scan uses low-dose radioactive material to visualize active areas of the brain, helping locate seizure activity.
Single-photon emission computerized tomography (SPECT)
SPECT creates a 3D map of blood flow in the brain during a seizure. A specialized form called SISCOM compares blood flow during and between seizures to help pinpoint seizure origin.
Treatment
Not everyone who experiences a single seizure will have another. Treatment usually begins if seizures recur and most often involves anti-seizure medications.
Medications
Anti-seizure medicines are usually taken daily to prevent seizures. The choice of medicine depends on seizure type, frequency, age, and pregnancy status.
Finding the correct medicine and dosage may take time. Treatment often begins with a single medicine at a low dose, gradually increased until seizures are controlled. Some people may require a combination of medicines if single-drug therapy is insufficient.
For effective seizure control:
• Take medicines exactly as prescribed
• Consult a healthcare professional before stopping or adding any medicines, including herbal remedies
Mild side effects may include:
• Fatigue
• Dizziness
• Weight gain
Serious side effects require immediate attention:
• Mood changes
• Skin rashes
• Loss of coordination
• Speech problems
• Extreme fatigue
• Swelling of lymph nodes, face, or eyes
• Trouble swallowing or breathing
• Yellowing of skin or eyes
• Unusual bruising or bleeding
• Fever and muscle pain
Some medicines, such as lamotrigine, are rarely linked to aseptic meningitis. Levetiracetam and clobazam may rarely cause serious reactions that can affect the liver, kidneys, lungs, heart, or pancreas. Seek emergency care if these occur.
Surgery and other therapies
If medications are not effective, additional treatments may be considered:
Surgery
Surgery can remove the brain area where seizures originate, often considered after two medicines fail. It works best for seizures that start in a single region.
Vagus nerve stimulation
A device implanted under the chest skin stimulates the vagus nerve in the neck to reduce seizures. Medication doses may be reduced but are often still needed.
Responsive neurostimulation
A device implanted on or within the brain detects seizure activity and delivers electrical stimulation to stop it.
Deep brain stimulation
Electrodes implanted in the brain deliver electrical impulses to regulate brain activity. A pacemaker-like device under the chest skin controls the stimulation.
Dietary therapy
A high-fat, low-carbohydrate ketogenic diet or variations such as the low glycemic index or modified Atkins diet may improve seizure control.
Pregnancy and seizures
Women with a history of seizures can usually have healthy pregnancies. Some medicines, like valproic acid, may increase the risk of birth defects and cognitive issues. Dose adjustments may be needed before or during pregnancy.
Contraception and anti-seizure medications
Some anti-seizure medicines can reduce the effectiveness of oral contraceptives. Conversely, certain contraceptives can alter medicine metabolism. Healthcare professionals can guide appropriate contraception and dose adjustments.
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