Seizures 

Diagnosis  

Diagnosing seizures typically involves a healthcare provider, often a neurologist, who relies on your reported symptoms and specific diagnostic tests to confirm the presence of a seizure and identify its potential cause. Genetic tests may also be utilized to uncover any hereditary conditions that could be responsible for the seizures, including the most likely type. One crucial aspect of the diagnosis is pinpointing a focal point, a specific region where the seizures originate, as this information greatly influences the course of treatment. The common diagnostic procedures for seizure include:  

• Neurological examination: This can provide information about the health of the brain and neurological system. The behavior, motor skills, and cognitive function may be evaluated. 
• Imaging tests:  
• Magnetic resonance imaging (MRI): An MRI may reveal brain abnormalities that could lead to seizures. An MRI scan creates a detailed image of the brain by using powerful magnets and radio waves. 
• Computerized tomography (CT): CT scans can detect changes in the brain such as tumors, hemorrhage, and cysts that could lead to a seizure. A CT scan takes cross–sectional photos of the brain using X–rays. 
• Positron emission tomography (PET): This test aids in revealing active brain areas and detecting changes. It examines brain metabolism to determine the source of the seizures. It can reveal the locations in the brain where the seizure occurred. PET scans employ a little amount of radioactive material with a low dose. The substance is injected into a vein. This aids in visualizing active brain areas.  
• Single–photon emission computerized tomography (SPECT): The scan reveals increased blood flow to the parts of the brain where the seizure starts. During the procedure, a tracer is injected into a vein to provide a detailed, three–dimensional map of blood flow in the brain during a seizure. A low–dose radioactive tracer is used in a SPECT test.  

An ictal SPECT or subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), is an advanced SPECT test that can provide even more detailed data. This test is usually performed in a hospital and includes overnight EEG recording.  

• Blood tests: These tests are done to detect metabolic and blood chemical abnormalities, immune system issues, toxins, and poisons in the body. Specifically, the quantity of salts in the body, referred to as electrolytes, blood sugar levels and evidence of infections or genetic problems. A blood sample is extracted for laboratory analysis.   
• Spinal tap: This procedure requires getting a sample of cerebrospinal fluid for testing to check for presence of bacteria, fungi or abnormal cells, glucose levels, protein types and levels, as well as white blood cell types and levels. This is often done if the healthcare provider believes an infection is the cause of the seizure. Spinal tap is also known as a lumbar puncture. 
• Electroencephalogram (EEG):  In this test, special stickers are placed on your head to measure the electrical activity of your brain. This activity is shown as wavy lines on a recording. The test helps to see if a seizure may happen again. It also helps your healthcare provider check if other conditions that look like epilepsy are not causing the seizures. The test can be done at a clinic, overnight at home, or over a few nights in the hospital, depending on your seizure details. 

Treatment  

Not everyone who experiences a seizure will necessarily have another one. Sometimes, a seizure can be a one–time event, and your healthcare provider might choose not to begin treatment unless you’ve had multiple seizures. The main objective in treating seizures is to find the most effective therapy that can stop seizures while causing the fewest side effects. 

Medication 

The treatment of seizures typically involves the administration of anti–seizure medications, with numerous options available. For the majority of people with epilepsy, one or two medications prove effective in stopping seizures. The primary objective is to discover the most suitable medication that minimizes side effects. In some cases, healthcare providers may recommend a combination of medications to achieve optimal results. However, finding the right medicine and dosage can be a complex process. Common side effects include weight changes, dizziness, fatigue, and mood alterations, while severe side effects, like liver or bone marrow damage, are exceptionally rare. 

When prescribing medication, your healthcare provider will consider your specific condition, the frequency of seizures, your age, and other relevant factors. Additionally, they will thoroughly review any other medications you may be taking to ensure that the anti–seizure medicines do not interact adversely with them. By taking these aspects into account, the goal is to provide you with an effective treatment plan that minimizes seizures and promotes overall well–being.

Dietary therapy 

A ketogenic diet, which is high in fat and very low in carbohydrates, has been found to enhance seizure control. However, adhering to this diet can be challenging due to the limited range of allowed foods. There are variations of high–fat, low–carbohydrate diets, such as low glycemic index and Atkins diets, which may also be beneficial, though their effectiveness is still under study. 

Surgery

When at least two anti–seizure medications fail to effectively control seizures, surgery may be considered as an option. The primary objective of surgery is to prevent seizures from occurring. Surgical intervention is most successful for individuals whose seizures consistently originate from a specific area in the brain. Various types of surgeries exist, including: 

• Lobectomy: In this procedure, surgeons identify and remove the specific brain region where seizures originate. 
• Thermal Ablation (Laser Interstitial Thermal Therapy): This minimally invasive method uses concentrated energy to target and destroy the brain cells responsible for causing seizures. 
• Multiple Subpial Transection: This surgery involves making several cuts in the brain’s areas to disrupt the pathways causing seizures when removing them is not possible. 
• Corpus Callosotomy: By cutting the connections between the two halves of the brain, this surgery is used to treat seizures that spread from one side of the brain to the other. However, seizures may still occur on the original side after the procedure. 
• Hemispherotomy: In cases where medications fail to manage seizures and they affect only half of the brain, this surgery disconnects that side from the rest of the brain and body. While this procedure may result in the loss of some daily functional abilities, rehabilitation can often help children regain those functions over time. 

Electrical stimulation 

When the area of the brain where seizures originate cannot be removed or disconnected, alternative approaches involving electrical stimulation devices may provide relief. These devices, used in conjunction with ongoing anti–seizure medication, aim to reduce seizures effectively. Some of the stimulation devices that offer seizure relief are as follows: 

• Vagus Nerve Stimulation: An implantable device located beneath the skin of the chest stimulates the vagus nerve in the neck, transmitting signals to the brain that can inhibit seizures. 
• Responsive Neurostimulation: This device is implanted either on the surface of the brain or within brain tissue. It can detect seizure activity and deliver electrical stimulation to interrupt the seizure. 
• Deep Brain Stimulation: Surgeons insert thin electrode wires into specific areas of the brain to produce controlled electrical impulses. These impulses help regulate the brain activity responsible for seizures. The electrodes are connected to a pacemaker–like device, which is placed under the skin of the chest and controls the stimulation intensity. 

Pregnancy and seizure

While women with seizures can usually have healthy pregnancies, certain medications, like valproic acid used for generalized seizures, have been linked to birth defects and cognitive issues in babies. The American Academy of Neurology advises against using valproic acid during pregnancy due to these risks. It is crucial to discuss these concerns with your healthcare provider and create a pre–pregnancy plan. Pregnancy can also affect medication levels, so adjusting the seizure medicine dosage may be necessary. The goal is to use the safest and most effective medication at the lowest possible dose for seizure control. Taking folic acid before pregnancy can help prevent some complications associated with anti–seizure medicines during pregnancy, and it is recommended for all individuals of childbearing age taking such medications.