Traumatic Seizure Disorders
Approximately 1.7 million Americans sustain a brain injury each year. Most are able to return to normal lives again; however, at least 125,000 persons each year sustain a permanent injury following their injury, including developing a seizure disorder.
A human brain is extremely fragile and subject to serious injury in motor vehicle accidents, falls, sports injuries and penetrating injuries. Brain injuries can result in bruised brain injury, large or small brain lacerations, bleeding inside or outside the brain, swelling, fever, nerve damage from shear forces on the brain, seizures or neurological chemical problems.
The good news about traumatic brain injuries is that most of them are treatable as long as the right providers are used, such as physical therapy, occupational therapy, surgery and medications for seizures. A few people continue to suffer from catastrophic injuries from which they don’t fully recover.What is a Traumatic Seizure Disorder?
Some cases of traumatic brain disorder result in seizures and even fewer result in epilepsy, which is a relatively permanent disorder that results from extraneous surges of electrical impulses that cause seizures. Some people have seizures in which they blank out for a few seconds and others can have real convulsions in which they jerk, shake, and are unconscious.
Approximately 2 percent of people in the US will have an unprovoked seizure at least once in their lifetime. Fortunately, just one seizure in your lifetime doesn’t mean you have epilepsy. It takes at least two seizures in your lifetime to have the diagnosis of epilepsy.
Mild seizures might even have to be treated medically because having a mild seizure can result in a motor vehicle accident or a swimming accident. This can result in needing medications or having surgery to reduce or eliminate the number of seizures.
Traumatic seizures result from a traumatic brain injury in which the brain has damage to nerve fibers. These nerve fibers will spontaneously fire and spread throughout the brain, resulting in jagged nerve firings and unconsciousness. These types of seizures can last just a few seconds or several minutes. Medications reduce the severity and length of seizures. The disrupted brain activity can also cause a change in behavior or attention.
Common causes of epilepsy include brain trauma, stroke, Alzheimer’s dementia, and infections of the brain, especially brain abscess, encephalitis, meningitis, and AIDS.
People can be born with abnormal brain fibers that cause epilepsy, a brain injury occurring at birth due to a medical error, metabolic disorders occurring at birth (including phenylketonuria), brain tumors, abnormally shaped blood vessels in the brain, illnesses that wreck brain tissue or the use of specific medications, such a tramadol, cocaine, antidepressants, and amphetamines. Epilepsy can occur at any age but usually begins between aged 5 years to 20 years. Family history of seizures predisposes a person to have seizures of their own.Signs and Symptoms of Epilepsy
Individuals can have different types of symptoms of their seizures. These can include everything from staring spells to shaking and loss of consciousness. It all depends on the area of the brain affected by the epilepsy. Most people have similar seizures time after time. A few people have auras telling them that they are about to have a seizure. Auras can include a tingling sensation, smelling something that isn’t there, or emotional changes.
Petit mal seizures or absence seizures are the mildest form of seizures. They often include only staring spells lasting fifteen seconds or less. The seizures often occur many times a day but can occur many months without actually being diagnosed or noticed. It can interfere with learning and can be misunderstood a being the result of misbehavior or an attention disorder.
During the absence seizure, the person might stop walking and will start again in a few seconds or will stop talking for a few seconds. There is no falling in this type of seizure and the person is usually wide awake, thinking normally and unaware of having had the seizure after the seizure is over with. There is generally no movement but you can have fumbling of the hands, fluttering of the eyelids, chewing or lip smacking.
Staring spells are common and the person is unaware of the seizure. It can be triggered by hyperventilation or flashing lights.
Grand mal seizures or tonic-clonic seizures involve the whole body. Most epilepsy cases are grand mal seizures. The person may have an aura before having their seizure, which is a vision, smell, hallucination, sensory changes or change in smell prior to a seizure. Then there is muscle rigidity and violent muscle contractions and unconsciousness. The patient may bite their tongue or cheek, clench their jaw, stop breathing, have cyanosis or lose bowel/bladder function.
Following the seizure, the person will have normal breathing, will be sleepy for at least an hour and will have a loss of memory of the seizure. There can be a headache, fatigue or confusion along with a brief period of weakness of one side of the body, a condition called Todd’s paralysis.
A focal or partial seizure is also called a Jacksonian seizure. This type of seizure occurs only in a part of the brain. They can remain partial seizures or can go on to become a grand mal seizure. This phenomenon is called “generalization”. A partial seizure can be simple and does not affect memory or awareness during the seizure. It can be complex and affect memory of things that happen before, during and after the seizure. It can alter a person’s behavior.
Symptoms of a focal seizure depend on where in the brain the seizure occurs. There can be muscle contractions like in tonic-clonic seizures. It can affect a single side of the body or just an extremity; it can cause abnormal head movements. The head can be forcibly turned to one side.
Staring spells are common with partial seizures and there can be complex, repetitive behaviors that can include habitual behaviors, abnormal mouth movements, lip smacking, and chewing behaviors. There can be turning of the eyes, numbness or tingling, hallucinations, nausea, abdominal pain, sweating, flushed face, rapid heart rate, and dilated pupils. There can be loss of memory, visual changes, mood changes, and a sensation of déjà vu.Diagnosis of Epilepsy
The first thing a doctor will do to evaluate a person with epilepsy is to o a complete physical exam, with special attention paid to the nervous system and the brain. The best test to see if epilepsy is present is to do an EEG or electroencephalogram. Electrodes are placed on the scalp and they pick up brain waves to see if there are spikes in the brain waves or other abnormalities indicative of a seizure disorder.
When doing the EEG, the doctor will do one at rest and then have the patient hyperventilate. This increases the frequency of abnormalities in the brain. A bright strobe light will be put before the patient then, which also increases the rate of abnormal spikes. An EEG may have to be worn for several days or weeks in order to pick up epileptic spikes over time. You might need to stay in the hospital on an EEG monitor and watched on video cameras to try and match brain wave activity with seizures picked up on cameras.
Certain tests may need to be performed to see why the seizures are occurring. These include:
- Blood chemistry, which can rule out certain metabolic diseases.
- Blood sugar, as seizures can occur when the blood sugar gets too low.
- CBC to see what the red blood cells, white blood cells and platelets are doing.
- Kidney function studies tell whether the kidneys are failing or not.
- Liver function tests tell if there are toxins built up because of liver failure.
- Spinal tap or lumbar puncture to check for brain infections.
- Other tests for infectious diseases that can affect the brain.
- You can have a head CT scan or MRI scan that is done to see if there is bleeding or a tumor within the brain.
A positron emission tomography can be used to find the part of the brain that is causing the seizures. It is a newer test that can give doctors more information about how the brain is working. The PET scan is performed by injecting a small amount of radioactive tracer into the arm where it interacts with negatively charged particles in the body. It makes an image on the screen. It allows the body to be seen by different angles so it can detect problems in the brain. It can find parts of the brain involved in epileptic activity. Because it involves radioactivity, there is a small chance that it can damage some cells in the body. It can cause some arm pain following injection into the body.Treatment of Seizure Disorders
Medications form the crux of the treatment for seizure disorders. Certain types of seizures respond to different types of drugs. There are a number of recently-released drugs that work well to control the number of seizures a person has.
The older medications used to treat seizures include:
- Valium and other benzodiazepines
The newer drugs out there vary differently in the way they work. Some are better for absence seizures while others are better for tonic-clonic seizures. They include:
- Oxteller XR
These drugs vary also with their side effects so these factors are used to decide which one to pick. In reality, all types of seizure drugs will generally work on at least 70 percent of seizure patients.Side Effects of Seizure Medication
All seizure drugs will have side effects and it’s a matter of picking a drug or drugs that control seizures with a minimum of side effects. Much of the time, side effects depend on dosage of the drug, too. Sometimes, the side effects tend to go away over time.
The side effects can be broken down into a few types:
- Common side effects, common to all seizure drugs. These include blurry vision, fatigue, double vision, steadiness, sleepiness and unsteadiness.
- Idiosyncratic side effects. These are unpredictable and rare side effects that are not dose-related. These include skin rashes, liver problems and low blood cell counts.
- Unique side effects, dependent on the medication chosen, such as gum swelling with Dilantin and hair loss/weight gain with Depakene.
Seizure management can, in some cases, be temporary and can last just a few years. Other patients need lifelong care with varying kinds of epilepsy treatment. If the patient is seizure-free for a long time, the doctor can gradually reduce the medication until it is withdrawn. Ideally, the patient should be free of seizures for at least ten years before the decision is made to withdraw the medication. The withdrawal of the medication should be gradual so as to avoid triggering a seizure.Surgery for Seizures
If a patient has a seizure that originates on one side of the head, such as a traumatic seizure and if medications are not working, the patient may need surgery. If a person has tried up to three drugs without success, surgery may need to be considered. Of the 30 percent of uncontrollable seizures, about one third are good candidates for a possible seizure surgery. On average, however, there are only about 3000 seizure surgeries are done each year.
Many specialists are involved in an epileptic surgery including a seizure disorder specialist, a neuroradiologist, a neuropsychologist, a social worker and a neurosurgeon. The surgery is usually done to treat partial surgery because only a part of the brain is involved. The part that is causing the surgery is removed which leaves the patient free of seizures. In some cases, a hemispherectomy is performed to remove the half of the brain that is affected, or a corpus callosum transection is performed in order to separate the halves of the brain so that the person doesn’t have tonic clonic seizures anymore.
Children with seizures that are difficult to control can eat a high fat, low carb diet, called the ketogenic diet. It is used in younger kids who have no good medicine to treat their seizures.
A newer treatment involves electrical stimulation of the vagus nerve. It involves implanting a stimulator that constantly stimulates the vagus nerve, which blocks seizure in about 40-50 percent of patients who get the implant. It rarely blocks seizures completely, however, but can reduce the amount of seizure medication the patient needs to take.Complications of Seizure Disorder
There are several complications of seizure disorder, including an increase in stillbirths among women with seizure disorder and birth defects such a cleft palate and cleft lip, which seems to be caused by the medication.
Status epilepticus is a severe seizure that lasts greater than ten minutes with loss of consciousness. It is considered a medical emergency because seizures lasting an hour or longer can result in permanent brain damage or even death. Status epilepticus can happen if the seizures are from a trauma or from suddenly stopping the seizure medications.
Permanent brain damage can happen when someone has too many seizures that cut down on the oxygen level of the brain. Over time, this can cause learning disabilities, stroke and other phenomena of permanent brain damage.
A person with epilepsy is always at risk for injury. They can fall or have a motor vehicle accident if it happens when they’re driving. This is why there is restrictions on driving with patients who have seizures.
People with seizures can develop aspiration pneumonia. This means that fluid has passed from the mouth into the lungs during a seizure. This results in pneumonia in the lungs that can require hospitalization or lead to death.
If you or a loved one suffers from traumatically induced seizures and would like to get your questions answered and discuss your legal options, contact me online or call us at 916.921.6400 to set up a FREE consultation.