It is interesting how often I can encounter clients who come to me with history or current concerns about seizures. Perhaps the most common attribute of these complaints can often be an ‘embarrassment’ to discuss the issue. “it’s nothing… it was just a turn… I had a blackout of sorts…” Some other cases are a little more prevalent where a tremor or shake can be a social embarrassment or something to hide. But we should all be aware that these conditions should and do need to be taken seriously and discussed. It does not mean that everyone needs a CT Scan straight away but an awareness about what different types of seizures can and do entail is worth discussing so that the ‘embarrassment’ factor is not cause for non-investigation.
Many people have an idea of seizures or epilepsy that can form through having seen someone or knowing someone that suffers from the condition. Seizures are slightly more common in the population than some may believe with figures of around 1% of the population having experienced a seizure – of these approximately 30% can then go on to be identified as epileptic seizures.
Seizure disorders can be categorised as epileptic but not all of them have a cause in epilepsy. Other conditions that can lead to the development of epilepsy include stroke, infection, head injury or fever. It is documented that of those reported cases of seizures, 75% do not have these preceding conditions present and thus, seizures can qualify more than those who do suffer just from epilepsy.
Seizures have been well documented in medical history with the first known conditions being recognised almost 2000BC and cases being reported throughout history (usually associated with demonic possession) although in the mid 19th Century medical knowledge began to investigate the conditions more succinctly.
At the outset, seizures can be traced back to what sometimes is termed a ‘neural lightning storm’ where interconnecting neurons in the brain are stimulated and create a ‘burst of electrical impulses’ that fire off neighbouring neurons. This ‘lightening storm’ of sorts affects the body in many different ways.
Triggers of this neural condition render the individual prone to any different combinations of effects, including, blackouts, loss of co-ordination, and then moving on to the more ‘known’ collapse, loss of consciousness and loss of muscular control. The over-excitement of the neurons firing can create catatonic contractions and muscular involvement which can result in the known “epileptic fit”. Understanding the role of neurotransmitters and the ‘excitability’ of neuron synapses (the spaces between nerve cells where electrical messages are passed) is a key to understanding how these electrical currents travel throughout the body.
There is a discrepancy between the usual petit mal or grand mal seizure (the epileptic fit with uncontrollable shaking, loss of consciousness and even bladder control) to isolated mini seizures if you like affecting singular areas of the body or behavioural pattern. A fit is not always the result of neuron activity and a ‘seizure’ can have the effect of someone being involved in a repetitive action, such as walking continuously in a circle or smacking of the lips. These Partial Seizures affect only specific areas of the brain (the temporal lobe and motor cortex) and thus only have an effect on motor function and even sense of taste or smell.
Generalised seizures are more complete in their effects on the brain and can also have varying results.
Absence Seizures - are quite literally the effect of someone ‘checking out’ or having a momentary lapse in focus and concentration with no memory of the event.
Tonic-Clonic Seizures – involve the more known uncontrolled shaking and contraction of the muscular system, loss of consciousness, falling to the floor and disorientation.
Myoclonic Seizures – involve bilateral muscular contractions and can sometimes more subtle than noticeable, particularly in young children.
Status Epilepticus- life threatening variation of tonic-clonic that last for a prolonged period and can stran the body to a great degree. These seizures require medical emergency.
Seizures can be traced back to neuron activity and brain activity that is embedded in our DNA but there are also types of seizures that are brought on by head injuries, tumours pressing on nerve cells, toxic infections and hypertension. These are all conditions for which medical assistance should be sought.
Sometimes seizures do not appear until a particular injury occurs. Particularly where the injury or impact occurs around the brain and head, then Post Traumatic Seizure (PSI) can be a direct result of the impact affecting the delicate balance of neural activity in the brain and the electrical impulses. These can be traced back to the original injury and can be a short term issue for up to 3 months post injury or in some more advanced cases 10 -15 years after the injury, depending on the severity and pariticularities of the damage to the brain itself and the associated toxicity and oxygen issues.
Perhaps the more interesting and uninvestigated aspect of seizures lies in those who suffer after a particularly traumatic emotional experience. In this instance western medicine blurs the lines between psychology and neurology and it is somewhat of a no man’s land when it comes to diagnosing and investigating these conditions. Traumatic events can lead to Psychogenic Nonepileptic Seizures (PNES) where the link between a physical reaction to a stimulated emotional trauma can occur. This type of seizure has been investigated more in the fields of cognitive neurology over recent years which is leading to many Neurologists looking into the emotional nature of trauma and how it can be physically expressed.
Seizures are in fact a primitive way to express emotions or feelings that cannot be expressed verbally or in other ways, such as crying.
RADHA CHITALE - ABC NEWS MEDICAL UNIT
There is some support that subdued emotional content can create a physical response within the body to assist with the body voiding itself of emotional content. This has been shown in some instances where polar bears, being targeted for treatment in Alaska after having been chased by a helicopter, were shot with a tranquiliser dart for tagging and investigation. Upon recovering from the subdued state, the polar bear releases the trauma of being hunted and shot via a series of seizures, effectively voiding the body of the experience. The result was a ‘deep guttural breathing and calmed state’. Some investigators liken this to a way of releasing the excess neurotransmitter (such as adrenaline) out of the body after a fight/flight experience. Some pschoanalysts have likened this to abuse victims, particularly in early childhood, citing this as a primitive response to trauma and a way to process the content of the experience.
It can be an issue for someone who is recovering from Trauma be it physical or emotional that there may be a link to a seizure state. It’s difficult sometimes for someone to come to terms with it and deal with the understanding of why this is occurring, particularly when you have no medical solution or reasoning for the occurence. This is where the blurred line of psychology and neurology differ and are probably yet to be reconciled.
Its an interesting sidebar to many conversations around trauma and it is no less prevalent to being investigated once medical reasoning may have drawn a blank on the related seizure condition. Seizures vary in many ways and being sensitive to their various faces is perhaps important to recognizing and seeking the most appropriate investigation and treatment. Understanding this is paramount to being able to move forward with seizure treatment.