What Do Seizures Mean?

Seizure, convulsion, epileptic fit, spasms!!? All confusing words, some of which sound terrible, yet they are thrown about freely, most often without any explanation of what they are or what they mean.

The words seizure, convulsion, and epileptic fit are interchangeable. They all describe the same event. It is what happens when there is a sudden, unexpected, uncontrollable burst of electrical discharge from an area of the brain which may or may not spread to other parts of the brain. What we see at the patients bedside is a symptom or a sign of something happening in the brain.

For most people who are up and walking about, the sudden onset of a seizure indicates that something is wrong with the brain and the cause of the seizure has to be found and, if possible, removed. If no cause is found and the seizures are frequent or uncontrollable, medication has to be given to stop and to control them.

When a person has been in a coma for a long time, inactive, with only the most basic signs of life, the occurrence of a seizure may be a good sign, an indication of activity appearing in a part of the brain that was up to now inactive.

To the person lying in a bed, an occasional seizure is not harmful. The seizure only becomes harmful if it is so severe that it causes the lips and the nail beds to become blue (lack of oxygen) or if the seizures are so frequent that they exhaust the patient. Harmful seizures need to be treated with medication if they cannot be controlled in any other way. In most circumstances, however, medication can be tapered or discontinued with only beneficial effects. In a later issue, management of seizures will be discussed.

Seizures or convulsions occurring in an individual with a previously normal brain are an indication or a symptom of an abnormal occurrence. In the last issue of this newsletter, we described the significance of seizures or convulsions in an individual in coma or recovering from coma.

The management of seizures varies according to the physician or the institution. In this issue we will review the most widely used method of managing seizures and the method preferred by the International Coma Recovery Institute.

Commonly Used Forms of Seizure Management

All people who suffer a severe brain injury are at risk with respect to developing seizures and many will have a seizure or a series of seizures in the first few days following the injury to the brain (traumatic or hypoxic injury).

When seizures occur early they are usually treated with medication commonly known by the brand names of valium phenobarbital and dilantin, using either a simple medication or a combination of up to all three of these medications. Once the seizures have been "controlled", the dosage of the medication is then adjusted according to the levels in the blood stream, trying to provide enough medication to keep the level in the “therapeutic range” (the amount of medication in the blood stream felt to be sufficient for the medication to be effective). Even if seizures do not occur early, either phenobarbital or dilantin is given three or four times a day to "prevent" seizures.

When patients do not recover consciousness rapidly, the anticonvulsant medications usually are not modified and most patients will still be on their initial doses 6 months, 12 months, 2 years after onset of coma, even if they have never had a seizure.

Occasionally a patient either will not respond to the medications mentioned above or may develop an allergy to the medications. In those cases other medications are used such as Tegretol, Depakene, Mysoline or Zarontin.

All of these medications have possible side effects which are usually reversible when the medication is stopped.

The Method Used by the International Coma Recovery Institute

The first rule is to recognize that medication must not be used if it is not necessary.

The second rule is that when anticonvulsant medication is used, it should be limited to the lowest effective dose.

The third rule is to recognize causes of symptoms: seizures or convulsions are not a disease. They are a symptom of an event occurring in the central nervous system. The event is related to neurological disorganization, often aggravated by respiratory imbalance, metabolic imbalance, chemical imbalance, and/or fluid imbalance.

The management, therefore, should be to try to eliminate anticonvulsant medication. If medication is needed, reduce it to the lowest effective doses and to correct the symptom or prevent the symptom by restoring normal physiological function as it relates to respiratory, metabolic, chemical and fluid balance, and by restoring as much as possible normal neurological function through arousal and appropriate therapy. With this approach, approximately 90% of our patients have been weaned off all anticonvulsant medication with no increase in seizure activity, and usually with a decrease in seizure activity when seizures have been present previously despite the use of medication. The 10% that have remained on medication are on much lower doses than when we first examined them.

Much of the fear that relates to seizures or convulsions has been passed down through the centuries in our history books and great literary works. The fears are mythical, however, and have no foundation whatsoever in the scientific literature.

Mihai D. Dimancescu, M.D.
Director of International Coma Recovery Institute
Chairman, CRA