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THE FREE SEIZURE REPORT By: Dr. Clayton Sullwold What Is A Seizure? Seizures result from an abnormal electrical discharge in the brain. This abnormal "short circuit" can cause a change in behavior without you being aware of what is happening. During a seizure you may fall down, stare into space, make jerking movements, or have a funny feeling in your stomach. You cannot control what's happening while you are having a seizure. Your only memory of a seizure may be waking up with people asking questions such as "What is your name?" "Where are you?" and "What day is it?" Some seizures have “triggers” such as flashing lights, lack of sleep, stress, medications, or low blood sugar. A seizure is the outward sign of a malfunction in the electrical system in the brain. Seizures that occur more than once, without a special cause, are called epilepsy (also called a seizure disorder). Seizures may be convulsions, brief stares, muscle spasms, odd sensations, or episodes of automatic behavior and altered consciousness. What To Do During A Seizure? Most of the time a seizure lasts less than 3 minutes, so by the time an emergency medication is ready to be given, the seizure is over. The most important thing during a seizure is for you to stay calm and protect the person having a seizure. The following guidelines apply to tonic-clonic seizures (convulsions, grand mal) or complex partial seizures: 1. 2. 3. 4. 5. Cushion the head. Banging the head against a hard surface during a seizure may lead to head trauma. Use any available soft object, and, if needed, use your foot. Loosen tight neckwear to ease breathing. Turn the person onto his/her side. This position helps the tongue fall to the side of the mouth, leaving the airway clear for normal breathing. Do not insert any object into the person's mouth. An object in the mouth will not prevent tongue biting, nor will a person swallow his/her tongue, as some people think. In fact, if an object is placed into the mouth, you may cause more harm by breaking teeth or losing the object in the throat, causing choking. Do not restrain a person during a seizure unless there is a danger. They may become aggressive if you do so. Allow them to do what they want to do. Talk to them in a soft voice to reassure them. Afterward, tell the person that he/she has had a seizure and make sure they’re breathing normally. Check the person's awareness by asking a few questions, such as, "Where are you?" or "What is the day today?" If a tonic-clonic seizure has occurred, inform the doctor. What Causes Seizures? Approximately 70% of seizures have unknown causes. One in ten people will have a seizure during their lifetime. Known causes include: Neurological • Lack of oxygen to the brain Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 1 • • • • • • • • Poisoning (lead, carbon monoxide) Head and/or neck injury or trauma Genetic defect in the brain Brain tumor Arteriovenous malformation (AVM) Post operative side effect; following brain surgery Infection (meningitis, encephalitis, abscess) Pressure on the brainstem Cardiovascular • • • Stroke Irregular blood pressure Irregular heart beat (arrhythmia) Other • • • • • • • • • • Kidney or liver failure Metabolism disorders Low blood sugar (diabetes), hypoglycemia Pregnancy Withdrawal from drugs or alcohol High fever (febrile seizure) usually in children Psychological (non-epileptic attack) Hysteria or panic attacks Hyperventilation Mental illness Often confused with seizures is a condition called syncope, which is a fainting spell caused by a lack of blood flow to the brain. Syncope can be caused by cardiovascular disease. Types Of Seizures: The most common seizure types are classified as either partial or generalized. Partial seizures arise from one part of the brain and include simple partial and complex partial seizures. Generalized seizures seem to involve the entire brain and include generalized tonic-clonic, absence, myoclonic, as well as tonic and atonic seizures. Generalized Seizures If you have this type of seizure, your whole brain is involved and you lose consciousness. The seizure may then take one of the following five forms: 1. In a generalized tonic-clonic convulsive seizure (previously called "grand mal" seizure), you become rigid, and may fall if standing. Your muscles switch between periods of spasm and relaxation with jerking motions. You may bite your tongue. Your breathing is labored and you may urinate or defecate involuntarily. Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 2 2. 3. 4. 5. In a tonic seizure, your muscles generally stiffen without rhythmical jerking. This stiffening or rigidity also involves the breathing muscles and you may cry out or moan. In an atonic seizure (also known as a drop attack), your muscle control is suddenly lost, causing you to fall if you are standing. In a myoclonic seizure, your limbs jerk abruptly. These seizures often occur soon after you wake up, either on their own or with other forms of a generalized seizure. In an absence seizure, your consciousness is briefly interrupted, with no other signs, except perhaps for a fluttering of your eyelids. These seizures happen most often in children and are sometimes known as "petit mal" seizures. Type Of Seizure "Grand Mal" or Generalized TonicClonic Absence Myoclonic Sporadic Clonic Tonic Atonic Symptom Unconsciousness, convulsions, muscle rigidity Brief loss of consciousness Isolated, jerking movements Repetitive, jerking movements Muscle stiffness, rigidity Loss of muscle tone There are six types of generalized seizures. The most common and dramatic, and therefore the most well known, is the generalized convulsion, also called the grand-mal seizure. In this type of seizure, the patient loses consciousness and usually collapses. The loss of consciousness is followed by generalized body stiffening (called the "tonic" phase of the seizure) for 30 to 60 seconds, then by violent jerking (the "clonic" phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the "postictal" or after-seizure phase). During grand-mal seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. While many types of repetitive behavior may represent a neurological problem, a doctor needs to establish whether or not they are seizures. Generalized seizures are characterized by: • • • • • • • All areas of the brain (the cortex) are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures. ◦ The person experiencing such a seizure may cry out or make some sound, stiffen for several seconds to a minute and then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping. Eyes are generally open. The person may appear to not be breathing and actually turn blue. This may be followed by a period of deep, noisy breathes. The return to consciousness is gradual and the person may be confused for quite some time— minutes to hours. Loss of urine is common. The person will frequently be confused after a generalized seizure. Partial Seizures Partial seizures are divided into simple, complex and those that evolve into secondary generalized seizures. The difference between simple and complex seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 3 Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. 1. 2. 3. 4. Motor symptoms include movements such as jerking and stiffening. Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste, or touch). When simple partial seizures cause sensory symptoms only (and not motor symptoms), they are called "auras." Autonomic symptoms affect the autonomic nervous system, which is the group of nerves that control the functions of our organs, like the heart, stomach, bladder, intestines. Therefore autonomic symptoms are things like: racing heartbeat, stomach upset, diarrhea, and loss of bladder control. The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by some patients with a type of epilepsy called temporal lobe epilepsy. Simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of dejavu), emotions (such as fear or pleasure), or other complex psychological phenomena. Complex Partial Seizures By definition, these include impairment of awareness. Patients seem to be "out of touch," "out of it," or "staring into space" during these seizures. There may also be some "complex" symptoms called automatisms. Automatisms consist of involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting, and walking. The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive ("grand-mal") seizure. Most patients with partial seizures have simple partial, complex partial, and secondarily generalized seizures. In about two-thirds of patients with partial epilepsy, seizures can be controlled with medications. Partial seizures that cannot be treated with drugs can often be treated surgically. If you are having a partial seizure, the disturbance in brain activity begins in or involves a distinct area of your brain. The nature of these seizures is usually determined by the function of the part of your brain that is involved. For example, if the motor cortex area of your brain is affected, then your arm or leg may jerk uncontrollably. Partial seizures are sometimes known as "focal." There are basically three types of partial seizure: simple partial, complex partial, and partial seizures that develop into secondarily generalized seizures. In a simple partial seizure, your consciousness is not impaired, but either one limb (or part of a limb) will rhythmically twitch or you will experience unusual tastes or sensations, such as a feeling of "pins and needles," in a distinct part of your body. If a simple partial seizure develops into another type of seizure, it is often called a "warning" or "aura." Complex partial seizures differ from partial seizures in that your consciousness is affected. This type of seizure usually begins with a blank or empty stare, and your awareness changes, even though the seizure does not involve convulsions. You may fiddle with clothes or nearby objects, wander around, and generally be confused. This type of seizure usually lasts 2-4 minutes and involves the temporal lobes of the brain, but may also affect the frontal and parietal lobes. If either of these types of seizure spreads to involve the whole brain, your seizure is called a secondarily generalized seizure. Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 4 Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. However, it is a medical emergency if seizures last longer than 5 minutes or if a person has many seizures and does not wake up between them. Seizures can have many causes, including medicines, high fevers, head injuries and certain diseases. Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary. ◦If the part of the brain controlling movement of the hand is involved, and then only the hand may show rhythmic or jerky movements. If other areas of the brain are involved, symptoms might include strange sensations like a full feeling in the stomach or small repetitive movements such as picking at one's clothes or smacking of the lips. Sometimes the person with a partial seizure appears dazed or confused. This may represent a complex partial seizure. Doctors use the term complex to describe a person who is between being fully alert and unconscious. Absence or Petit Mal Seizures These are most common in childhood. ◦Impairment of consciousness is present with the person often staring blankly. Repetitive blinking or other small movements may be present. Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day. Absence seizures cause a short loss of consciousness (just a few seconds) with few or no symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of "losing time." Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. What Treatments Are Available? Medication Your doctor may prescribe a drug called an antiepileptic drug, or anticonvulsant, used to treat seizures. These drugs are taken every day, sometimes several times a day, for as long as needed. The drugs help control the seizures. There are over two-dozen medications for seizures. Common anticonvulsants include: Dilantin (phenytoin), Tegretol (carbamazepine), Depakote (valproic acid), and phenobarbital. Several recent medications, such as Lamictal (lamotrigine), Neurontin (gabapentin), Cerebyx (fosphenytoin), Keppra (levetiracetam), and Felbatol (felbamate), have been approved since 1993 for seizure disorders. These drugs may be used alone or in combination with each other. Your doctor may prescribe anticonvulsants briefly after you have had brain surgery, head trauma, or a cerebral hemorrhage. If you have no seizures, the dosage of the drug is usually tapered until it is stopped within a short time. However, that time period may vary, based on your condition and specific problem. As with all drugs there are side effects and drug interactions. Most common side effects include fatigue, drowsiness, nausea, and blurred vision. Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 5 Surgery If medications do not control your seizures, then surgery in the portion of the brain responsible for your seizures (e.g., brain resection, disconnection, or stimulation) may treat the condition. Surgery is the most invasive form of treatment and hopefully you do not have to resort to such procedures. Upper Cervical Care A less invasive option, which is becoming more well known and utilized, is called Upper Cervical Care. Upper Cervical Care is a non-invasive drugless approach to helping seizure patients. It is a specialization within Chiropractic. The goal of Upper Cervical Care is to remove subluxation from the upper cervical complex and thereby release any interference on the brainstem. The upper cervical spine consists of the top two bones in the neck where the brainstem sits. The top bone is named Atlas. As in Greek Mythology, Atlas holds up the world, (the brain and skull.) Axis is the second bone in the neck and is called Axis because it is the bone in which Atlas rotates around. These two bones allow for 90% of head rotation. Minor misalignments in these two bones can cause subluxation and impair nerve communication. More About Upper Cervical Care What is Subluxation? Subluxation is compression of the brainstem due to upper cervical misalignments and shut down neurological function of the brain, brainstem, and spinal cord. For optimal health, the brain needs to freely communicate with the entire body. When neurological firing is crippled and proper communication is lost from the brain to the body serious health issues may result. How Upper Cervical Care Relates to Epilepsy / Seizures Upper Cervical Patients have access to the latest imaging and diagnostic tools available. Most doctors use Digital Infrared Spinal Thermography as well as Digital Radiography, which pinpoint minor misalignments in the upper cervical complex and cause subluxations. Upper Cervical Doctors examine minute misalignments to the upper cervical spine where the brainstem sits and then deliver a specific correction to the misalignment to remove subluxation and brainstem pressure. While the exact cause of seizures is unknown, medical researchers have focused upon traumatic brain injury (specifically mild concussive injury to the head, neck, or upper back) as a risk factor for seizure onset. Following the injury, seizures can be triggered immediately or can take months or years to develop. The purpose of upper cervical chiropractic care is to reverse the trauma-induced upper neck injury; thereby reducing irritation to the nerves in the brain stem and spinal cord that can trigger neurological dysfunction. While many seizure sufferers recall specific traumas such as head injuries, auto accidents or falls, some do not. An evaluation is necessary in each individual's case to assess whether an upper cervical injury is present and whether benefit from upper cervical care can be achieved. Even mild seizures may require treatment, because they can be dangerous during activities such as driving or swimming. Upper Cervical Care Doctors have experience with epilepsy to help eliminate or reduce the frequency and intensity of seizures, from children to adults. Removal of subluxation is the primary focus of Upper Cervical Care. Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 6 It has been noted that most people with seizures also do have an upper cervical misalignment, which puts pressure on the brainstem. Be sure to look back over your past history as many times trauma to the upper cervical complex is a major component of the onset of seizures. Many people with seizures have suffered from whiplash, fall, auto accidents, sports injuries and other head trauma. The atlas is the lightest bone in the spine and encompasses the brainstem where it exits the skull. It holds on the head, which can weigh 10 to 12 pounds. It is easy to see how the forces directed upon the atlas can predispose it to misalignments compared to the rest of the spine. For more information about Upper Cervical Care, visit durangochiropractor.com Or, send an email to [email protected]! Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 7 About The Author Dr. Clayton Sullwold D.C. practices in Durango, Colorado. In addition to completing his Doctor of Chiropractic degree, he completed his postdoctoral certification in Upper Cervical Specific Care through the Knee Chest Society. Dr. Clayton is interested in working with people who have tried everything to regain balance and quality of life and have not had prior success. He has worked with chronic and debilitating conditions such as Multiple Sclerosis, migraines, dystonia, seizures, equilibrium issues and other neurological conditions. Dr. Clayton is also a certified animal chiropractor through the International Veterinary Chiropractic Association. Sources and Links www.durangochiropractor.com www.efa.org www.epilepsy.com www.erinelster.com www.webmd.com/epilepsy/guide/default.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.mayfieldclinic.com/PE-Seizure.htm www.webmd.com/epilepsy/guide/default.htm www.webmd.com/epilepsy/guide/default.htm www.webmd.com/epilepsy/guide/default.htm www.mayfieldclinic.com/PE-Seizure.htm www.erinelster.com www.erinelster.com Atlas Specific | 1800 East Third Avenue, Suite 108, Durango, CO 81301 | 970.259.6803 8