November is Epilepsy Awareness Month, a time of the year to help promote awareness and educate the general public about epilepsy and seizures.
One of the common challenges seen with brain injury is seizure disorder – more commonly known as epilepsy. Epilepsy and seizure disorder are terms often used interchangeably, but there are distinct differences.
Seizures are the individual events of a sudden loss of control of functions associated with normal brain activity. They are sudden, temporary episodes of brain dysfunction, caused by the abrupt, non-purposeful discharge of electrical activity in the brain. Typically lasting 1-5 minutes, they are characterized by changes in sensation, emotional experience, motor control, and levels of consciousness.
Epilepsy is the general term for a variety of neurological conditions characterized by recurrent unprovoked seizures – it’s the fourth most common neurological disorder in the United States. And, approximately 110,000 people in Michigan are diagnosed with epilepsy. In about 60% of cases, there is no known cause. Among the remaining 40%, brain injury is one of the most frequent causes.
Most common with brain injuries are partial seizures, which typically arise from scar tissue from the injury. Partial seizures affect only one portion of the brain and have more limited symptoms such as visual distortions, odd sensations, unexplained emotional experiences, or non-purposeful behaviors or jerking movements.
Sometimes, partial seizures spread and become generalized (Grand Mal), before they resolve. Grand Mal seizures involve a loss of consciousness and uncontrolled shaking as all muscle groups receive an overload of messages for movement. If a person has more than one seizure in a short period of time without recovering consciousness, or does not resolve a seizure episode within 5 minutes, it is called Status Epilepticus – and is a medical emergency.
There are many types of seizures. Any initial occurrence of a seizure warrants medical attention as it is a sign that something is not right with the brain. Common causes are electrolyte imbalance, dehydration, fever, sleep deprivation or exhaustion, a new neurological injury such as bleeding or hydrocephalus, medication or illicit drug side-effects, or genetic predisposition. Some seizures are idiopathic, not known to be caused by anything in particular. Other times, seizures may have no clear physiological component, thought to be caused by neuropsychiatric features. Careful diagnosis of new-onset seizures is critical to appropriate treatment.
Approximately 10% of individuals with brain injuries severe enough to require hospitalization have seizures. Seizures at the time of injury are quite common, but are not always an indicator of later problems with seizures. Seizures associated with the time of injury possibly represent a different type of convulsive phenomena. In later appearing seizures, those with open head injuries are associated with a higher risk.
There are relationships between the severity and occurrence of injuries. Individuals with a severe traumatic brain injury are 29 times more likely than the general population to have epilepsy. When seizures appear later in recovery they are often more persistent, with 80% experiencing at least one more seizure.
When seizures occur, or where sufficient risk factors are present, medication may be required to prevent or control them. In about 80% of cases, seizures can be controlled with medication. For others, surgery may be used to eliminate the likely source of irritation. Behavioral strategies associated with maintaining a healthy lifestyle such as good sleep, diet, hydration, and appropriate medication use are also critical. The effects of substance misuse, like alcohol withdrawal, and misuse of some types of medicines, can also increase seizure risk.
There are many implications associated with seizure disorder including safety risks, loss of driving privileges, mortality risks, mental health vulnerabilities, as well as the social stigma still unfairly endured by persons with epilepsy and brain injury.
Accommodations can help minimize these influences on adjustment. Support may include allowing additional time for tasks, pacing activities to limit fatigue, managing stimulation levels from noise or distractions, facilitating transportation or providing safe activity alternatives. Such supports help keep people with brain injury and seizures active and included, participating as part of their communities. First aid for seizures is largely supportive, providing protective monitoring with vigilance to provide assistive resuscitation in extreme events.
While sometimes a frightening and challenging symptom to manage, people with epilepsy and brain injury have many resources and treatment options to support the successful management of these symptoms.
Martin J. Waalkes, Ph.D., ABPP(rp), CBIS-T
Director of Neuro Rehabilitation
Hope Network Neuro Rehabilitation