A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movements, feelings, and levels of consciousness. A first-time seizure in adults can be frightening. This article explores possible causes, symptoms to watch for, and steps you should take immediately. Learn what to expect and how to manage this unexpected event.
First Time Seizures in Adults
Seizures are characterized by uncontrolled electrical activity in the brain, leading to temporary changes in awareness, movement, or sensations.
There are two primary categories of seizures: focal onset seizures, which start in one part of the brain, and generalized onset seizures, which involve both hemispheres. Focal seizures can either remain localized or spread across the brain, leading to varying symptoms based on the areas affected.
Generalized onset seizures can occur simultaneously across both sides of the brain and often start in childhood. Tonic-clonic seizures, which can emerge from either focal or generalized seizures, indicate a severe manifestation of seizure activity.
Common Causes of First Time Seizures
Seizures can occur due to various reasons, including trauma, infections, and abnormal growths in the brain. Identifying the underlying cause of a first-time seizure is crucial for determining the appropriate treatment and management strategies.
Let’s explore the common causes of adult onset seizures in adults.
1. Epilepsy
Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, including epileptic seizure manifestations. It can manifest in various forms, including focal seizures, generalized epilepsy, absence seizures, nonconvulsive status epilepticus, and convulsive status epilepticus. The Epilepsy Foundation provides resources and support for those affected by this condition.
2. Brain Injury or Trauma
Traumatic brain injuries (TBI) and other forms of brain trauma can significantly increase the risk of seizures. The severity of the injury often influences the likelihood of seizure occurrence.
Seizures can present immediately after the injury or even years later, making it essential to monitor individuals with a history of head injuries for potential seizure activity.
3. Stroke or Transient Ischemic Attack (TIA)
Strokes and transient ischemic attacks (TIAs) can disrupt brain function and lead to seizures. The difference between stroke-related seizures and other types lies in the underlying vascular issues.
4. Brain Tumors
Brain tumors can trigger seizures by putting pressure on neurons and causing abnormal electrical activity. Various types of brain tumors, including gliomas and meningiomas, may lead to first-time seizures.
Symptoms such as headaches, nausea, and changes in vision or behavior should be monitored closely in individuals with brain tumor.
5. Infections and Illnesses
Infections of the central nervous system infection, such as meningitis, encephalitis, or brain abscesses, are significant potential causes of seizures. High fever and viral or bacterial infections can also contribute to the risk of seizures in adults.
Reducing seizure risks involves promptly treating these infections.
6. Metabolic Disorders
Metabolic disorders, such as imbalances in blood sugar levels or electrolyte disturbances, can lead to seizures. Conditions like hypoglycemia (low blood sugar) and hyponatremia (low sodium levels) are common metabolic issues that can trigger seizures.
Proper diet and medical care are key in managing these disorders and preventing seizures.
7. Alcohol or Drug Withdrawal
Withdrawal from alcohol or certain recreational drugs can trigger seizures, particularly in individuals with a history of drug abuse. The timeline and risk factors associated with withdrawal seizures vary, but they often occur within the first few days of cessation. Long-term substance abuse can lower the brain’s seizure threshold, increasing the likelihood of seizures during withdrawal.
8. Genetic Factors
Genetics play a significant role in the development of seizure disorders. Specific genetic conditions, such as juvenile myoclonic epilepsy, can cause first-time seizures in adults. A family history of epilepsy or other seizure disorders can also increase an individual’s risk of experiencing seizures.
9. Sleep Deprivation and Stress
Sleep deprivation and high-stress levels can lead to seizures in predisposed individuals. Lack of sleep and chronic stress can affect the brain’s electrical activity, increasing the risk of seizures, as evidenced by sleep deprived eeg studies.
Reducing seizure risk involves managing sleep and stress through healthy lifestyle choices and stress-reduction techniques.
Symptoms of First-Time Seizure in Adults
Symptoms of first-time seizures can vary widely, including physical, sensory, and emotional signs. Timely intervention and management depend on recognizing these symptoms of acute symptomatic seizure.
Let’s delve into the different symptoms that may indicate a first nonfebrile seizure.
1. Aura or Warning Signs
Some adults experience warning signs, known as auras, before a seizure. These can include visual disturbances, strange smells, or sensory changes, such as unusual tastes or feelings.
Auras serve as important indicators, allowing individuals to prepare for an impending seizure.
2. Loss of Consciousness or Awareness
Seizures can cause a loss of consciousness or awareness, ranging from brief lapses to complete unconscious states. The recovery of consciousness is often gradual, with individuals experiencing confusion or disorientation post-seizure. The duration of time a seizure lasts can vary significantly.
3. Convulsions and Muscle Stiffness
Generalized tonic-clonic seizures, also known as grand mal seizures, often involve:
- Involuntary muscle contractions
- Rhythmic jerking of the limbs
- Muscle stiffness
- Convulsions
- Convulsive seizure
- Tonic clonic seizure
These symptoms can lead to significant physical stress and potential injury.
4. Focal Symptoms
Focal seizures manifest through localized symptoms, such as twitching or abnormal sensations in a specific body part. A focal seizure may also lead to behavioral changes, affecting how individuals respond to their environment.
5. Incontinence or Loss of Bladder Control
During generalized seizures, particularly tonic-clonic seizures, loss of bladder control or incontinence can occur. Managing and responding to these symptoms appropriately ensures the individual’s dignity and comfort.
6. Postictal State (Post-Seizure Recovery)
The postictal state, or post-seizure recovery phase, can involve various symptoms, including confusion, exhaustion, and memory loss. Recovery time varies, with some individuals experiencing emotional changes such as anxiety or irritability during this period.
Diagnosing a First Time Seizure
A complete neurologic examination should be conducted after the postictal period following a first seizure. The specialist will want to know details about the seizure event before, during, and after.
Electroencephalogram (EEG) and magnetic resonance imaging (MRI) scans are commonly referred by specialists after a first seizure to detect any structural or electrical abnormalities in the brain’s electrical activity. An EEG should ideally be performed within 24 hours after an unprovoked seizure for effective results. MRI is recommended as soon as practical after confirming a probable seizure to identify structural issues.
Around 50% of first seizure patients show EEG abnormalities, nearly doubling the risk of recurrence. Common lab findings after a seizure include abnormal levels of glucose and sodium. Symptoms of infection or altered mental status may necessitate a lumbar puncture following a first seizure.
Provoked vs. Unprovoked Seizures
Provoked seizures occur in response to identifiable factors, such as electrolyte imbalances, alcohol withdrawal, or high fever. About 25-30% of first seizures are classified as a provoked seizure and typically resolve once the underlying cause is managed.
Unprovoked seizures, on the other hand, occur without apparent triggers and may indicate underlying neurological conditions. The risk of having a second seizure increases significantly after experiencing an initial unprovoked seizure, with known etiologies like traumatic brain injury contributing to two unprovoked seizures.
Risk Factors for First Time Seizures
Identifying risk factors is vital as they significantly increase the likelihood of experiencing seizures. Common risk factors that can trigger seizures include:
- Prolonged periods of not getting enough rest
- Low blood sugar levels
- Sudden drops in sodium levels
- Substance abuse
- Nutritional deficiencies
Immediate Steps After a First Seizure
Assessing the individual’s condition, including vital signs and oxygenation, is critical after a first seizure before conducting further tests. Not all seizures indicate epilepsy; a diagnosis typically requires multiple seizures, and the first appointment with a specialist will involve assessing the risk of subsequent seizures and providing necessary safety information.
Individuals at risk of further seizures should consult their healthcare provider about emergency treatment options. If you did not visit a hospital after your first seizure, seeking medical advice from your GP is crucial to facilitate a referral to a specialist. This ensures proper evaluation and management of the condition.
Treatment Options for First Time Seizures
The main treatment for most people diagnosed with epilepsy is anti-seizure medications. Adhering to medication schedules significantly enhances treatment effectiveness in managing seizures. Starting antiepileptic drug treatment right away can lead to a 35% decrease in seizure recurrence. This effect is noticed within the first two years. Additionally, seizure medicines play a crucial role in this management process.
Lifestyle adjustments can also play a significant role in reducing the likelihood of future seizures. Engaging in regular exercise helps alleviate stress, and avoiding known seizure triggers is crucial for effective seizure management.
Additionally, new advancements in epilepsy surgery and devices have improved options for controlling seizures. These advancements provide alternatives for individuals who do not respond well to medication alone.
Monitoring and Preventing Recurrent Seizures
The risk of recurrence after a first unprovoked seizure is approximately 42% over the next two years. This risk increases significantly after a second unprovoked seizure, with 70-80% of individuals experiencing recurrence.
Nighttime seizures, EEG abnormalities, and abnormal brain imaging are significant factors. Additionally, a history of brain insult can more than double the risk of recurrent seizures.
Tracking seizure triggers can help individuals recognize potential seizure onset and prepare to reduce the risk. Routine follow-up and early treatment with EEG monitoring can significantly diminish the chances of seizure recurrence.
Safety Measures and Lifestyle Adjustments
Discussing how to assist during a seizure with friends and family can enhance safety and preparedness for future incidents.
People with epilepsy should consider developing a personalized safety plan to address potential risks during and after seizures. Modifying home environments to minimize injury risks, such as padding sharp corners and securing heavy furniture, is also essential.
Engaging in activities that pose a high risk of injury should be avoided until a significant seizure-free duration is achieved. Using the buddy system when swimming and adhering to driving restrictions are critical safety measures.
If you experience a seizure and are employed, inform your employer for a risk assessment and safety measures.
When to Consult an Epilepsy Specialist
If there is a second seizure following the first, it is important to inform your GP to potentially expedite a referral to a specialist. Ongoing evaluation and appropriate medication adjustments by a neurologist are crucial.
Epileptologists, who are neurologists specializing in epilepsy, are recommended for persistent seizure issues. A Comprehensive Epilepsy Center consists of a team, including an epileptologist, to address various needs related to epilepsy.
Frequently Asked Questions
What is a seizure that lasts over an hour?
A seizure that lasts over an hour is known as status epilepticus. This medical condition can involve either a single prolonged seizure or multiple seizures occurring without recovery in between, and it necessitates urgent medical attention.
What causes seizures in adults with no history?
Seizures in adults with no prior history may be triggered by various factors, including high blood pressure, substance abuse, toxic exposures, brain injuries, infections such as encephalitis, and underlying heart conditions. It is essential to seek medical evaluation to determine the specific cause.
