First Seizure Clinc

A common reason to be referred to neurology is concern that you may have had a seizure. Many things can look like a seizure and it can be difficult to tell. Some people have jerking movements after passing out that can look like a seizure. Other people have events that are a result of trauma or other medical issues.

The first thing we will do in clinic is determine if it is possible or likely that the event was a seizure. It is helpful to have notes from anyone who witnessed the event or a video if one exists. From a neurology perspective, we use the term seizure when there is a sudden, uncontrolled, rhythmic discharge of electricity in the brain. This can result in a single arm or leg jerking for several minutes, but when it involves both sides it always results in loss of consciousness. Less commonly seizures do not result in muscle jerking and can result in staring, unresponsiveness, or other atypical movements. There are dozens of patterns we look for and that is why detailed descriptions are helpful. Most people are confused for a period of 10 minutes to hours after a seizure depending on the situation and how long it lasted.

Many people who have a siezure, have a cause for the seizure. This can inlcude fevers, head injury, medication or alcohol changes (alcohol withdrawl is a common reason), problems with blood sugar, kidney and liver issues. There can be generic contributions and sometimes there is a brain disorder that changes the structure of the brain such as a tumor, stroke, or other change. In other people, there is no definite known cause.

Because some seizures have a cause, people are advised to go to immediate evaluation after their first seizure. An emergency department, primary care, or urgent care will draw blood and look for a range of causes and talk to the patient about possible contributing factors. In adults, an emergency deparment will often get a CT scan of the brain to make sure there is not a medium to large change in the brain that would explain it. Unfortunteately, CTS do not find the smaller changes that can trigger seizures.

If a cause of the seizure is identified then treatment can be started immediately. But for many patients, the cause of the seizure is still unknown when they finish immediate care. This requires follow up with neurology or primary care to discuss the remaining options.

Follow up is fairly standard in neruology. Sometimes we are less certain about the event itself and may do some heart tests. If we think a seizure was possible, neurologists typically pursue an MRI brain and an EEG before deciding on other steps.

MRIs can find the smaller causes and are frequently done but require review from insurance and advanced scheduling. There are no xrays (like in CT scans) and MRI is safe as long as there is no metal in the body. The machine does make loud humming sounds and sometimes some banging noises - but this is normal. The magnet and recievers for the information need to be clustered around the body so the tube does feel small for some. An MRI of the brain takes around a half an hour, plus or minus 10 minutes, depending on how many measurements.

In most cases, an EEG is helpful at determining if there is a cause. An EEG is typically done as a scheduled test in an outpatient center. It requires a specially trained technician to attach electrical probes to your scalp. The machine amplifies and records the electrical activity so a specialist can compare the electric pattern and determine if one dozens of abnormal patterns are seen. It takes 15 - 30 minutes to set up, recording range from 20 minutes to a few hours in most cases, and then it takes another 15 minutes to take everything off.

If you do have a second seizure or a condition is found that is likely to cause more seizures, you may be diagnosed with epilepsy. Epilepsy is just the term for people who have recurrent seizures when not treated with appropriate medications. There is a lot of inaccurate information online about epilepsy. Consider using a site like https://www.epilepsy.com/ that is maintained by professionals. Please remember that most people with epilepsy have rare or few seizures when treated with medication. Many people get brain injuries from different causes and it is estimated that 1-2 people in 100 in the United States have epilepsy.