Seizures, Epilepsy And Chiropractic

El Paso, TX. Chiropractor, Dr. Alexander Jimenez takes a look at seizures, epilepsy and treatment options.
Seizures are defined as, abnormal movements or behavior from unusual electrical activity in the brain. Seizures are a symptom of epilepsy but not all who have seizures have epilepsy. As there is a group of related disorders characterized by recurrent seizures. Epilepsy is a group of disorders that are related and characterized by recurrent seizures. There are different types of epilepsy and seizures. There are medications for epilepsy that are prescribed to control seizures, and surgery is rarely needed if medication is ineffective.

Seizures & Epilepsy

• Seizures occur when there is spontaneous depolarization and synchronized firing of groups of neurons, often in response to a trigger such as metabolic compromise
• Any brain can have a seizure if the conditions are right
• Epilepsy or seizure disorder, is the pathologically increased likelihood of seizure activity occurring in a persons brain

Seizure Categories

• General/Global onset seizures

• Generalized motor seizure (Grand mal)

• Absence seizure (Petite mal)

• Focal onset seizures

• Simple partial seizure

• Motor cortex (Jacksonian)
• Sensory cortex
• Somatosensory
• Auditory-vestibular
• Visual
• Olfactory-gustatory (uncinate)

• Complex partial seizure (libmbic)

• Continuous/Ongoing seizures

• Generalized (status epilepticus)
• Focal (epilepticus partialis continua)

Generalized Motor Seizure

• Electrical depolarization of neurons in the entire cerebral cortex simultaneously
• Trigger assumed to be outside of the cerebral cortex, such as in thalamus or brainstem
• Episodes begin with loss of consciousness followed by tonic contraction (extension)
• Respiration is halted, and hair is expelled past the closed glottis (“cry”)
• Elevated blood pressure, dilated pupils
• Intermittent contraction and relaxation (clonic activity)
• Usually lasts a few minutes, but for some patients can last hours or even days (status epilepticus)
• Generally begin in childhood

Tonic Clonic Seizure

nanfoundation.org/neurologic-disorders/epilepsy/what-is-epilepsy

My Tonic Clonic/Grand Mal Seizure

Seizure Triggers

• Ionic abnormalities (Na, K, Ca, Mg, BUN, pH)
• Sedative withdrawal in addicts (alcohol, barbiturates, benzodiazepines)
• Hypoglycemia
• Hypoxia
• Hyperthermia (especially patients under 4 years old)
• Toxin exposure
• Genetic abnormal sensitivity of neurons (rarely)

EEG Of Grand Mal Seizure

• Tonic phase
• Clonic phase
• Postictal phase

Swenson, R. Epilepsy. 2010

Absence (Petit Mal) Seizures

• Most often occur in children
• Originate in the upper brainstem
• Often look like losing train of thought or staring off into space
• These children may go on to develop focal seizures later in life
• Spontaneous remission possible as neurons mature

Absence Seizure Caught On Camera

EEG Of Petit Mal Seizure

• 3 spike-waves/second
• Can be elicited by hyperventilation
• Spike = excitation
• Wave = inhibition

Swenson, R. Epilepsy. 2010

Simple Focal/Partial Seizures

• May be with or without secondary generalization
• Patient generally retains consciousness
• Begin in a localized primary functional area of the cortex
• Different symptoms and classifications depending on where in the brain the epileptiform activity originates
• Sensory areas usually produce positive phenomenon (seeing lights, smelling something, etc, as opposed to lack of sensation)
• Motor areas may produce positive or negative symptomology
• Function of area of involvement may be reduced during the postictal phase
• If the primary motor cortex is involved = “Todd paralysis“

Partial (Focal Seizure) 12 Yr Old Boy

Partial Seizure In The Motor Cortex

• May begin as a jerking of one body area, on the side contralateral to the epileptiform activity, but may spread through the body in a homuncular pattern (Jacksonian seizure/march)

www.maxplanckflorida.org/fitzpatricklab/homunculus/science/

Partial Seizure In The Somatosensory Cortex

Produces paresthesia on the contralateral side to the epileptiform activity and can also spread in a homuncular pattern (march) similar to the motor type

en.wikipedia.org/wiki/Cortical_homunculus

Partial Seizure In The Auditory – Vestibular Area

• Posterior temporal region involvement
• May produce tinnitus and/or vertigo
• Audiometry will be normal

Partial Seizure In The Visual Cortex

• May produce hallucinations in the contralateral visual field
• Visual cortex (calcarine cortex) produced flashes, spots, and/or zig-zags of light
• Visual association cortex produces more complete hallucinations such as floating balloons, stars, and polygons

Partial Seizure In The Olfactory – Gustatory Cortex

• May produce olfactory hallucinations
• Likely area to spread to more generalized seizure

Complex Partial Seizures

• Involves the association cortices of the frontal, temporal or parietal lobes
• Similar to simple partial seizures but there may be more confusion/reduced consciousness
• Limbic Cortex (hippocampus, parahippocampal temporal cortex, retro-splenial-cingulate-subcallosal cortex, orbito- frontal cortex, and insula) is the most susceptible to metabolic injury

• Therefore this is the most common type of epilepsy

• May produce visceral and affective symptoms (most likely), peculiar and unpleasant smells and tastes, bizarre abdominal sensations, fear, anxiety, rarely rage, and excessive sexual appetite, visceral and behavioral phenomena such as sniffing, chewing, lip smacking, salivation, excessive bowel sounds, belching, penile erection, feeding, or running

Clips Of Different Seizures In Same Child

Continuous/Ongoing Seizures

• 2 Types

• Generalized (status epilepticus)

• Focal (epilepticus partialis continua)

• Continuous or recurrent seizures over a 30-minute period without return to normal over the period
• Prolonged seizure activity or multiple seizures occurring close together without full recovery in between
• Most often seen as the result of acute sensation of anticonvulsive medications due to rebound hyperexcitability
• Emotional excess, fever, or other hypermetabolic states, hypoglycemia, hypocalcemia, hypomagnesemia, hypoxemia, toxic states (e.g., tetanus, uremia, exogenous, excitatory agents such as amphetamine, aminophyline, lidocaine, penicillin) and sedative withdrawal may also predispose to ongoing seizure

Status Epilepticus

• Ongoing grand mal seizure is a medical emergency because it may result in brain damage or death if prolonged seizure is not stopped
• Elevated temperature due to sustained muscle activity, hypoxia due to inadequate ventilation and severe lactic acidosis can damage neurons
• Death can result from shock and overtaxation of cardiopulmonary

Epilepsia Partialis Continua

• Less life threatening than status epilepticus, but seizure activity must be terminated as it may progress to generalized seizure form if allowed to go on for prolonged periods
• May be a result of neoplasm, ischemia-infarction, stimulant toxicity or hyperglycemia

Treatment Of Seizures

• If the seizures are the result of an underlying condition, such as infection, disorders of fluid and electrolyte balance, exogenous and endogenous toxicities, or renal failure, treatment of the underlying condition should ameliorate seizure activity
• Most antiepileptic medications treat multiple seizure types – not perfect though
• Some are slightly more effective (phenytoin, carbamazepine, valproic acid and phenobarbital)
• There are those that have fewer side effects (gabapentin, lamotrigine and topiramate)
• Certain medications only treat one seizure type (such as ethosuximide for absence seizures)

Sources

Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.
Swenson, R. Epilepsy. 2010.