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What is a Seizure?

Program: Diagnosis of Epileptic and Non-epileptic Spells
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Dr. Schuele:

I'm using the term "seizures" relatively broad because I'm getting patients sent with all sorts of if you want to call it fits or spells or seizures. And part of my task is to figure out what of these seizures is epileptic and which one of these seizures is not epileptic.

Epileptic seizures is a sudden phenomenon of an electrical shortcut in your brain causing basically your brain waves going haywire and nonfunctioning and either in the whole brain or in a particular part of the brain. So that's why some patients only have symptoms from that particular part and others pass out completely, and if the discharge gets very strong then they start convulsing.

On the other hand there are sudden spells or seizures that grab us or "seize" us which are not epileptic. They are caused by a sudden lack of oxygen to our brain or a sudden lack of blood supply to our brain or a sudden intoxication or they can be stress related. They can be provoked by panic attacks or they can be just an expression of the human body of some inner psychologic stress going on.

Andrew Schorr:

Well, it was really scary, as I talked about that story of my small children. My understanding is with a spike in fever with a young brain you can have that shutdown or whatever, febrile seizure. So is that epilepsy?

Dr. Schuele:

No, that is not epilepsy. I think we share with our patients that we all have the ability to have epileptic seizures. I'm trying to point that out to many of my patients, that our brain runs on electricity and if the electricity has a shortcut we can have a seizure, an epileptic seizure. The difference is the trigger it takes for someone with epilepsy to have a seizure and the trigger it takes for someone who doesn't have epilepsy to have a seizure.

And we only call epilepsy if you're brain produces epileptic seizures without any outside trigger, reliably repetitive trigger, if your brain has a seizure out of the blue. Sometimes they can be related to stressful times. They can be brought on more frequently by sleep deprivation or they can be produced perimenstrual. But the brain is a little bit hyperexcitable in either a part or the whole brain and that leads to unprovoked seizures, and that's what we call epilepsy.

On the other hand, every human brain goes through phases where it is more vulnerable to have what we call provoked seizures, meaning small children in a certain time of the ripening of their brain have a phase where they are particularly susceptible to high temperature and fever and in that time they can have seizures. Most of them will outgrow this phase and they will never have seizures again in their life. This problem is also not directed towards the brain, so you're usually not trying to treat the epileptic brain, you're trying to treat the fever. Because if you control the fever you don't have seizures.

Another example is that many of us, we have many patients who have epilepsy, actually have a single seizure in their life in some vulnerable phase, sometimes in the college years when they don't sleep a lot or maybe they drank a little bit too much. They can have a single seizure and once their life is a little more regulated they will never have that again. Is it fair to call it epilepsy? We usually tend not to call it epilepsy because we think if you call it a disease you usually also tend to try to treat it and why would you want to treat something that's never, ever going to happen again? So we restrict the term epilepsy not only to seizures that are unprovoked but also to conditions which are recurrent. So you need at least two seizures in your life in order to call it epilepsy.

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