A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in behavior, movements or feelings, and in levels of consciousness.

A seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation.

The brain is involved in nearly every bodily function, including the higher cortical functions; if the affected cortical network is in the visual cortex, the clinical manifestations are visual phenomena.

The pathophysiology of focal-onset seizures differs from the mechanisms underlying generalized-onset seizures.

Overall, cellular excitability is increased, but the mechanisms of synchronization appear to substantially differ between these 2 types of seizure and are therefore discussed separately.

Aura: An aura (unusual sensations) precedes seizures in about 20% of people who have a seizure disorder.

Short duration: Almost all seizures are relatively brief, lasting from a few seconds to a few minutes; most seizures last 1 to 2 minutes.

Postictal state: When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue; these after-effects are called the postictal state.

Todd paralysis: In some people, one side of the body is weak, and the weakness lasts longer than the seizure (a disorder called Todd paralysis).

Visual hallucinations: hallucinations (seeing unformed images) occur if the occipital lobe is affected.

Convulsions: A convulsion (jerking and spasms of muscles throughout the body) occur if large areas on both sides of the brain are affected.

It is characterised by a sudden and momentary blankness of expression or a facial or limb twitch.

The patient does not usually fall, nor do they drop anything, and incontinence is unusual.

This is characterised by generalised convulsions that follow a definite pattern.

There is usually an aura, followed by the tonic stage, clonic stage, and finally the convulsive stage.

The patient usually looses consciousness and passes from the unconscious stage to a deep sleep.

Symptoms are confined to one part of the body, and include simple partial seizures, which do not entail any alteration in consciousness.

Seizure symptoms are accompanied by loss of consciousness.

Monotherapy- Monotherapy is desirable because it decreases the likelihood of adverse effects and avoids drug interactions

Anticonvulsant therapy-The mainstay of seizure treatment is anticonvulsant medication; the drug of choice depends on an accurate diagnosis of the epileptic syndrome

Ketogenic diet-The ketogenic diet, which relies heavily on the use of fat, such as hydrogenated vegetable oil shortening (e.g., Crisco), has a role in the treatment of children with severe epilepsy;

Discontinuing anticonvulsant agents- After a person has been seizure free for typically 2-5 years, the physician may consider discontinuing that patient’s medication

Atkins diet-Preliminary data have been published about improvement of seizure frequency following a modified Atkins (low-carbohydrate) diet that mimics the ketogenic diet

Vagal nerve stimulation. VNS is a palliative technique that involves surgical implantation of a stimulating device; VNS is FDA approved to treat medically refractory focal-onset epilepsy in patients older than 12 years;

Anticonvulsants-These agents prevent seizure recurrence and terminate clinical and electrical seizure activity

Anticonvulsants, barbiturates. Like benzodiazepines, barbiturates bind to the gamma-aminobutyric acid (GABA) receptor, enhancing the actions of GABA by extending GABA-mediated chloride channel openings and allowing neuronal hyperpolarization.

Anticonvulsants, benzodiazepines. These agents bind to the gamma-aminobutyric acid (GABA) receptor, thereby enhancing the actions of GABA.

Anticonvulsants, succinimide. These agents reduce current in T-type calcium channels.

Anticonvulsants, neuronal potassium channel opener. Stabilizes neuronal KCNQ (Kv7) channels in the open position, increasing the stabilizing membrane current and preventing bursts of action potentials during the sustained depolarizations associated with seizures.

Anticonvulsants, hydantoins. These agents stabilize sodium channels and prevent the return of the channels to the active state.