What factors determine if a seizure is excessive?

What Determines if a Seizure is Excessive?

Having a seizure can be a scary experience. Most seizures only last a couple minutes and don’t cause much harm. But some seizures go on too long or happen too often, which can be dangerous. So how do doctors decide if someone’s seizures have crossed the line into “excessive” territory? There’s no single test or timeline, but rather a few key factors doctors look at.

Seizure Frequency

One of the biggest things doctors evaluate is how often someone has seizures. There’s no magic number that automatically makes seizures excessive. But the more frequently seizures occur, the more likely it is they’ll be considered excessive. For example, having 1 seizure every 6 months is generally not a major concern. But if someone has 1 seizure per week—or even per day—that’s likely excessive. Frequent seizures take a toll on the brain and body. They also increase the risk of physical injury during a seizure. So the more often seizures happen, the more urgent it is to get them under control.

Seizure Duration

Doctors also look at the length of each seizure episode. Again, there’s no definitive cutoff. But in general, seizures lasting more than 5 minutes are considered prolonged. Seizures longer than 10 or 15 minutes can be dangerous. During seizures, breathing, heart rate, and oxygen levels can be affected. Prolonged seizures may not allow enough oxygen to the brain. They can also cause muscle damage from the nonstop muscle contractions. The risks go up the longer each seizure lasts. So doctors take notice if someone’s seizures routinely last a long time.

Recovery Time

How long it takes to recover after a seizure is also important. Normally, people start feeling back to normal within minutes to hours after a seizure ends. But some people experience prolonged recoveries, feeling foggy or exhausted for days after a seizure. This post-seizure fatigue can really disrupt work, school, and quality of life. Long recoveries after seizures tend to signal that the seizures are excessive and need more aggressive treatment.

Injury Risk

Doctors also look at the physical risks of someone’s seizures. Seizures with violent muscle jerks or falls have a high risk of injury, like head trauma, broken bones, and burns. Even without visible injuries, repeated seizures take a toll on the body. Things like biting the tongue or muscle strains during seizures can cause chronic pain and damage over time. If doctors think the physical risks from seizures are too high, they’ll likely push for better seizure control.

Triggers

The triggers for someone’s seizures are important too. Seizures that happen randomly and unpredictably tend to be more concerning than seizures mainly triggered by specific things like lack of sleep, stress, or illness. Random seizures suggest the underlying problem isn’t being properly treated or controlled. Known triggers allow some ability to anticipate seizures and take precautions. So frequent seizures without clear triggers often raise red flags for doctors.

Impacts on Daily Life

Doctors also have to look at the functional impacts of seizures. Even short, infrequent seizures can make activities like driving dangerous. And seizures during sleep can still greatly impair daytime energy and function. The more seizures affect work, school, driving, relationships, and quality of life, the more excessive they’re considered. Stopping seizures becomes more urgent if they’re making it hard for someone to live a normal, independent life.

Age of Onset

The age when seizures start can also determine how concerning they are. Childhood seizures may be more tolerated since brains are still developing. But new onset seizures in older adults often require fast action. Older brains have less plasticity to adapt to seizures. And seniors have higher risks of medication side effects. So new seizures in someone elderly might be treated as excessive more quickly.

Response to Treatment

How well seizures respond to treatment is a major factor too. Refractory seizures that keep happening despite multiple medications at therapeutic doses are deemed uncontrolled. Doctors consider uncontrolled seizures excessive and dangerous no matter their frequency, duration, or type. Difficult to treat seizures usually lead to early consideration of alternative treatments like surgery, implants, or special diets.

Seizure Causes

The underlying cause of someone’s seizures also guides whether they’re excessive. Seizures from metabolic issues like low blood sugar might not be as concerning as seizures from progressive neurological disorders like a brain tumor. Seizures from a correctable problem like infection require less aggressive treatment than seizures from irreversible brain damage. And seizures without any cause found are more likely to be labeled excessive.

Seizure Spread

Doctors also look at whether seizures start in one area of the brain versus spreading across both sides. Partial seizures in one area aren’t always as problematic as seizures that generalize to both hemispheres. Generalized seizures affect more brain function, cause loss of consciousness, and are more likely to cause injuries. Uncontrolled spreading of seizures is more concerning than seizures that remain confined to one spot.

Type of Seizures

The specific type of seizures also matters. For instance, atonic seizures with drops and myoclonic seizures with jerks raise injury risks. Absence seizures that impair awareness are more likely to disrupt daily function. And tonic-clonic seizures with convulsions are most associated with risks like breathing problems. Doctors weigh the risks and impacts of each seizure type when deciding if overall seizure control is adequate.

Other Health Issues

Someone’s overall health also affects how well seizures are tolerated. Seizures in people with conditions like heart disease or brittle bones may be riskier to let go uncontrolled. And issues like memory problems and mood disorders might get exponentially worse if seizures aren’t well-managed. Doctors have to look at the whole patient picture when determining acceptable seizure frequency and severity.

Testing Results

Various tests also guide decisions about excessive seizures. EEGs that show frequent seizure activity or abnormal brain waves between seizures indicate poor control. Brain scans like MRIs that reveal underlying structural problems suggest higher seizure risks. Blood tests can uncover issues like electrolyte imbalances contributing to seizures. The testing data helps doctors assess risks and determine when seizures are happening too often.

Patient & Family Feedback

Doctors also listen to feedback from patients and families about how seizures are affecting life and what level of control is acceptable. Quality of life is a major factor in treatment decisions. If seizures aren’t bothering the patient much, aggressive treatment may not be warranted even if they seem frequent on paper. Patient priorities and input help guide the approach.

Medication Side Effects

The side effects of seizure medications have to be weighed too. Multiple drugs at high doses may control seizures, but intolerable side effects might impair function as much as the seizures themselves. Doctors have to balance seizure control with medication burden. If quality of life isn’t much improved, excessive medications may not be the answer.

Overall Trends

Doctors look at the overall trajectory too. Are seizures stable but perhaps not perfectly controlled? Or are they progressively worsening over time despite treatment? Worsening seizure patterns usually prompt more assertive treatment approaches. The goal is preventing significant progression before it happens.

As you can see, many factors go into deciding if seizures are excessive for an individual. There’s no universal definition. It’s about looking at someone’s unique seizure situation and thoughtfully assessing what level of control is needed for their safety and wellbeing. With so many variables at play, these decisions require experienced epilepsy specialists who understand how to strike the right balance for each patient.

References

Here are some references used as sources for this article:

What Are Prolonged or Serial Seizures

What is a Seizure?

Intractable Epilepsy

What is an Epilepsy Center?