What's Actually Happening During a Seizure

welcome to the anatomy lab everybody in today's video we're going to use a cadaver brain to discuss seizures we'll talk about the difference between seizures and epilepsy as well as many different types of seizures that are out there we'll even talk about treatment and management techniques used for them it's going to be a fascinating one let's do this [Music] let's start by taking a look at the brain and discussing some of the functions of various areas on the brain that way we can better understand what's going on during a seizure so you are looking at a human cerebrum now this has been removed or was removed in a dissection course that we held here in the lab by one of our students and so you're going to see some cut marks from the surgical equipment used to remove the brain but all in all i think this is a fantastic dissection and you can see a lot of fantastic anatomy but another thing you're probably going to notice right away are all of the blood vessels and these blood vessels are actually embedded inside of this tissue that i can lift up with my probe here this is part of the meningeal system and it wraps the entire brain so you're seeing about two of the three layers of the meningeal system here and the blood vessels are just embedded inside but if we could remove this you would then see this color of tissue over the entirety of the brain now this surface tissue here this is called the cortex of the brain cortex just means surface and the cortex of the brain is going to be made up of neurons a lot of neurons neurons are the cells of communication and in the brain it's estimated there are around 86 billion of them all communicating back and forth with one another and that's where consciousness is going to come from but we can also divide the entirety of the brain into different lobes or sections now this front most area here is called the frontal lobe surprise surprise and this is where you're going to find personality rational decision making morality all the things that make you human but really important to our discussion today this is also where you're going to find motor control motor control is going to be in this area right about here then back here we have what's called the parietal lobe and the parietal lobe is where sensory information is going to be coming from from different parts of the body but there's an area right around here called the primary somatosensory cortex and this is where you're going to get information coming from various parts of your body like here like if i'm poking my hand here with my probe well that's going to this aspect of my parietal lobe and saying hey you're getting poked in the hand then on the back we have the occipital lobe the occipital lobe and i can even lift it up here the occipital lobe just could be this posterior part of the brain here this is where visual information is going to be processed so i mean you can literally say kind of like you have eyes in the back of your head then if i rotate it back this way and then lift it up again you can see that incision from the surgical equipment this part of the brain here is called the temporal lobe and the temporal lobe is where you're going to get auditory processing so think like sound is going to get processed here it's extremely important that we discuss the differences between seizures and epilepsy because they're often confused for one another and they are not one in the same seizures broadly speaking are going to be a sudden surge of electrical activity in the cortex of the brain epilepsy on the other hand is a disease involving recurrent unprovoked seizures meaning we don't know what causes them but there are multiples of them so that means that you can have seizures but not suffer from epilepsy meaning there are non-epileptic seizures and epileptic seizures in an epileptic seizure what we see is that sudden surge of electrical activity in the cortex of the brain but we have no idea what's causing it well there are theories and hypotheses and we do have some ideas in some cases but by far and large we don't know what causes it but we see that electrical activity occurring with the use of an electroencephalogram or an eeg and that's going to be very important to the diagnosis of epilepsy in a non-epileptic seizure this is a provoked seizure so we're going to discuss this in greater detail in a moment but let's say just for example you get hit very hard in the head that can cause a seizure to occur but that doesn't mean you have epilepsy now it just means that the head trauma itself caused it that's a provoked seizure and the last one is probably the least understood it's called a psychogenic non-epileptic seizure now this is something that is caused by psychological distress and it seems by all intents and purposes it seems like it's going to be epilepsy but then when you use an eeg on them you don't see any of that electrical activity you don't in the cortex of the brain which makes this very mysterious and like i said not very well understood now there are a lot of different causes of seizures out there but broadly speaking we can narrow it down we can narrow it down to things such as infections so if you recall this outer wrapping of the brain here is part of the meningeal system well if this were to get a bacterial or viral infection we can call that meningitis and meningitis can be enough to produce seizures metabolism or metabolic issues can also create seizures maybe you have too low of calcium in your body or maybe too high of urea in your blood structural problems can also happen such as say like a brain tumor i mean you can just picture that maybe there is some kind of tumor pressing on the brain here that can obviously be enough to create a seizure and then you even have medications or substances as a cause so or maybe even just withdrawing from the substance i think a lot of people out there understand that alcoholics when they are going through withdrawals they can actually be more prone to seizures then you have blood-related causes this is going to be things like a stroke high blood pressure or even brain bleeds like we previously discussed you're then also going to have fever now fevers we're going to discuss this in greater detail later on but too high of a fever in certain populations can also create seizures we then have stress but i don't want you to think that stress like if you're just out there too stressed that you could suffer from a seizure we see that stress induces seizures in epileptics not on your average individual and then last is going to be genetics but again this is going to be for epileptics but i don't think anyone is really surprised that genetics are going to play a role and that's because we are constantly learning just how important genetics plays in overall health not just in epilepsy and seizures that's why i'm excited about the sponsor of today's video self-decode self-decode is genetic testing and analysis 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future is super cool if you're interested go ahead and click the link down in the description below and use our promo code human to get 25 off self-decode let's now discuss the different phases of a seizure but it's important to understand that not everyone's going to experience each of these phases and even if they do they're probably not going to experience them in the exact same way so the first phase is what's known as the prodrome phase this is the least understood of all of them and that's because for those who suffer from it it can happen anywhere from hours to days before they actually experience the seizure itself it's going to look like things like mood swings anxiety trouble sleeping and those might be easier to recognize after the fact and be like oh yeah that was the pro drone that i was experiencing that's why things were a little bit off but for some it's just too difficult to parse out and discover so if we're not even sure if everybody experiences it or if even if they do it's difficult in recognizing it the next phase is what's called the aura phase and for some individuals this is the only thing they experience and that's because this itself is a seizure it's what's called a focal seizure and we'll see more about that in a second but for some this is actually the beginning the initial stages of a more generalized seizure that's about to come but what uh comes with the orifas see things like deja vu odd smells tastes and sounds they might get nauseous uh they could get automatisms which are going to be these unconscious repeated behaviors so maybe they start smacking their lips like or maybe they start blinking repeatedly right those are what are called automatisms there are a ton of these symptoms and we're going to see why there's so many here in a moment but i'm curious if you can let us know in the comments below some of these auraphase symptoms that you've experienced or maybe someone you know has experienced because there is such a wide variety i've had many students over the years who've been epileptic and i've gotten to hear their different rfa symptoms one in particular stood out to me she would smell chlorine as though she was in a swimming pool or in the locker room to a swimming pool just that overwhelming smell of chlorine would hit her and she knew she was about to have um a seizure so be sure to let us know in the comments below next we have what's called the ichthyl or middle phase and the experience of this phase is going to vary widely depending on the type of seizure that is occurring here but this correlates very strongly to the electrical activity of the brain so you can picture as this thing is just going haywire that is going to be the ichthyl phase now this is going to come with typically i should say is going to come with things like convulsions loss of consciousness or maybe just twitching those are all very common inside of that ictyl phase and then the last phase is what's known as the postictal phase in the postictal phase there's a lot of gray area as to the timeline of how long this persists most of the texts that i've seen suggested somewhere around 30 minutes at most but i've seen it also go as far as the hours and days after the seizure persisting that far but this is going to be confusion anxiety fear but you're also going to get fatigue and exhaustion and that's because with some of these seizures they can be just so physically demanding it makes a lot of sense that someone would be extremely tired once it's over now generally speaking there are two main types of seizures and the first is called a focal seizure the way i've always made sense of it in my head is that vocal sounds like local and so it's going to be a very specific spot but focal is going to be a very focused spot now typically individuals will maintain consciousness throughout this and if you think back to what we just discussed the aura phase is a focal seizure and that's because it's going to affect one specific type of area but we have to then look at the back of the brain here to understand how that can vary so widely because you can have let's say you have a seizure in the motor cortex that is what's called a motor seizure or a motor focal seizure but depending on which area of the brain in that motor cortex that actually experiences the seizure that's going to mean something specific to that area of the body it's responsible for but on the opposite side right because the right hemisphere of the brain controls the left side of the body so if you have a seizure in the motor cortex responsible for like your hand or your foot or your face you name it well that's going to then manifest on the opposite side of the body right and that can cause those contractions that's a motor seizure but you could also have a sensory seizure so that could happen in the parietal lobe or maybe in the occipital lobe in the back or the temporal lobe and depending on which one because if you have a seizure happening a focal seizure in the temporal lobe you may be hearing things in the occipital lobe you may be seeing things in the parietal lobe you may be feeling things you might be feeling you know pain or scratching or tickling you name it all of those are going to be on the table and then the last type is what's called an autonomic seizure and that's going to be deeper structures in the brain that we can't see in this dissection but if you can kind of picture like right around here here like deep down where these two points are intersecting just down there you're going to have a system called the limbic system that's going to connect to the sympathetic nervous system the parasympathetic nervous system those are kind of wordy just understand this is responsible these nervous systems for heart rate digestion sweating a whole wide variety of things within the body if those areas start to experience seizures then you're going to have far-reaching consequences throughout the entire body these are what we call focal seizures but it's important to understand that the seizure can start to spread just because the seizure say starts here in this area does not mean it only stays in that area what can happen is it can start to spread to the entirety of the hemisphere that it's inside of it at this point it's still called a focal seizure but you can and some individuals do lose consciousness at this point but it's important to understand that even if they do lose consciousness that it's going to stay inside of that one hemisphere and now we can discuss the second type of seizure which is the type of seizure most people are thinking about when they think of a seizure and this is a generalized seizure it's important to understand that in a generalized seizure the entirety of the cerebral cortex is activated right the electrical storm is occurring in both hemispheres not just one and not just in one area like in a focal seizure now there may be a loss of consciousness or there may not be a loss of consciousness it just depends on the type of seizure now the first type is what's called an absence seizure now this is a very common type of seizure and it can often be mistaken for daydreaming in fact there were a lot of have and continued this day i imagine to be misdiagnoses of children suffering they think they suffer from adhd when in reality they're suffering from an absence seizure so what's happening is they basically just in the conversation or activity or anything just kind of fade out and it will only last for a few seconds this is not a really prolonged seizure but as they fade out and then they come right back to it they are the experience from what i've heard is very interesting because it's just like you're missing pieces of information right imagine during this talk all of a sudden you just miss you know you come into it and i'm 5 to 10 seconds down the road and you're just like what happened and you could easily see how this could get mistaken for adhd from say like a teaching standpoint right if you have a group of say like fourth graders and the teacher is responsible for all of them and they just notice you know you know little janine over there it just consistently fades out it can be easily mistaken for adhd it doesn't justify it but you can see exactly how that could happen now it's important if someone does suffer from these to not you know panic not yell at them not to shame them for it you know it's one of those things that they can't control this at all literally their brain is just firing for those 5-10 seconds and they are tuning everything out the next type of seizure is what's called an atonic or drop seizure now atonic just means without muscle tone and this is a sudden loss of muscle strength now this can happen to various spots on the body but if they are standing typically they will fall down and that's why you may see if someone suffers from an atonic seizure they wearing some kind of protective head gear and that's to help them not get a traumatic brain injury from falling during one of these seizures so if you know someone suffers from one of these seizures and you're around you can see their body beginning to go limp because this can happen in slight groups it'd be best for you and especially for them to ensure that they are not going to injure themselves during this seizing event the next seizure is pretty much the exact opposite of an atonic seizure this is called a tonic seizure or toned and this seizure is where they're going to have a sudden stiffness in their muscles and it's going to be in the arms and the legs and the torso and they're going to stay like that for around 20 seconds or so and it's important for you if you ever witness this happening to not try and restrain them you don't want to try and do anything instead you're going to time it make sure it is that 20 seconds because once it starts to get into the minutes especially past five minutes you're in real dangerous territory but if it's under that timeline then in all honesty you just need to let the seizure happen but what you can do is immediately after is roll them onto their side so you don't want to restrain them but you're going to roll them onto their side they're going to likely be tired because all of their muscles in their limbs and in their torso are going to be contracting very uh strongly and that can be extremely tiring the next type of seizure is what's called a clonic seizure and a clonic seizure is when there is sustained rhythmic jerking and so you can just see them kind of in this rhythm the muscles rhythmically jerking and this will typically last up to one minute in duration now again it's important to not restrain them you just want to make sure they're not suffering any head injuries or injury to themselves but once the seizure has is finished you're then going to roll them once again onto their side into a recovery position the next one is the most famous type of seizure it's the one you see in all the movies and tv shows it's what you're probably picturing if you think of a seizure the tonic clonic seizure or what used to be known as the grand maul so based off the name tonic and clonic you can probably already tell me what's about to happen but they're going to have an initial tonic phase and then they're going to transition into a clonic phase that rhythmic jerking now this is going to last for just a few minutes typically and what you will also see is typically an audible groan occurring so as the muscles are contracting it's going to expel air out of the respiratory tract and at the end of the seizure there may even have been a loss of bladder or bowel control now it's important to understand that if you ever see or around someone experiencing a tonic clonic seizure that what you want to do is ensure they get to the ground safely and then that's when you're going to want to pad their head it's so important again to not restrain them during this process they're going to seize you need to let that seizure actually happen but that doesn't mean you can't help protect them so you're going to lay them down you're going to let them go through the seizure and you're not going to put anything in their mouth whatsoever because anything you try to put in their mouth they are likely to break and it can injure their own mouth and their own teeth so don't even do it there may be blood because they may be biting down on their tongue again you just have to let that go for the time being but they're also likely to salivate uh quite a bit that occurs a lot with it but you're going to time this seizure so if you're helping this individual you want to time the seizure because it should not be lasting any longer than five minutes if it does you want to contact emergency services but once the seizure has subsided that's when you're going to roll them onto their side into the recovery position and you just stay with them until they slowly regain consciousness and it's at that point you're just going to talk very calmly very gently until things start to come back to normal the next type of seizure is called a myoclonic seizure that just stands for muscle jerking now this is a sudden jerk of a muscle it happens extremely quickly it could be one isolated jerk or it could be a whole bunch of them but it's typically going to happen in the neck and shoulders and upper arm and it might just kind of like thrust like this there's nothing really you can do as someone who's watching someone go through this it's just so quick there's nothing really to manage here but unfortunately you know those who suffer from myoclonic seizures you know they may break things they may drop things so it does come with its own set of troubles and the last seizure we're going to discuss today is what's called a febrile seizure now this is a fever induced seizure that occurs with typically children around three to six months of age all the way up into about five to six years of age now the best thing to do if this starts to happen is to remove clothing to try and bring their body temperature back down but the longer they're in this state the more severe the consequences can be so obviously you're going to want to get medical attention after this if the child does go into a febrile seizure but the best thing you can do in that immediate time frame is to simply try and cool the body down to lower the body temperature in regards to treating seizures it really depends on whether you're an epileptic or not if you're not an epileptic well it comes down to what caused the initial seizure right if it was high blood pressure then obviously you're going to want to lower your blood pressure so that's where it's going to be important to work with your healthcare providing team to figure out exactly what are the right steps to prevent this type of thing from happening again but if you are an epileptic this is where the standard of care is going to be anti-epileptic drugs uh of which there are many but there also are other options just depends on your specific circumstances brain surgery might be a viable option especially if you have like a brain tumor that's actually pushing onto it but then you also have what's called vagus nerve stimulation which is where they put an implant in the chest and then actually go up to the vagus nerve in the neck which is going to alter how the nervous system communicates and information is spread that is going to help then you also have which surprises a lot of people a ketogenic diet i know the keto fad has kind of just ran its course throughout society but the ketogenic diet has long been known to be anti-epileptic which is really really fascinating and then it's also important to understand kind of some of the things that i was discussing today in terms of how to manage it right because if whether you suffer from them or you know someone i think it's important for everyone to understand what to do in case someone is suffering from a seizure in your presence and that's why i really and strongly encourage every single one of you to go and watch videos read blogs about what to do if someone is ever experiencing a seizure and in fact i'm going to go ahead and link several managing techniques for seizures down in the description below and i encourage every single one of you to go check them out thanks again for watching everybody i hope you learned something in today's video i also want to give another thanks to our sponsor of today's video self-decode be sure to click the link in the description below and use our promo code human to get 25 off self-decode but again thanks for watching everybody and i'll see you in the next video you

Channel: Institute of Human Anatomy

Views: 576,436

Keywords: seizures, seizure, epilepsy, what is epilepsy, what is epilepsy disease, what causes seizures, do seizures cause brain damage, do seizures affect memory, do seizures hurt, what are seizures, atonic seizure, focal seizure, generalized seizure, focal vs generalized, focal vs generalized seizures, focal vs generalized epilepsy, myoclonic seizure, tonic seizure, clonic seizure, seizure video, tonic clonic seizure, absence seizure, aura phase, prodrome phase, ictal phase, postictal

Id: rAAYQ1exE9Y

Length: 23min 54sec (1434 seconds)

Published: Fri Jan 21 2022

Reddit Comments

[u/candyspyder]

Surprised he didn't go over focal seizures, especially since they're the most common type.

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