What Does a Neurologist Do for Seizures?

A seizure is a transient neurologic dysfunction caused by abnormally excessive and hypersynchronous electrical discharges in the brain, leading to motor, sensory, cognitive, or psychic phenomena. Seizures can result from acute conditions, such as electrolyte imbalances (like low sodium or blood glucose), neuroinfections (such as meningitis or encephalitis), or brain trauma. They can also be chronic and long-lasting, known as epilepsy, which involves the genesis of a neuronal network that produces seizures.

Evaluation and Diagnosis

The first step a neurologist takes is to gather a comprehensive history. This process helps in discerning the nature, cause, and specific characteristics of the seizure, while also ruling out other conditions that may mimic seizures, such as migraines, transient ischemic attacks, or drop attacks.

Diagnostic Tests

After obtaining the patient's history, the neurologist proceeds with diagnostic tests to investigate the seizure. These typically include blood tests, neuroimaging (such as MRI or CT scans), and electroencephalography (EEG).

EEGs provide a graphic record of the brain's electrical activity, which is crucial for diagnosing and characterizing seizures. MRI brain scans help identify any structural abnormalities that might be contributing to the seizures, such as tumors or strokes.

Treatment Plan

The final step is to develop a treatment plan. For actively seizing patients, immediate hospitalization and intravenous administration of anticonvulsants are necessary to terminate the ongoing seizure. In cases of acute symptomatic seizures, the focus is on short-term antiepileptic medication combined with treatment of the underlying cause.

In classic epilepsy cases, long-term antiepileptic drugs are prescribed to prevent recurrence. Some patients may require only close follow-up after a single seizure if there are no pressing indications, such as genetic epilepsy or high-risk professions. However, treatment may be initiated earlier if there is a strong likelihood of future seizures.

Management Strategies

Patients undergoing antiepileptic drug therapy are followed up periodically. After a two-year period of seizure freedom, the medication may be gradually tapered and eventually discontinued. However, in certain selected cases, lifelong antiepileptic drug therapy may be required.

Frequently Asked Questions

1. What is the role of a neurologist in managing seizures?

A neurologist evaluates and diagnoses seizures, performs diagnostic tests, and develops a treatment plan. They also monitor the patient's progress and adjust treatment as needed.

2. What are the most common causes of seizures?

Seizures can be caused by acute conditions like electrolyte imbalances, neuroinfections, or brain trauma, or they can be chronic and referred to as epilepsy, which involves the development of a seizure-generating network.

3. How is the treatment plan for seizures determined?

The treatment plan varies based on the type and cause of the seizure. For acute symptomatic seizures, short-term antiepileptic medications are used. For classic epilepsy, long-term antiepileptic therapy is typically required, and the decision to start treatment depends on the risk of future seizures and the patient's situation.