What causes seizures, and how can we treat them? - Christopher E. Gaw
Nearly three millennia ago,
a Babylonian tablet described
a curious illness called miqtu.
Said to cause symptoms ranging from
facial twitching to full body convulsions,
the Babylonians believed those afflicted
were possessed by evil spirits,
and the only treatment was
divine intervention.
Today, we know the symptoms
of miqtu by another name,
and modern medicine has developed
numerous treatments
for those experiencing seizures.
But these ancient afflictions still hold
a surprising number of secrets.
Doctors define a seizure
as any set of symptoms
resulting from excess
electrical activity in the brain.
Outside this shared feature, there is a
massive range of seizure symptoms,
and researchers have identified a variety
of different seizure types.
But regardless of the underlying
conditions that cause them,
every seizure begins here.
Hippocrates identified the brain
as the source of seizures around 400 BCE.
However, this insight didn't immediately
lead to better treatments.
Generally, ancient Greeks prescribed
medicinal herbs and alterations in diet.
If they believed the seizure was caused
by bleeding in the skull,
they sometimes employed
a technique called trepanation.
This early surgery involved drilling
a hole in the skull to let blood escape
and relieve pressure on the brain.
Trepanation had... sizable risks.
But it wasn’t until the 19th century
that scientists would make
the next leap forward
in seizure treatment.
In 1870, two German researchers discovered
that using electricity
to stimulate specific areas of a dog’s
brain could move parts of its body.
Around the same time, other scientists
discovered the brain and nervous system
were connected via a network of cells
called neurons
that transmitted electrical signals
throughout the body.
This established the brain
as the control center for nerve impulses
that determine our thoughts and movement.
Better yet, this model made it clear
that seizures were due to errors
in that control center,
such as misfiring neurons
or excess electrical activity.
Early experiments even suggested
that different patterns of misfiring
could account for different
seizure types and symptoms.
So if seizures were due
to neurons misfiring,
how could doctors stop
this from happening?
Physicians like Sir Charles Locock
hypothesized that sedative drugs
might calm overactive brain activity,
a theory he confirmed by treating seizures
with a medication called
potassium bromide.
Others like Sir Victor Horsley
suspected that removing damaged parts of
the brain might stop a patient's seizures.
In 1886, he performed a craniotomy,
temporarily removing part of a patient's
skull to extract scarred brain tissue.
Not only did his patient survive,
but his seizures improved,
launching further research
in surgical treatments.
Over the next two centuries,
seizure treatments advanced rapidly.
And today, there are dozens of available
seizure medications
that work with unprecedented specificity.
Some newer medications are able
to focus on specific proteins
in the neuron to help manage
electrical activity.
And advanced brain imaging techniques can
sometimes allow doctors to pinpoint
exactly what parts of the brain are
causing an individual's seizures.
Surgeons then use this information
to perform targeted surgeries.
These various treatments help doctors
manage the majority of seizure cases,
allowing most people with seizures
to live healthy and comfortable lives.
But the underlying pathology
of many seizures remains elusive.
In cases without clear brain damage or
certain types of pre-existing conditions,
it's incredibly difficult to determine
what causes neurons to misfire.
It's also not always clear why some
treatments are effective.
And even more mysterious are cases where
seizures are resistant
to existing treatments that work
on similar seizure types.
Scientists are still working
on these questions,
but there are clear answers for what to do
if you encounter someone
experiencing a seizure.
You should never hold
a seizing person down,
put objects in their mouth,
or perform CPR.
Instead, try to keep the person safe
from falling or bumping their head,
shift them onto their side
to keep airways open,
and stay with them until
medical help arrives.
