Differences In Study Design
Each study that investigates seizures and the brain has a different design. Different researchers may use different methods to address a question. They may also interpret their results differently from another group.
Sample size is also important. For example, a study with only a small number of people may not be representative of whats happening in larger groups.
Some studies may also assess participants at only a single point in time. This is much different than following the course of someones epilepsy over many years.
Can Seizures Injure The Brain
Brain damage happens when nerve cells in the brain are damaged or destroyed. Depending on the part of the brain thats impacted, damage can lead to a variety of different physical, cognitive, and emotional symptoms.
Most types of seizures last only a short amount of time and do not lead to damage to neurons. However, experiencing a prolonged seizure can cause injury.
These types of seizures are called status epilepticus. Permanent neurological damage can happen after about 30 minutes of status epilepticus due to prolonged abnormal electrical activity in the affected area of the brain.
Status epilepticus is a medical emergency. Its a good rule of thumb to treat any seizure that lasts over 5 minutes as status epilepticus and call 911 or your local emergency number.
While most seizures do not cause damage to the brain, some may lead to changes that may impact brain structure or cognitive functions. Below, well look at some of the research into this topic.
type of focal epilepsy in adults.
Individuals with temporal lobe epilepsy often have problems with memory and other cognitive functions. Additionally, in about one-third of people with temporal lobe epilepsy, seizures do not resolve after starting antiseizure medications.
Below, well touch on some of the research into seizures and the brain, much of it focusing on temporal lobe epilepsy. Then, in the next section, well cover some of the ongoing questions related to this topic.
Causes Of Brain Death
Brain death can happen when the blood and/or oxygen supply to the brain is stopped.
This can be caused by:
- cardiac arrest ;;when the heart stops beating and the brain is starved of oxygen
- a heart attack; when the blood supply to the heart is suddenly blocked
- a stroke;;when the blood supply to the brain is blocked or interrupted
- a blood clot;;a blockage in a blood vessel that disturbs or blocks the flow of blood around your body
Brain death can also be caused by:
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Diagnosis Of Vegetative State
A doctor’s evaluation
Tests such as magnetic resonance imaging and electroencephalography
Doctors suspect a vegetative state based on symptoms. However, before a vegetative state can be diagnosed, people should be observed for a period of time and on more than one occasion. If people are not observed long enough, evidence of awareness may be missed. People who have some awareness may be in a minimally conscious state rather than a vegetative state.
An imaging test, such as magnetic resonance imaging or computed tomography , is done to check for disorders that may be causing the problem, especially those that can be treated. If the diagnosis is in doubt, doctors may do other imaging testsâpositron emission tomography or single-photon emission computed tomography . These tests can indicate how well the brain is functioning.
Electroencephalography may be done to check for abnormalities in the brain’s electrical activity that suggest seizures, which may impair consciousness.
Functional MRI may be done to check for brain activity and thus determine whether awareness is completely impaired. This test can detect when a person responds to questions and commands, even when the response is not apparentâthat is, when the person does not speak or move in response . EEG can also detect this brain activity. The results of these tests can affect decisions about long-term care.
How Can I Lower My Risk Of Cerebral Hypoxia
Its important to manage conditions like high blood pressure. Conditions that can cause a heart attack or stroke increase the risk of cerebral hypoxia.
You can also take safety measures to lower the risk of accidents that cause cerebral hypoxia. You and your family can:
- Buckle up with seatbelts.
- Install smoke detectors and carbon monoxide detectors in your home.
- Use life vests, swim at places that have lifeguards and supervise children around water, including bathtubs.
- Wear helmets during high-impact physical activities or while biking, skating or skiing.
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Is Surgical Treatment An Option For Post
- Surgery may be an option for people with drug resistant post-traumatic epilepsy
- Similar to other types of epilepsy, the goal of surgery in post-traumatic epilepsy is to safely remove epileptogenic brain tissue.;
- A pre-surgical evaluation will take place to determine where seizures are coming from and to decide if a person is a surgical candidate
- Vagus nerve stimulation;should be considered for people who have medication resistant epilepsy and are not candidates for surgical resection
- Newer surgical therapies, responsive neurostimulation and deep brain stimulation;are two techniques available to treat medication resistant seizures in epilepsy which may provide possibilities for further treatment in PTE;
Responsibilities Of Physicians Determining Brain Death
The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, is conclusively performed. In the absence of either complete clinical findings consistent with brain death, or confirmatory tests demonstrating brain death, brain death cannot be diagnosed and certified. These guidelines apply to patients one year of age or older.
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What Types Of Seizures Do People With Post Traumatic Epilepsy Have
Most seizures in post-traumatic epilepsy are focal and may spread to become bilateral tonic clonic seizures. This means that they start in one area of the brain but spread to involve the entire brain . Sometimes the beginning of these seizures can be determined and relates to the area of the brain injured, other times it is harder to determine where a seizure begins. A person may have focal aware or focal impaired awareness seizures but these are less frequent .
In 1 out of 2 people post traumatic epilepsy occurs within one year of their brain injury. The more severe the head injury the longer a person is at risk for developing epilepsy. Risk for PTE developing decreases substantially with time but can extend out to 15 years after the original traumatic injury for people with the most severe brain injuries.
A person is at higher risk for developing PTE if,
Things To Look For When Considering A Setting To Care For Your Loved One:
Here are some things to look for when choosing a place for care:
- Your family members current treatment team has received good feedback about the programs quality of care when they have referred others there.
- The staff make you feel comfortable. They are available to talk about your concerns, and they answer your questions.
- The program has a multidisciplinary treatment team that, at a minimum, includes a rehabilitation physician, nurse, speech pathologist, physical therapist, occupational therapist, psychologist, and social worker.
- The treatment team meets together to identify treatment goals and review progress.
- The program and treatment staff have worked with the same kinds of problems that your family member has.
- The facility knows about the specific care your loved one needs and can meet those needs. You can help to make sure that a detailed nursing care plan is created.
- The program includes case management to help plan for the next level of care, whether its moving to a rehabilitation program, an LTACH, a SNF, or home.
- The program provides education and training for future caregivers.
- The program has a systematic approach to measure progress in all patients.
- The program is guided by recommendations for rehab programs from the American Congress of Rehabilitation Medicine and the NIDILRRs Traumatic Brain Injury Model System.
- The program receives good grades in state and/or federal quality ratings
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What Are Late Seizures
Seizures which occur more than a week after a traumatic brain injury are considered late seizures. Most often when this happens, it is because there has been more serious injury to brain cells and the chemical environment around the cells has also changed. Late seizures are more likely to lead to the complication of post-traumatic epilepsy.
Evolution Of The Criteria For Brain Death
Historically death was defined by the presence of putrefaction or decapitation, failure to respond to painful stimuli, or the apparent loss of observable cardio respiratory action. The widespread use of mechanical ventilators that prevent respiratory arrest has transformed the course of terminal neurologic disorders. Vital functions can now be maintained artificially after the brain has ceased to function. In 1968, an ad hoc committee at Harvard Medical School reexamined the definition of brain death and defined irreversible coma, or brain death, as unresponsiveness and lack of receptivity, the absence of movement and breathing, the absence of brain-stem reflexes, and coma whose cause has been identified.
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Transitions To Different Levels Of Care
During recovery, people in the VS or the MCS may get care in many settings. A person with a DOC will likely start treatment in an acute care hospital; the focus is on saving the patients life and stabilizing the patient. Once those needs are met, the focus moves to restoring as much function as possible. Sometimes this takes place in an acute rehabilitation hospital. These hospitals provide high-intensity, team-oriented services. Services include physical therapy, occupational therapy, speech-language therapy, recreational therapy, neuropsychological services, and medical and nursing care.
Some patients dont go from the acute care hospital to an acute rehab program. These patients may go directly to a long-term acute care hospital , a skilled nursing facility , a subacute rehab program, or a nursing home. They may also go home with family or have home health care or outpatient treatment. People who get care in an acute rehab program first are usually discharged to one of these places as well.
When patients are medically unstable or dont show signs of recovery for a long time, doctors may consider palliative care. In this type of care, the focus of treatment shifts from recovery to comfort.
Many factors affect where a person with severe DOC or other severe impairments goes after leaving an acute care hospital or rehab program. These factors include:
Can Someone Die From A Tonic
It is possible to die from a tonic-clonic seizure. For example, some people may fatally injure themselves while having a seizure, or they may drown if they have a seizure in water.
It is also possible for someone to die from sudden unexpected death in epilepsy . According to the Centers for Disease Control and Prevention , this happens in about 1 in every 1,000 people with epilepsy every year.
Certain factors may contribute to SUDEP. For example, while having a seizure, a person may unintentionally pause their breathing. If they pause for too long between breaths, the oxygen in their blood may drop to a life threatening level.
It is also possible that a persons airways may become obstructed during a seizure, leading to suffocation. A seizure may also cause cardiac arrest.
To reduce the risk of death from a tonic-clonic seizure, people should:
- try to avoid seizure triggers
- try to avoid drinking too much alcohol
People should only call emergency services if the person:
- has not had a seizure before
- has difficulty breathing or waking up after the seizure
- has a seizure that lasts for longer than 5 minutes
- has another seizure soon after the first
- is hurt during the seizure
- has a seizure in water
- is pregnant or has another health condition, such as diabetes or heart disease
If someone is having a tonic-clonic seizure, the people around them can do the following first aid steps to help:
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How Seizures Can Affect A Brain Injury Lawsuit
An injury victim who has also experienced seizures may be at serious risk for additional complications and medical difficulties. They may develop difficulties in performing everyday tasks, communicating with loved ones, commuting, and performing various work tasks. Their relationships may undergo strain as a result of the drastic changes caused by the initial injury, as well as by the seizures.;
In many instances, seizures and brain damage or traumatic brain injury are the results of the actions of another person or party. For example, brain injuries can be caused by:
- Negligence or recklessness, such as in a car accident where the other driver disregarded road safety laws
- Intentional conduct, such as when a person strikes another person on the head
- Medical malpractice cases, such as a botched brain surgery
- Defective product injuries, especially those involving dangerous pharmaceuticals;
In such cases, it may be necessary to pursue legal action. Monetary damages awards can help provide compensation for medical bills, lost wages, lost earning capacity, pain and suffering, and other costs.;
Behavioral Variant Frontotemporal Dementia
Behavioral variant frontotemporal dementia was previously known as Pick’s disease, and is the most common of the FTD types. BvFTD is diagnosed four times more than the PPA variants. Behavior can change in BvFTD in either of two waysit can change to being impulsive and disinhibited, acting in socially unacceptable ways; or it can change to being listless and apathetic. About 1213% of people with bvFTD develop motor neuron disease.
The Pick bodies in behavioral variant FTD are spherical inclusion bodies found in the cytoplasm of affected cells. They consist of tau fibrils as a major component together with a number of other protein products including ubiquitin and tubulin.
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Symptoms Of Vegetative State
People in a vegetative state can do some things because some parts of the brain are functioning:
They can open their eyes.
They have relatively regular sleeping and waking patterns .
They can breathe, suck, chew, cough, gag, swallow, and make guttural sounds.
They may even be startled by loud noises and appear to smile or frown.
Because of these responses, they may appear to be aware of their surroundings. However, they have no awareness of themselves or their environment. Their apparent responses to their surroundings result from automatic basic reflexes and not from a conscious action. For example, they may instinctively grasp an object when it touches their hand, as a baby does.
People in a vegetative state cannot do things that require thought or conscious intention. They cannot speak, follow commands, move their limbs purposefully, or move to avoid a painful stimulus.
People in a vegetative state have no control over urination and bowel movements .
Brain Death Is Legal Death
If someone’s brain dead, the damage is irreversible and, according to UK law, the person has died.
It can be confusing to be told someone has brain death, because their life support machine will keep their heart beating and their chest will still rise and fall with every breath from the ventilator.
But they will not ever regain consciousness or start breathing on their own again. They have already died.
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What Your Caregiver Should Do If You Are Having A Seizure
A family member or caregiver should watch closely to what happens during a seizure, so they can explain it to medical professionals. They should make a diary describing the date, time of day, length of time, and description of each seizure. Your doctor will need this information about your seizures and the drugs you are taking to control them.
The majority of seizures are short and do not result in significant injuries. However, it is important for your caregivers to know what to do to keep you from hurting yourself.
Prognosis For Brain Death
The diagnosis of brain death is equivalent to the persons death. No further treatment can prevent death.
After brain death is confirmed, all supporting cardiac and respiratory treatments are ended. Cessation of ventilatory support results in terminal arrhythmias. Spinal motor reflexes may occur during terminal apnea; they include arching of the back, neck turning, stiffening of the legs, and upper extremity flexion . Family members who wish to be present when the ventilator is shut off need to be warned of such reflex movements.
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Can A Person Who Is Brain Dead Open Their Eyes
A person who is brain dead is dead, with no chance of revival. Coma: A state of profound unresponsiveness as a result of severe illness or brain injury. Patients in a coma do not open their eyes or speak, and they do not exhibit purposeful behaviors. Some patients need ventilators while others do not.
Features Of The Confusional State
- Acting lost or confused. This may include not being able to keep track of the correct place and time.
- Severe problems with attention, memory, and other mental abilities.
- Changes in level of responsiveness.
- Feeling very tired and sleeping during the day.
- Believing things that arent true.
- Seeing things that arent there.
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How Does Lack Of Oxygen Affect The Brain
Your brain runs your nervous system. It needs oxygen to function. In fact, the brain uses about a fifth of your bodys total oxygen supply. Oxygen helps send nerve signals and messages throughout the body.
When the brain doesnt get enough oxygen, brain cells begin to die. Cell death happens within 5 minutes of low oxygen.