Epilepsy is the most common cause of seizures; it is a condition where sudden ‘storms’ of electrical activity in the brain have an impact on the body. Seizures can also have other causes, however, and can be triggered by several of the conditions which affect the central nervous system.
The idea of spinal cord injury (SCI) independently causing spinal cord seizures was described by Charles-Édouard Brown-Séquard, the 19th Century physician for whom the manifestation of a single-sided spinal cord injury is named. However, this does not tend to appear in modern literature; the animal experiments through which he demonstrated seizures associated with acquired SCI were largely debunked.[i] Seizures which were thought to be of a spinal cord origin[ii] found in medical literature from the 1960s[iii] have not translated into modern medical practice. Seizures are usually described according to the area of the brain from which they arise and their symptoms, which often inherently involve motor activity affecting the spinal cord, but which do not specifically arise from the spinal cord.
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What are seizures?
Seizures often used to be known as ‘fits’, but the word became associated with historically negative views of the people who experience seizures, so the more accurate term ‘seizures’ is preferred. The term ‘fit’ or describing someone as ‘fitting’ when they experience a seizure is still in use in some areas and among some groups of people. There are different types of seizure, and it’s helpful to categorise them according to the area of the brain they start in and how they affect the body.
Different types of seizure may be described as:
- Absence seizures: these are more common in children than adults, and appear as a ‘blank’ episode. This typically occurs without any obvious physical features except for a short period of what looks like ‘daydreaming’, but where the person is not responsive. Absence seizures used to be known as ‘petit-mal’ seizures.
- Focal onset seizures: these are seizures that only affect one area of the brain, although they can develop into other types of seizures with a broader impact. They are further divided according to how much they affect a person’s awareness; in a focal aware seizure the person stays awake and knows what it is happening, whereas in a focal impaired awareness seizure, the person affected has changes in their levels of consciousness and comprehension.
- Myoclonic seizures: these are typified by jerking muscle movements and may be accompanied by other types of seizure at the same time.
- Tonic and atonic seizures: a tonic seizure is one where a person’s muscles become very, uncontrollably stiff, and an atonic seizure is one where the muscles suddenly relax. Both of these types of seizure typically cause a person to fall down, during which time they may injure themselves.
- Tonic clonic seizures: previously called ‘grand mal’ seizures, they are typified by a loss of consciousness, falling down with classic jerking and shaking of the muscles with repetitive alternating tonic and atonic episodes. They are usually associated with a classic, archetypal picture of epilepsy, and media portrayals of epilepsy usually centre on this kind of seizure as the symptoms are very visible.
Afterwards, the person who experienced the seizure may continue to have some symptoms, and this time is known as the ‘postictal’ period. It can last any length of time from a few seconds to several days. The symptoms can include confusion, drowsiness, and reduced levels of consciousness. Headaches, nausea and fatigue often follow seizures.
The nature of a person’s postictal symptoms depend on the type and severity of the seizure, and the part of their brain that’s affected.[iv] Other existing conditions can affect the way a person presents in the postictal period and can also have overlapping symptoms which can make diagnosis more difficult. For example, urinary tract infections, can cause seizures in some people and the symptoms may mimic postictal-type symptoms.
What causes spinal cord seizures?
Although seizures are usually caused by epilepsy, or sometimes some serious acute systemic illness, occasionally seizures can arise from other conditions that affect the central nervous system. These can include transverse myelitis, multiple sclerosis, and sometimes toxicity. A rare condition known as spinal muscular atrophy associated with progressive myoclonic epilepsy (SMA-PME) is caused by a faulty genetic mutation where the affected person experiences epileptic seizures and progressive spinal muscular atrophy.[v]
An episode of spinal cord injury independently causing seizures is almost unique in medical literature[vi], but spinal cord injury can indirectly cause seizures primarily as a secondary symptom of autonomic dysreflexia.
As seizures are generally related to a specific area of the brain experiencing abnormal bursts of electrical activity, they are intrinsically linked to nerve activity throughout the central nervous system – i.e. the brain and spinal cord, and also impact the peripheral nervous system, hence the symptoms of muscle twitching and jerking movements.
Who is at risk of spinal cord seizures?
Spinal cord seizures are rare, but where they occur they affect people with those central nervous system conditions that are known to be linked with seizures, mainly transverse myelitis and multiple sclerosis. Some conditions that affect the spinal cord can also cause movement disorders which can result in seizure-like activity. Spinal cord-mediated seizures have also historically been associated with contrast dye administration for medical imaging in persons with specific rare circulatory disorders[vii] or conditions affecting the blood-brain barrier.[viii] Modern use of contrast dye is very safe and managed by experienced practitioners.
People who have spinal cord injuries or serious neurological conditions with a profound effect on movement and sensation can be liable to experience a condition known as autonomic dysreflexia (AD) where the body’s autonomic nervous system mounts a systemic reaction to a stimulus.
One of the symptoms of autonomic dysreflexia can be seizures, so people with spinal cord injuries and anybody involved in their care or who are close to them can benefit from an awareness of this potentially serious condition. Knowing how to identify and manage AD can help save the life of someone with a spinal cord injury.
Seizure treatment
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The immediate treatment of a seizure depends on the symptoms and how long it lasts. In the short-term, the main thing is to make sure that the person having a seizure is safe and won’t hurt themselves if they’re experiencing muscle jerking and weakness. Protecting the head is the most important consideration, and the risk of injury can be reduced with cushions, pillows, or rolled-up coats against any nearby sharp corners of furniture.
Sometimes people having a seizure can accidentally bite the inside of their mouth, but there isn’t any easy way to prevent this and you should not put anything inside the mouth of someone having a seizure. It’s quite common for people having tonic clonic seizures to lose control of their bladder during a seizure, which may be embarrassing afterwards, and when this happens it’s important to try and preserve that person’s privacy and dignity as much as possible.
A first seizure or seizure without an obvious manageable cause will usually be investigated and local healthcare providers may have specific clinics for investigating first seizures (sometimes known as a ‘first fit clinic’). Investigations may include blood tests, medical imaging of the brain, and an encephalograph (EEG). Sometimes a person may have one seizure without a clear cause and never have another, but more than one seizure will usually mean that ongoing treatment will need to be considered.
If a seizure happens to someone who has never had one before, it’s important to get urgent medical attention. It’s also important to get medical help for a seizure that lasts more than five minutes. Sometimes seizure activity can affect a person’s breathing, and if they appear to stop breathing properly that should be treated as a medical emergency, and anyone at the scene should get help and begin first aid as needed. If in doubt: get help.
In the longer-term, people who have seizures may be treated with medication. The cause of the seizure and the severity and frequency at which they occur influences the kind of preventative treatment given for seizures. Typical antiepileptic drugs may be tried for recurrent seizures; these include carbamazepine, sodium valproate and lamotrigine, among others. Antiepileptic drugs need to be taken exactly as described and not stopped without advice from a doctor.
Can a spinal cord injury cause seizures?
An injury that affects nerve pathways could cause something akin to seizure activity, but SCI is not usually independently associated with seizures, unless there is involvement of the brain stem or there is a secondary complication, for example autonomic dysreflexia.
Autonomic dysreflexia (AD) is a condition that can occur in people with spinal cord injury where there is some physical problem that a person is unable to sense due to their spinal cord injury affecting sensation, but which stimulates the autonomic nervous system. It can occur due to physical injuries like pressure damage, to constipation or urinary retention, infection, and even sometimes dysmenorrhea or sexual stimulation.
AD causes a rise in blood pressure and systemic effects, which sometimes include seizures.[ix] AD can become very serious, very quickly and it’s important to be aware of signs of AD if you’re involved in the care of someone with a spinal cord injury or another condition that means significant loss of sensation or motor control. Signs of AD can include sudden profuse sweating, reddening of the face, confusion or anxiety, bradycardia (a slow heart rate) and sometimes breathing problems and seizures. Sometimes AD can be managed simply by managing the underlying cause, but medical help should be sought as AD can lead to serious adverse events including strokes.
Seizures in multiple sclerosis
Multiple sclerosis (MS) is an autoimmune condition that affects the central nervous system. A person’s own immune system begins to attack the myelin sheath, the protective process of the nerves. MS is chronic and may or may not be progressive. Changes in the function of the central nervous system can cause lots of different symptoms, and seizures – usually focal motor seizures – can be experienced as a result of the changes in MS.[x] People with MS are more likely to experience seizures than the general population.
Seizures in transverse myelitis
Transverse myelitis is another condition affecting the nervous system, where sections of the spinal cord become inflamed and fail to function normally. It can happen as a result of other conditions like MS or infections affecting the central nervous system. Transverse myelitis can affect anyone, of any age and background, and can sometimes be the first indication of other conditions. The symptoms include pain, weakness, and reduced sensory function.
The changes in nerve function caused by transverse myelitis can occasionally trigger seizures.[xi]
Living with seizures
People who are prone to seizures with any underlying cause may need to take extra care with some normal day-to-day activities. This can include anything where a sudden loss of control or function could cause harm to themselves or others, such as driving, bathing, and swimming.
People who have seizures associated with neurological conditions may need extra care for their combined conditions. A care package designed to support someone who has seizures should be made up of care workers who have had special training in managing seizures, what to do if there’s a problem and when to get help. The close friends and relatives of someone who has seizures may also wish to learn more about what to do in an emergency.
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Medication used to prevent seizures is usually considered a ‘critical’ medication, as maintaining regular timing of administration may be crucial. Antiepileptic medicine can be given in many forms, and liquid preparations are available for people who are unable to swallow tablets or who are fed by percutaneous endoscopic gastrostomy (PEG).
Around 1 in 10 people will experience a seizure at some point in their lives, and at least 50 million people worldwide have epilepsy.[xii] Specialist medical, nursing, and allied health professional teams may be involved in the care of someone who has seizures, and there are lots of local or online support groups and resources to help people living with seizures.
[i] Koehler, P. (1994). Brown-Séquard’s spinal epilepsy. Medical History, 38(2), 189-203.
[ii] Castaigne, P., Cambier, J., & Brunet, P. (1968). Spinal sensory-motor seizures. The Lancet, 291(7538), 357.
[iii] Ekbom, K. A., Westerberg, C. E., & Osterman, P. O. (1968). Focal sensory-motor seizures of spinal origin. The Lancet, 291(7533), 67.
[iv] Pottkämper, J. C., Hofmeijer, J., van Waarde, J. A., & van Putten, M. J. (2020). The postictal state—What do we know?. Epilepsia, 61(6), 1045-1061.
[v] Topaloglu, H., & Melki, J. (2016). Spinal muscular atrophy associated with progressive myoclonus epilepsy. Epileptic Disorders, 18(s2), S128-S134.
[vi] Meythaler, J. M., Tuel, S. M., & Cross, L. L. (1991). Spinal cord seizures: a possible cause of isolated myoclonic activity in traumatic spinal cord injury. Spinal Cord, 29(8), 557-560.
[vii] Willison, H. J., Kendall, B. E., Trend, P., Thomas, P. K., Symon, L., & Thrush, D. (1990). Spinal arteriovenous malformation unmasked during intravenous urography. Journal of Neurology, Neurosurgery, and Psychiatry, 53(2), 175.
[viii] Rüber, T., David, B., Lüchters, G., Nass, R. D., Friedman, A., Surges, R., … & Elger, C. E. (2018). Evidence for peri-ictal blood-brain barrier dysfunction in patients with epilepsy. Brain, 141(10), 2952-2965.
[ix] Hartman, K. C., Vadivelu, S., & Hueschen, L. A. (2021). Seizures: A Rare Presentation of Autonomic Dysreflexia in a Young Adult with Complete Spinal Cord Injury. The Journal of emergency medicine, 61(5), 529-532.
[x] Gupta, K., Burchiel, K.J. Atypical facial pain in multiple sclerosis caused by spinal cord seizures: a case report and review of the literature. J Med Case Reports
[xi] Cherrick, A. A., & Ellenberg, M. (1986). Spinal cord seizures in transverse myelopathy: report of two cases. Archives of physical medicine and rehabilitation, 67(2), 129-131. https://doi.org/10.1016/0003-9993(86)90125-5
[xii] World Health Organization (2022) Factsheets: Epilepsy. WHO.
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