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Fits

fits
By Medicover Hospitals / 18 Jan 2021
Home | symptoms | fits
  • Fits are an abnormal electrical activity in the brain that occurs quickly. It can go almost unnoticed or, in severe cases, it can cause unconsciousness and seizures, when your body shakes uncontrollably. Fits usually come on suddenly. Duration and severity can vary. Fits can happen just one time or repeatedly. If they come back, they have epilepsy or an epileptic disorder. Less than one out of ten people who have fits is epilepsy.
  • Article Context:

    1. What are Fits?
    2. Types
    3. Causes
    4. Diagnosis
    5. Treatment
    6. When to visit a Doctor?
    7. Home remedies
    8. FAQ's

    What are Fits?

    • Fits are sudden, uncontrolled electrical disturbances in the brain. It can cause changes in your behavior, movements or feelings, and levels of consciousness. If you have two or more fits or a tendency to have recurrent fits, you have epilepsy.
    • There are many types of fits, which range in severity. Fits types vary by where and how they begin in the brain. Most fits last from 30 seconds to two minutes. Fits that lasts longer than five minutes is a medical emergency.
    • Fits are more common than you might think. Fits can happen after a stroke, a closed head injury, an infection such as meningitis, or another illness. Many times, though, the cause of fits is unknown.
    • Most fits disorders can be controlled with medication, but the management of fits can still have a significant impact on your daily life. The good news is you can work with your health care professional to balance fits control and medication side effects.

    Types of Fits:

  • The International League Against Epilepsy (ILAE) introduced updated classifications in 2017 that better describe the many types of fits. The two major types called focal onset fits and generalized onset fits.
  • Focal onset fits:

  • Focal fits result from abnormal electrical activity in one area of your brain. Focal fits can occur with or without loss of consciousness:
    • Focal fits with impaired awareness: These fits involve a change or loss of consciousness or awareness. You may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles.
    • Focal fits without loss of consciousness: These fits may alter emotions or change the way things look, smell, feel, taste, or sound, but you don't lose consciousness. These fits may also result in the involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness, and flashing lights.
  • Signs of focal fits may confuse with other neurological disorders, such as migraine, narcolepsy, or mental illness.
  • Generalized onset fits:

  • These fits start on both sides of the brain simultaneously. Among the more common types of generalized onset, fits are tonic-clonic, absence, and atonic.
    • Tonic-clonic: These are also known as grand mal fits. “Tonic” refers to muscle stiffening. “Clonic” refers to the jerky arm and leg movements during the convulsions. You will probably lose consciousness during these fits that can last for a few minutes.
    • Absence: Also called petit-mal fits, these last for only a few seconds. They can cause you to blink repeatedly or stare into space. Other people may mistakenly think you’re daydreaming.
    • Atonic: During these fits, also known as drop attacks, your muscles suddenly go limp. Your head may nod or your entire body could fall to the ground. Atonic fits are brief, lasting about 15 seconds.
    • Clonic: Clonic fits associate with repeated or rhythmic, jerking muscle movements. These fits usually affect the neck, face, and arms.
    • Myoclonic: Myoclonic fits usually appear as sudden brief jerks or twitches of your arms and legs.

    Unknown onset fits:

  • Sometimes no one sees the beginning of fits. For example, someone may wake up in the middle of the night and observe their partner having fits. These are called unknown onset fits. They are unclassified because of insufficient information about how they started.
  • Causes:

  • Neurons in the brain create, send, and receive electrical impulses, which allow the brain's nerve cells to communicate. Anything that disrupts these communication pathways can lead to fits.
  • The most common cause of fits is epilepsy. But not every person who has fits has epilepsy. Sometimes fits happen because of:
    • High fever, which can associate with an infection such as meningitis
    • Lack of sleep
    • Hyponatremia, which can happen with diuretic therapy
    • Medications, such as certain pain relievers, antidepressants, or smoking cessation therapies, that lower the seizure threshold
    • Head trauma that causes an area of bleeding in the brain
    • Stroke
    • Brain tumor
    • Illegal or recreational drugs, such as amphetamines or cocaine
    • Alcohol abuse, during times of withdrawal or extreme intoxication
    • COVID-19

    Diagnosis:

    • Doctors can have a difficult time diagnosing seizure types. Your doctor may recommend certain tests to diagnose a seizure accurately and to help ensure that the treatments they recommend will be effective.
    • Your doctor will consider your full medical history and the events leading up to the seizure. For example, conditions such as migraine headaches, sleep disorders, and extreme psychological stress can cause seizure-like symptoms.
    • Lab tests may help your doctor rule out other conditions that can cause seizure-like activity. The tests may include:
      • blood testing to check for electrolyte imbalances
      • a spinal tap to rule out infection
      • a toxicology screening to test for drugs, poisons, or toxins
    • An electroencephalogram (EEG) can help your doctor diagnose a seizure. This test measures your brain waves. Viewing brain waves during a seizure can help your doctor diagnose the type of seizure.
    • Imaging scans such as a CT scan or MRI scan also can help by providing a clear picture of the brain. These scans allow your doctor to see abnormalities like blocked blood flow or a tumor.

    Treatment:

  • Not everyone who has one fits will have another one, and because fits can isolate an incident, your doctor may not decide to start treatment until you've had over one.
  • The optimal goal in fits treatment is to find the best possible therapy to stop fits, with the fewest side effects.
  • Medication:

    • Treatment for fits often involves the use of anti-fits medications. Several options exist for anti-fits medications. The goal is to find the medicine that works best for you and that causes the fewest side effects. Sometimes, your doctor might recommend over one medication.
    • Finding the right medication and dosage can be complex. Your doctor will consider your condition, your frequency of fits, your age, and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may take, to ensure the anti-epileptic medications won't interact with them.

    Surgery and other therapies:

  • If anti-fits medications aren't effective, other treatments may be an option:
    • Surgery: The goal of surgery is to stop fits from happening. Surgeons locate and remove the area of your brain where fits begin. Surgery works best for people who have fits that always originate in the same place in their brains.
    • Vagus nerve stimulation: A device implanted underneath the skin of your chest stimulates the vagus nerve in your neck, signaling your brain that inhibits fits. With vagus nerve stimulation, you may still need to take medication, but you may lower the dose.
    • Responsive neurostimulation: During responsive neuro-stimulation, a device implanted on the surface of your brain or within brain tissue can detect fits activity and deliver electrical stimulation to the detected area to stop fits.
    • Deep brain stimulation: Doctor’s implant electrodes within certain areas of your brain to produce electrical impulses that regulate abnormal brain activity. The electrodes attach to a pacemaker-like device placed under the skin of your chest, which controls the amount of stimulation produced.
    • Dietary therapy: Following a diet that's high in fat and low in carbohydrates, known as a ketogenic diet, can improve fits control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, though less effective, aren't as restrictive as the ketogenic diet and may provide benefit.

    Pregnancy and Fits:

    • Women who've had previous fits typically can have healthy pregnancies. Birth defects related to certain medications can sometimes occur.
    • In particular, valproic acid one medication for generalized fits has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. Discuss these risks with your doctor. Because of the risk of birth defects and because pregnancy can alter medication levels, preconception planning is particularly important for women who've had fits.
    • Sometimes, it may be appropriate to change the dose of fits medication before or during pregnancy. Medications may be switched in rare cases.

    Contraception and anti-seizure medications:

  • Some anti-fits medications can alter the effectiveness of birth control medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive and if other forms of contraception need to be considered.
  • When to visit a Doctor?

  • Seek immediate medical help if any of the following occurs:
    • Fits last over five minutes
    • Breathing or consciousness doesn't return after fits stop
    • A second fits follow immediately
    • You have a high fever
    • You're experiencing heat exhaustion
    • You're pregnant
    • You have diabetes
    • You've injured yourself during fits
  • If you experience fits for the first time, seek medical advice.
  • Home Remedies:

  • Here are some steps you can take to help with fits control:
    • Take medication correctly: Don't adjust the dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.
    • Get enough sleep: Lack of sleep can trigger fits. Be sure to get adequate rest every night.
    • Wear a medical alert bracelet: This will help emergency personnel know how to treat you correctly if you have other fits.
    • Be active: Exercising and being active may help keep you physically healthy and reduce depression. Drink enough water and rest if you get tired during exercise.
    • Make healthy life choices: Managing stress, limiting alcoholic beverages, and avoiding cigarettes all factor into a healthy lifestyle.

    Personal safety:

  • Fits rarely result in serious injury, but if you have recurrent fits, injury is a possibility. These steps can help you avoid injury during fits:
    • Take care near water: Don't swim alone or relax in a boat without someone nearby.
    • Wear a helmet for protection during activities such as bike riding or sports participation.
    • Take showers instead of baths, unless someone is near you.
    • Modify your furnishings: Pad sharp corners, buy furniture with rounded edges, and choose chairs that have arms to keep you from falling off the chair. Consider carpet with thick padding to protect you from falling.
    • Display fits first-aid tips in a place where people can easily see them. Include any important phone numbers there as well.

    Fits first aid:

  • It's helpful to know what to do if you witness someone having fits. If you're at risk of having fits in the future, pass this information along to family, friends, and co-workers so that they know what to do if you have fits.
  • To help someone during fits, take these steps:
    • Carefully roll the person onto one side
    • Place something soft under his or her head
    • Loosen tight neckwear
    • Avoid putting your fingers or other objects in the person's mouth
    • Don't restrict someone from having fits
    • Clear away dangerous objects, if the person is moving
    • Stay with the person until medical personnel arrive
    • Observe the person closely so that you can provide details on what happened
    • Time for the fits
    • Stay calm

    Frequently Asked Questions:

  • In cases where the aura is a smell, some people can fight off fits by sniffing a strong odor, such as garlic or roses. When the preliminary signs include depression, irritability, or headache, an extra dose of medication (with a doctor's approval) may help prevent an attack.
  • Not all fits are emergencies. To help someone having fits focus on safety. Give the person room, clear hard or sharp objects, and cushion the head. Don't hold the person down, stop movements, or put anything in the person's mouth.
  • Stay with the person until fits end and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms. Comfort the person and speak calmly.
  • Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms. Comfort the person and speak calmly.
  • Fits signs may include:
    • Temporary confusion
    • A staring spell
    • Uncontrollable jerking movements of the arms and legs
    • Loss of consciousness or awareness
    • Cognitive or emotional symptoms, such as fear, anxiety

    Citations:

  • Focal fits during chlorambucil therapy - https://pmj.bmj.com/content/55/649/806.short/
  • Epileptic fits and epilepsy in the elderly - https://www.sciencedirect.com/science/article/abs/pii/S0303846707001825