New Onset Seizures - Causes, Treatment & When to See a Doctor

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What is New Onset Seizures?

A new onset seizure is defined as a sudden, uncontrolled electrical disturbance in the brain that affects a person’s behavior, movements, feelings, or level of consciousness. Unlike previously experienced seizures, new onset seizures are often more concerning because they may indicate an underlying medical condition that requires evaluation. While occasional seizures can occur without an identifiable cause, recurrent or recurring new onset seizures may signal a neurological disorder such as epilepsy.

Seizures vary widely in type and severity. Some people may experience brief staring spells, while others may have convulsions or loss of consciousness. The key feature of a new onset seizure is its unpredictability for the individual experiencing it. If this is the first time a person or someone they know has had a seizure, prompt medical evaluation is critical to determine the cause and prevent future episodes.

Common Causes

New onset seizures can result from a variety of factors. Below are eight to ten common causes, based on information from the Mayo Clinic, CDC, and National Institutes of Health (NIH):

• Epilepsy: A chronic neurological disorder characterized by recurrent seizures. While epilepsy often develops over time, it can present as a new onset condition in some cases.
• Brain Tumors: Growths in the brain can disrupt normal electrical activity and trigger seizures.
• Stroke: A stroke can damage brain tissue, leading to post-stroke seizures in some individuals.
• Infections: Conditions like meningitis, encephalitis, or even a simple urinary tract infection (UTI) can cause inflammation in the brain, provoking a seizure.
• Traumatic Brain Injury (TBI): A head injury from a fall, accident, or sports-related impact can lead to seizures, even if there are no outward signs of brain damage.
• Electrolyte Imbalances: Low levels of sodium, potassium, or glucose in the blood can disrupt nerve signaling in the brain.
• Metabolic Disorders: Conditions such as diabetes, liver failure, or kidney disease can alter chemical balances in the body, increasing seizure risk.
• Alcohol Withdrawal: Sudden cessation of heavy alcohol use can cause seizures due to changes in brain chemistry.
• Pregnancy or Preeclampsia: Rarely, new onset seizures during pregnancy may indicate preeclampsia or other complications.
• Drug Abuse or Withdrawal: Stimulant or depressant drug use, as well as withdrawal from substances like benzodiazepines, can trigger seizures.

Associated Symptoms

New onset seizures often come with other symptoms that can help doctors diagnose the underlying cause. Common associated symptoms include:

• Loss of awareness: Staring into space or not responding to surroundings.
• Muscle stiffness or jerks: Sudden contractions of the body, often affecting the arms and legs.
• Unusual sensations: A feeling of tingling, numbness, or visions that the person cannot explain.
• Post-seizure confusion: Feeling disoriented, drowsy, or nauseous after the seizure ends.
• Temporary memory loss: Not remembering what happened during or immediately after the seizure.
• Loss of bladder or bowel control: In some cases, seizures may cause incontinence.
• Uncontrolled movements: Repetitive or random movements, often called automatisms.

It’s important to note that not all seizures involve loss of consciousness. Some people may experience absence seizures, which involve brief staring spells without physical activity.

When to See a Doctor

Anyone experiencing a new onset seizure should seek medical attention immediately. Even a single seizure without a known cause warrants evaluation. However, specific warning signs indicate urgent care is needed, as outlined by the CDC and CDC Foundation:

• The seizure lasts longer than 5 minutes
• Multiple seizures occur without the person regaining full consciousness
• Injuries occur during the seizure (e.g., hitting the head or body)
• The person is pregnant or has a medical condition like diabetes
• The seizure starts in water (risk of drowning)
• Unusual behavior before or after the seizure

Even if the seizure seems to resolve on its own, a doctor’s evaluation is necessary to identify potential underlying causes and prevent recurrence.

Diagnosis

Diagnosing the cause of new onset seizures involves a combination of medical history, physical examination, and testing. The process typically includes:

Medical History Review

Doctors will ask detailed questions about the seizure’s duration, type, and any associated symptoms. They will also inquire about the patient’s overall health, medications, and potential triggers.

Physical Examination

A neurological exam will assess reflexes, muscle strength, coordination, and speech to identify any signs of brain damage or neurological deficits.

Brain Imaging

Brain scans like MRI or CT scans are often used to detect tumors, strokes, or structural abnormalities that could cause seizures.

Electroencephalogram (EEG)

An EEG records electrical activity in the brain and can identify abnormal patterns associated with seizure disorders.

Blood Tests

Blood work may check for infections, electrolyte imbalances, or metabolic disorders that could trigger seizures.

Additional Tests

Depending on the suspected cause, other tests like sleep studies, lumbar punctures (to check for meningitis), or PET scans may be recommended.

Treatment Options

Treatment for new onset seizures depends on the underlying cause. Here are the primary approaches, according to the American Epilepsy Society and Cleveland Clinic:

Medical Treatments

• Antiseizure medications (ASMs): Drugs like levetiracetam, valproic acid, or carbamazepine are commonly prescribed to control seizures.
• Addressing the root cause: If the seizure is caused by an infection, tumor, or electrolyte imbalance, treating that condition is critical.
• Devices: In some cases, devices such as vagus nerve stimulators or responsive neurostimulation may be implanted to prevent seizures.

Home and Lifestyle Management

• Avoid triggers: Reduce stress, ensure adequate sleep, and avoid alcohol or recreational drugs.
• Dietary adjustments: For certain metabolic disorders, a ketogenic diet may help reduce seizure frequency.
• Safe environment: Modify living spaces to prevent falls or injuries during a seizure (e.g., removing sharp objects).

In some cases, especially when seizures are caused by reversible factors like low blood sugar or dehydration, simple interventions like hydration or glucose consumption can resolve the issue.

Prevention Tips

While not all new onset seizures can be prevented, the following strategies may reduce the risk of recurrence, per the NIH and Mayo Clinic:

• Manage stress through relaxation techniques or therapy
• Ensure consistent sleep patterns and avoid sleep deprivation
• Maintain a balanced diet and stay hydrated
• Avoid alcohol and recreational drugs
• Monitor and manage medical conditions like diabetes or hypertension
• Keep a seizure diary to track triggers and patterns

It’s also important to follow up with a neurologist even after an initial seizure has been treated. Recurrent seizures may require adjustments to medication or further investigation.

Emergency Warning Signs

New onset seizures can be unsettling, but with proper medical evaluation, many causes are treatable. Always prioritize seeking professional care to ensure an accurate diagnosis and appropriate management.

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