Spells seizures and TIA’s are transient changes in the function of the central nervous system. These transient disturbances all have their diagnostic codes.
What I usually tell patients is that the temporary symptom spells seizures, or TIA’s they’ve had is either an electrical short circuit, or a plumbing problem, with not enough blood temporarily getting to a part of their brain for a few seconds. Just as when a car misses or hesitates when we step on the accelerator—the “spell” could be caused by a problem in the electrical wiring, or a problem with the fuel supply. Sometimes, it’s a combination of both.
In the case of seizure-caused spells, we in neurology look at the electrical function of the brain with a test called an EEG carried out as an outpatient. Electrodes are placed over a person’s scalp in specific locations, and the electrical activity of the first few millimeters of the outside of the brain is monitored during waking, sometimes sleep, and for varying lengths of time—from about half an hour or an hour in an office to a few days, in the case of long-term monitoring, at home. This is even done in a hospital, though in the hospital setting, where all epilepsy drugs can be withdrawn, the testing is much more expensive than in the outpatient setting.
If these monitoring tests are abnormal during during the occurrence of spells or seizures, then those spells are likely caused by abnormal electrical activity in the brain, and can be treated with specific anti-seizure medications.
On the other hand, sometimes spells can be caused by a circulation problem—either from a rhythm disturbance in the main pump (the heart), or by a temporary disturbance in the blood flow to a particular area of the brain (either from “rust in the pipes” or from a clot being dislodged and temporarily stopping up an artery to the brain), called a Transient Ischemic Attack (TIA). We can look at the heart rhythm electrically with an EKG or Holter monitor, or longer term with a cardiac event monitor, worn for a month or two at home.
We can check the blood flow in specific arteries to the brain with Magnetic Resonance Angiography (MRA) and the walls of parts of the arteries supplying blood to the brain with ultrasound. We can see if there is a scar or another lesion in the brain causing the spells or seizures with a Magnetic Resonance Imaging of the brain, sometimes with contrast administered, but always done in a specific way.
And sometimes “electrical” and “plumbing” problems overlap, as in migraine symptoms, which can occur sometimes even without headaches. Sleep problems can affect migraine, seizures, and stroke, as well as heart rhythm disturbances that lead to clots forming in the heart and breaking loose and causing stroke or TIA.
So it’s critical always to find out what causes spells or seizures, because if the cause is not determined and appropriate treatment started, the spells and seizures and TIA’s can get worse, and a convulsive seizure, stroke, or heart attack can happen. When these occur, a person’s life is changed forever. What Ben Franklin said so many years ago is true today: “An ounce of prevention is worth a pound of cure.”
So it’s always best to find out the root cause of the spells seizures and TIA’s. That can save a lot of problems in the long run, and can lead to appropriate treatment. Nearly all testing for spells seizures and TIA’s can be carried out at the Rowe Neurology Institute in an outpatient setting, at a fraction of the cost of evaluations in hospitals.