Seizures

Managing seizure risk

A seizure is a sudden disruption of the brain’s normal electrical activity accompanied by altered awareness and/or other neurological and behavioral manifestations.

Epilepsy is a condition characterized by recurrent seizures that may include repetitive muscle jerking, called convulsions. Most seizures are benign, but a seizure that lasts 2 to 5 minutes can lead to status epilepticus, a life-threatening condition characterized by continuous seizures, loss of consciousness, and respiratory distress. Non-convulsive epilepsy can impair physical coordination, vision, and other senses. Undiagnosed seizures can lead to conditions that are more serious and more difficult to manage. Some people who have epilepsy have more than one type of seizure.

Types of seizures

  • A generalized epileptic seizure occurs when electrical abnormalities exist throughout the brain.
  • A generalized tonic-clonic (grand mal) seizure begins with a loud cry, before the person having the seizure loses consciousness and falls to the ground.
  • The muscles become rigid for about 30 seconds during the tonic phase of the seizure and alternately contract and relax during the clonic phase, which lasts 30 to 60 seconds.
  • The skin sometimes acquires a bluish tint and the person may bite his tongue, lose bowel or bladder control, or have trouble breathing.
  • A grand mal seizure lasts between 2 to 5 minutes, and the person may be confused or have trouble talking when they regain consciousness (postictal state). They may complain of head or muscle aches, or weakness in their arms or legs, before falling into a deep sleep.

  • A primary generalized seizure occurs when electrical discharges begin in both halves (hemispheres) of the brain at the same time.
  • Primary generalized seizures are more likely to be major motor attacks than absence seizures.

  • Absence seizures usually begin with a brief loss of consciousness and last between one and 10 seconds.
  • A person having a petit mal seizure becomes very quiet and may blink, stare blankly, roll their eyes or move their lips.
  • A petit mal seizure lasts 15 to 20 seconds.
  • When it ends, the person is able to resume whatever he was doing before the seizure began. He will not remember the seizure and may not realize that anything unusual has happened.
  • Untreated, petit mal seizures can recur as often as 100 times per day and may progress to grand mal seizures.

  • Myoclonic seizures are characterized by brief, involuntary spasms of the tongue or muscles of the face, arms, or legs.
  • Myoclonic seizures most commonly occur when waking after a night’s sleep.

  • A partial seizure begins in an area called an epileptic focus, but may spread to other parts of the brain and cause a generalized seizure. A partial seizure does not involve the entire brain.
  • Simple partial seizures do not spread from the area where they start. They are characterized by symptoms that are determined by the part of the brain affected. The patient usually remains conscious during the seizure and can later describe it in detail.
  • Complex partial seizures begin as simple partial seizures, but move beyond the focal area and cause loss of consciousness. A distinctive smell, taste, or other unusual sensation such as an aura may signal the onset of a complex partial seizure. Complex partial seizures can become major motor seizures. Although a person having a complex partial seizure may not seem to be unconscious, they do not know what is happening and may behave inappropriately. They will not remember the seizure, but may seem confused or intoxicated for a few minutes after it ends.

  • Status epilepticus is a state of prolonged, continuous seizures, during which the person and may have trouble breathing.
  • Status epilepticus can be caused by:
    • Sudden discontinuation anti-seizure medication
    • Hypoxic or metabolic encephalopathy, a brain disease resulting from lack of oxygen or malfunctioning of other physical or chemical processes
    • Acute head injury
    • Blood infection caused by inflammation of the brain or the membranes that cover it

Prevention

  • Eat properly.
  • Get enough sleep.
  • Control stress.
  • Control fevers.
  • Avoid flashing lights.
  • Wear a Medic-Alert bracelet.
  • Shower instead of taking a bath.
  • Never swim alone.
  • Avoid rough contact sports.
  • Speak with your physician regarding the operation of any motor vehicle.
  • Speak with your physician if you have questions about the use of stimulants like nicotine and caffeine.
  • Anticonvulsant medications should not be stopped suddenly and, if other medications are prescribed or discontinued, the doctor treating the seizures should be notified.

Treatment

  • Do not restrain a person who is having a seizure.
  • Move sharp or dangerous objects out of reach.
  • Loosen tight-fitting clothing.
  • Place a soft, flat object like a towel or the palm of a hand under the person’s head.
  • Do not force a hard object into the mouth of someone having a grand mal seizure, as this could cause injuries or breathing problems.
  • Turn the individual’s head to the side to help him breathe.
  • A person who experiences an aura should find a safe place to lie down and stay there until the seizure passes.
  • Warn an individual having a complex partial seizure away from danger by calling their name in a clear, calm voice.
  • Help a person having a grand mal seizure to lie down.
  • Following a grand mal seizure, tell the person who had the seizure what has happened and remind them where they are.

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