Photo by: Waldo Jaquith
November is National Epilepsy Awareness Month! Epilepsy, a neurological disorder characterized by frequent seizures, affects approximately 50 million people around the world, the majority of who live in developing countries. Since there are more than 40 types of epilepsy and each type is unique (different seizure types, age of onset, treatment options, etc.), epilepsy awareness is important as it serves to increase proper diagnoses, availability of affordable health care, and support for medical research.
What Is Epilepsy?
Seizures
What To Do When A Seizures Occurs
What To Do After A Seizure
Additional Resources
What Is Epilepsy?
Epilepsy is a neurological disorder. In epileptic patients, abnormal or excessive neural activity in the brain triggers physical symptoms, most commonly seizures. Epilepsy is difficult to generalize as there is a multitude of seizure types, triggers, and causes. Patients can be diagnosed with epilepsy if their seizures occur spontaneously and uncontrollably. However, in cases where seizures are triggered by external sources, patients are diagnosed with epilepsy syndromes known as reflex epilepsy. For example, in photosensitive epilepsy, seizures are triggered by flashing lights and in primary reading epilepsy, seizures are triggered by reading. Additionally, there are physical and emotional factors that can facilitate seizures such as stress, sleep deprivation, and even a woman’s menstrual cycle.
Epilepsy typically affects young children and older adults. In young children, genetic, congenital and developmental factors are normally the cause of the disorder, and, in adults over the age of 40, brain tumors are mostly associated with epilepsy. However, head trauma and infections in the central nervous system can also cause epilepsy in patients of any age.
Seizures
Its important to understand the various types of seizures as epilepsy syndromes can be defined by the seizures they produce. Seizures are first classified by their source and labeled as either a partial or generalized seizure. A partial seizure has a localized source within the brain while a generalized seizure has a distributed source.
Partial seizures are then classified by their effect on the patient’s consciousness. A simple partial seizure does not affect the patient’s consciousness (the patient is conscious during the seizure), while a complex partial seizure does (the patient loses consciousness during the seizure). Additionally, partial seizures can turn into generalized seizures if the source within the brain spreads (this is known as secondary generalization).
Generalized seizures are not classified by their effect on the patient’s consciousness as all generalized seizures include loss of consciousness. Rather, generalized seizures are classified according to their effect on the patient’s body.
Listed below are the various types of generalized seizures:
Absence (Petit Mal) Seizures
Patients typically “stare into space” for a period of time (usually seconds); can also include twitching of the eye muscles (sometimes it does not); named thus so because the patient appears mentally “absent”
Myoclonic Seizures
Patients experience involuntary muscle twitching (caused by rapid contraction and relaxation of the muscles); seizures affect both sides of the body and occur in unison
Clonic Seizures
Like Myoclonic seizures, patients experience involuntary muscle movements; however, movement is due to muscle contraction that is triggered by a stretching of the muscle, thus, Clonic seizures produce large motions (Myoclonic seizures produce small motions like twitches)
Tonic Seizures
Patients lose consciousness and then experience an abrupt tensing of their skeletal muscles; muscle tension causes the patient’s extremities to move towards or away from the body (this causes the patient to fall if standing)
Tonic-Clonic (Grand Mal) Seizures
Includes two phases preceded by an “aura” or simple partial seizure in which the patient experiences lightheadedness, dizziness, and altered vision and hearing; the Tonic phase is a Tonic seizure (described above) and lasts a few seconds; the Clonic phase occurs when rapid muscle contraction and relaxation causes the patient to convulse (ranges from twitching to violent shaking); Tonic-Clonic seizures are generally followed by patient confusion and amnesia which wear off as the patient regains consciousness
Atonic (Drop) Seizures
Patients lose muscle tone and control (i.e. Neck muscles release and the patient’s head “drops”); seizures are brief and last about fifteen seconds; physical injuries occur if patient is standing, walking or even sitting
What To Do When A Seizure Occurs
For most generalized seizures in which the patient loses consciousness, the best thing to do is to prevent patient injury. This means moving the individual away from sharp objects and heights, cushioning their head with a pillow or towel, and placing the individual in the recovery position to avoid asphyxiation (refer to figure below for the “recovery position”). In some cases, a seizing patient may also begin to throw up. If this happens, the individual should be rolled onto their side so the regurgitated matter can flow out of their mouth. Do not try to clean out the individual’s mouth until the seizures stop (remember, seizures can come in waves) and the individual regains consciousness.
Recovery Position
Photo courtesy of Wikipedia.org
Additionally, if someone is having a Tonic-Clonic seizure (violent body convulsions), objects should not be place in his or her mouth. Contrary to popular belief, a seizing patient does not benefit from “biting” on something (this actually increases their chance of biting their tongue), nor does this act prevent a seizing patient from swallowing their tongue (this is impossible during a seizure). Likewise, seizing patients should not be restrained with physical force. While in emergent cases physical force may be necessary to prevent injury to the patient, restraining seizing patients can often do more harm than good.
For simple or complex partial seizures, in which the patient experiences disorientation, unconsciousness and hallucination rather than physical convulsions, the best thing to do is to reassure and protect the patient. If necessary, physical force can be used to move the patient, but, like Tonic-Clonic seizures, it is not recommended as it may cause even more distress. If the patient is unconscious, do not work to revive them. Rather, let the seizure run its course and simply make sure the unconscious patient is not in physical danger.
What To Do After The Seizure
With all seizure patients, tending to the patient after their episode is just as important as during. No matter what the type of seizure, most patients will feel disoriented, confused and tired afterward (many tend to fall into a deep sleep right after). Additionally, patients often experience temporary amnesia and do not immediately regain their memory of the event. No matter if sleeping or awake, a seizure patient should never be left alone after an incident. If the patient is confused, attempts should be made to reassure and comfort them while keeping them calm. Finally, when a seizure occurs, those around the patient should make note of the characteristics of the seizures. Characteristics include how the patient’s body moves (to the left, to the right, etc.), what part of the body twitches, if the patient mumbles words, and if the patient pulls at their clothes. These characteristics, or seizure behaviors, can help the patient’s medical professional diagnose the type of seizures that are occurring.
Additional Resources
For more information, visit the following websites:
Epilepsy Foundation
National Institute of Neurological Disorders and Stroke (National Institute of Health)
Center for Disease Control and Prevention
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