What are they and what to do
Many people have an isolated seizure at some time in their lives. This can happen to anyone if the circumstances are appropriate.
This is not the same thing as epilepsy which means having a tendency to recurrent spontaneous seizures. The information in this leaflet relates to people with epilepsy.
What is a Seizure?
A seizure (often called a fit and sometimes an attack, turn or blackout) happens when ordinary highly complex brain activity is suddenly disrupted.
Seizures can take many forms, since the brain is responsible. for such a wide range of functions. Personality, mood, memory, sensations, movement and consciousness are all controlled within the brain; any of these functions may be temporarily disturbed during the course of an epileptic seizure.
Some very young children have a generalised convulsion when there is a sudden rise in their body temperature and this is called a “febrile convulsion”. If a baby has recurrent febrile convulsions, preventative drug treatment may be recommended. These are not, however, epileptic seizures.
How can Seizures be described?
Not all seizures involve convulsions and many different terms are used. It is important to use terms which describe what is happening during the seizure.
A person with epilepsy can experience more than one type of seizure, but the pattern of seizures tends to remain fairly constant in an individual.
Although epilepsy can be classified in different ways the International Classification of Seizures (published by the International League Against Epilepsy) is the most commonly used.
In this type the whole of the brain is involved and consciousness is lost. The seizure may then take one of the following forms:
- The most dramatic form is the generalised tonic clonic convulsive seizure (still sometimes called a ‘grand mal’ seizure) in which the person becomes rigid, and may fall if standing. The muscles then relax and tighten rhythmically causing the person to convulse. Breathing is laboured and they may be incontinent. Other types of generalised seizures include:
- Tonic in which there is general stiffening of muscles without rhythmical jerking. The person may fall to the ground if standing with consequent risk of injury.
- Atonic (also known as drop attacks) in which there is a sudden loss of muscle tone, again causing the person to fall if standing.
- Myoclonic in which abrupt jerking of the limbs occurs.These often happen within a short time of waking up, either on their own or in company with other forms of generalised seizure.
- Absences in which there is a brief interruption of consciousness without any other signs, except perhaps for a fluttering of the eyelids. These occur most commonly in children and are still sometimes known as “petit mal”.
During a partial seizure the disturbance in brain activity begins in or involves a distinct area of the brain. The nature of these seizures is usually determined by the function of the part of the brain that is involved. Partial seizures are sometimes known as ‘focal’.
There are basically three types of partial seizure – simple partial, complex partial and secondarily generalised.
In simple partial seizures consciousness is not impaired and the seizure is confined to either rhythmical twitching of one limb, or part of a limb, or to unusual tastes or sensations such as pins and needles in a distinct part of the body. Simple partial seizures sometimes develop into other sorts of seizures and they are often referred to as a “warning” or “aura”.
Complex partial seizures differ from partial seizures in that consciousness is affected. The seizures may then be characterised by a change in awareness as well as ” semi-purposful ” movements such as fiddling with clothes or nearby objects, wandering about and general confusion. Complex partial seizures usually involve the temporal lobes of the brain, however they can also affect the frontal and parietal lobes.
In some people either of these seizures may spread to involve the whole of the brain and if this happens it is called a secondarily generalised seizure.
What to do when a Seizure Happens
These seizures can be frightening to watch, but the person having the seizure is not in pain and will have little or no memory of what has happened. At the start of the attack the person may cry out as the air from the lungs is expelled through the voice box. During the early phase of the seizure, breathing may stop and the person may go slightly blue. This looks frightening but is to be expected until normal breathing resumes later on.
The attack cannot be stopped or altered, so the best thing to do is to follow these guidelines:
DURING THE SEIZURE
- Prevent others from crowding around.
- Put something soft under the person’s head (like a jacket or cardigan) to prevent injury. Only move them if they are in a dangerous place i.e. at the top of a flight of stairs or in the road.
- Do not attempt to restrain the convulsive movements.
- Do not put anything in the person’s mouth. There is no danger of swallowing the tongue and teeth can easily be broken.
ONCE THE CONVULSIONS HAVE STOPPED
- Roll the person on to their side in to the recovery position.
- Wipe away any excess saliva and if breathing is still laboured check that nothing is blocking the throat such as dentures or food.
- Do all you can to minimise any embarrassment. If the person has been incontinent deal with this as quickly as possible.
- Stay with the person giving reassurance until they have fully recovered.
- Making yourself aware ‘of how long the seizure has gone on for will be useful.
As these seizures can take many different forms, the response of observers will need to vary. If a person falls during a seizure you should make sure they have not done any injury to themselves which needs medical attention. If prolonged confusion occurs do nothing except:
- Gently guide them away from obvious dangers like wandering into the road.
- Keep others from crowding around.
- Speak gently and calmly to the person to help reorientation to surroundings as quickly as possible.
- Remember that the person may be confused for some time after the seizure and it is better to leave well alone than to keep offering help and have it rejected with what might be misunderstood as aggression.
- Stay with the person until they are able to resume their activities.
Medical Help Should Be Called If:
- Someone has injured themselves badly in a seizure.
- They have trouble breathing after the seizure.
- One seizure immediately follows another or the seizure lasts more than five minutes and you do not know how long they usually last.
- The seizure continues for longer than usual (remember they may be carrying a card which says how long their seizures usually last).
Information written and provided by:
The Information and Education Department
The National Society for Epilepsy
Chalfont St. Peter, Gerrards Cross
Bucks SL9 ORJ
On the internet at http://www.erg.ion.ac.uk/NSEhome