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Frequently Asked Questions
About Epilepsy
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Epilepsy is a condition in which a person has recurrent seizures. A seizure is defined as an abnormal, disorderly discharging
of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function. |
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Epilepsy is a condition in which a person has recurrent seizures. A seizure is defined as an abnormal, disorderly discharging
of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function. | |
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In most cases, the cause of epilepsy is unknown. However, epilepsy may be caused by a number of illnesses and injuries
including:
- Genetic metabolic defects
- Head trauma
- Nervous system infections such as meningitis
- Down’s syndrome
- Cerebral palsy
- Brain tumors
- Stroke
- Alzheimer’s disease
- High blood pressure
- Multiple sclerosis
- Depression
Although epilepsy can begin at any age, often the first signs are seen before the age of 20. |
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A seizure is the way your body reacts to nerve cells that are over-excited and fire too many signals to the rest of your
body. When the over-firing starts in a small part of the brain, it is called a partial seizure. |
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Yes. In general, there are two kinds of partial seizures: simple and complex. A person who has a simple partial seizure
stays alert and is able to answer questions and follow commands. He or she can also remember what happened during the seizure.
A person who has a complex partial seizure experiences a change in or loss of consciousness. The person may not be able
to answer questions or follow commands. Often he or she cannot remember what happened during part or all of the seizure. |
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An “aura” is a term used to describe symptoms that may occur at the beginning of a seizure. The signs of a
seizure depend on what part of the brain is involved.
Some signs include:
- Odd muscle movements, like stiffening, twitching, or jerking (these may affect one part of the body or can spread)
- Change in the senses, like feeling pins and needles, having a bad taste in the mouth, smelling something bad, seeing flashing
lights, or hearing buzzing or a person’s voice
- Changes in heart rate or breathing rate
A person can also feel:
- As if he or she is in a dream
- Fearful, anxious, or depressed
- As if time is slowing down or speeding up
- That well known things seem strange or that strange things seem well known
A person who has a simple partial seizure stays alert and remembers what happened during the seizure.
After the seizure, the person may feel weak in the part of the body affected. He or she may also have problems seeing or
talking. These problems can last from minutes to hours. |
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A change in or loss of consciousness is one sign of a complex partial seizure. Most often a person stares and does not
answer questions or follow commands.
A simple partial seizure may come before a complex partial seizure. For example, some people may have an odd taste in their
mouths or smell an odor. Other people may feel that they have already gone through what is happening.
Other signs may include:
- Smacking lips, chewing, or swallowing
- Making a face
- Making the same movement over and over, like picking at clothes or walking in a circle
- Making sounds, like grunts, or repeating a group of words
Often the person cannot remember all or part of what happened. He or she may be confused after the seizure. This confusion
usually lasts less than 15 minutes. Often symptoms, such as feeling tired, can last for hours. |
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Anti-epileptic drugs (AEDs) are medications given to control seizures. Yet, approximately 40% of people who develop
seizures will continue to have recurrent seizures despite treatment. In many cases, people require two or more AEDs to improve
seizure control. In some cases, people resort to surgery.
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If you have epilepsy, the best thing to do is talk to your doctor.
The following Web sites also offer helpful information:
WebMD
www.mywebmd.com
Epilepsy Foundation of America (EFA)
www.efa.org
Epilepsy.org
www.epilepsy.org
Myoclonic Seizures
Myoclonic seizures are rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides
of the body. Occasionally, they involve one arm or a foot. People usually think of them as sudden jerks or clumsiness. A variant
of the experience, common to many people who do not have epilepsy, is the sudden jerk of a foot during sleep. |
Generalized Tonic Clonic Seizures (also called Grand Mal or a Convulsion)
A generalized tonic clonic seizure.
Here the whole brain is affecting from the beginning.
In (a) there is a cry and
loss of consciousness,
arms flex up then extend in (b) and remain rigid (the tonic phase)
for a few seconds. A series of jerking movements
take place (the clonic phase) as muscles contract and relax
together. In (c) the jerking is slowing down and
will eventually stop. In (d) the man has been placed
on his side to aid breathing and to keep the airway clear.
Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure.
They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).
During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds,
and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually
lasts less than a minute.
Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements;
still others may have a tonic-clonic-tonic pattern.
Incontinence may occur as a result of the seizure. The tongue or inside of the mouth may be bitten during the episode;
breathing afterwards may be noisy and appear to be labored. Contrary to popular belief, nothing should be placed in the mouth
during the seizure; turning the patient on one side will help prevent choking and keep the airway clear.
Following the seizure, the patient will be lethargic, possibly confused, and want to sleep. Headache sometimes occurs.
Full recovery takes minutes to hours, depending on the individual.
Absence Seizures (also called Petit Mal)
What to Do:
No first aid is necessary, but if this is the first
observation of an absence seizure, medical evaluation is recommended.
Absence seizures (also called petit mal seizures) are lapses of awareness, sometimes with staring, that begin and end abruptly,
lasting only a few seconds. There is no warning and no after-effect.
More common in children than in adults, absence seizures are frequently so brief that they escape detection, even if the
child is experiencing 50 to 100 attacks daily. They may occur for several months before a child is sent for a medical evaluation.
Some absence seizures are accompanied by brief myoclonic jerking of the eyelids or facial muscles, or by variable loss
of muscle tone. More prolonged attacks may be accompanied by automatisms, which may lead them to be confused with complex
partial seizures. However, complex partial seizures last longer, may be preceded by an aura, and are usually marked by some
type of confusion following the seizure.
Atonic Seizures (also called Drop Attacks)
What to Do:
No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the child should
be given a thorough medical evaluation.
Atonic seizures produce an abrupt loss of muscle tone. Other names for this type of seizure include drop attacks, astatic
or akinetic seizures. They produce head drops, loss of posture, or sudden collapse. Because they are so abrupt, without any
warning, and because the people who experience them fall with force, atonic seizures can result in injuries to the head and
face.
Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy.
Simple Partial Seizures
A simple partial seizure with motor symptoms.
Here the neuronal discharge begins in the motor strip
in the right
hemisphere of the brain, affecting first one
muscle then another on the left side of the body as it spreads.
In (a)
first the fingers then the hand and arm are jerking.
In (b) it has spread to the upper shoulder.
In (c) the woman's
head is drawn towards her shoulder.
In (d) the leg is drawn up. The woman remains conscious but
unable to prevent her
muscles' response to the excessive stimulation
they are receiving from her brain.
People who have simple partial seizures do not lose consciousness during the seizure. However, some people, although fully
aware of what's going on, find they can't speak or move until the seizure is over.
They remain awake and aware throughout. Sometimes they can talk quite normally to other people during the seizure. And
they can usually remember exactly what happened to them while it was going on.
However, simple partial seizures can affect movement, emotion, sensations, and feelings in unusual and sometimes even frightening
ways.
Movement: Uncontrolled movements can occur in just about any part of the body. Eyes may move from side
to side; there may be blinking, unusual movements of the tongue, or twitching of the face.
Some simple partial seizures start out with shaking of a hand or foot which then spreads to involve an arm or a leg or
even one whole side of the body.
Emotions: A sudden feeling of fear or a sense that something terrible is about to happen may be caused
by a simple partial seizure in the part of the brain which controls those emotions.
In rare cases, partial seizures can produce feelings of anger and rage, or even sudden joy and happiness.
Sensations: All five senses -- touch, hearing, taste, smell, and sight -- are controlled by various areas
of the brain.
Simple partial seizures in these areas can produce odd sensations such as a sense of a breeze on the skin; unusual hissing,
buzzing or ringing sounds; voices that are not really there; unpleasant tastes; strange smells (also usually unpleasant);
and, perhaps most upsetting of all, distortions in the way things look.
For example, a room may suddenly seem narrower, or wider, than it really is. Objects may seem to move closer or get farther
away. Part of the body may appear to change in size or shape.
If the area of the brain involved with memory is affected, there may be disturbing visions of people and places from the
past.
Sudden nausea or an odd, rising feeling in the stomach is quite common. Stomach pain also may, in some cases, be caused
by simple partial seizures.
Episodes of sudden sweating, flushing, becoming pale, or having the sensation of gooseflesh are also possible.
Some people even report having out of body experiences during this type of seizure. Time may seem distorted as well.
In many ways, our usual, comfortable sense of familiar things and places may be disrupted by a simple partial seizure.
Well-known places may suddenly look unfamiliar. On the other hand, new places and events may seem familiar or as if they've
happened before, a feeling called déjà vu.
Simple partial seizures can also produce sudden, uncontrolled bursts of laughter or crying.
Complex Partial Seizures
First Aid for Complex Partial Seizures
- Do not restrain the person.
- Remove dangerous objects from the person's path.
- Calmly direct the person to sit down and guide him or her from dangerous situations. Use force only in an emergency to
protect the person from immediate harm, such as walking in front of an oncoming car.
- Observe, but do not approach, a person who appears angry or combative.
- Remain with the person until he or she is fully alert.
Complex partial seizures affect a larger area of the brain than simple partial seizures and they affect consciousness.
During a complex partial seizure, a person cannot interact normally with other people, is not in control of his movements,
speech, or actions; doesn't know what he's doing; and cannot remember afterwards what happened during the seizure.
Although someone may appear to be conscious because he stays on his feet, his eyes are open and he can move about, it will
be an altered consciousness, a dreamlike, almost trancelike state.
A person may even be able to speak, but the words are unlikely to make sense and he or she will not be able to respond
to others in an appropriate way.
Although complex partial seizures can affect any area of the brain, they often take place in one of the brain's two temporal
lobes. Because of this, the condition is sometimes called "temporal lobe epilepsy."
"Psychomotor epilepsy" is another term doctors may use to describe complex partial seizures.
Typically, a complex partial seizure starts with a blank stare and loss of contact with surroundings.
This is often followed by chewing movements with the mouth, picking at or fumbling with clothing, mumbling and performing
simple, unorganized movements over and over again.
Sometimes people wander around during complex partial seizures. For example, a person might leave a room, go downstairs
and out into the street, completely unaware of what he or she was doing.
In rare cases, a person might try to undress during a seizure, or become very agitated, screaming, running or making flailing
movements with his arms or bicycling movements with his legs.
Other complex partial seizures may cause a person to run in apparent fear, or cry out, or repeat the same phrase over and
over again.
Actions and movements are typically unorganized, confused and unfocused during a complex partial seizure.
However, if a complex partial seizure suddenly begins while someone is in the middle of a repetitive action – like
dealing cards or stirring a cup of coffee – he or she may stare for a moment th
Managing Prolonged Seizures
Status Epilepticus
Prolonged or clustered seizures sometimes develop into non-stop seizures, a condition called status epilepticus.
Do not attempt to transport an actively seizing child in your car unless an ambulance is not available.
Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control. If your
child has had episodes of non-stop seizures that had to be treated in the emergency room, you will want to have a plan of
action ready in case they occur again.
Managing Status Epilepticus
Ask the doctor if there are any new treatments you can use at home or school to stop a seizure from developing into status.
Call an ambulance. Do not attempt to transport an actively seizing child in your car unless an ambulance is not available.
Be aware of where the nearest hospital is, how long it takes to get there. If you live a long way from the hospital, you
may plan to call earlier than you would if it were closer. If there are several hospitals nearby, ask your doctor in advance
which one to call.
Consider arranging for standing orders prepared by the doctor to be kept in the emergency room so the seizure can be managed
as your doctor directs. Ask for a copy for yourself if you and your child travel out of town.
Leave detailed written instructions with babysitters or adult caregivers. If you have been instructed in the use of in
home therapy, make sure that a responsible caregiver also receives instruction.
Fortunately, most seizures, even those that are prolonged, end without injury. The important thing is to work with your
doctor so that you have a plan to follow when they occur.
en continue with the action during the seizure, but in a mechanical, unorganized kind of way.
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