Epilepsy - seizures

Epilepsy is a common neurological condition in which a person has a tendency to have recurring seizures. It is estimated that as many as ten percent of people will have an isolated seizure and at least a third will go on to have a recurrence and eventually be diagnosed with epilepsy. Approximately two percent of people are living with active epilepsy in the community.

The brain controls the body’s actions, sensations and emotions through nerve cells (neurones) that carry messages between the brain and the body. These messages are transmitted through regular electrical impulses. A seizure occurs when sudden bursts of electrical activity in the brain disrupt this pattern.

The kind of seizure and the parts of the body affected by it relates to the part of the brain in which the irregular electrical activity occurred. Seizures can involve loss of consciousness, a range of unusual movements, odd feelings and sensations or changed behaviours.

Types of seizures

There are many different types of seizures. Many people think the word ‘seizure’ means a convulsion or ‘fit’, where someone becomes unconscious and falls, with their limbs initially stiff and then jerking. However, this is just one type of seizure, called a tonic-clonic seizure (previously known as grand mal).

Some people may have episodes where they ‘go blank’ for a few seconds or minutes. Some people remain fully conscious during a seizure and can describe their experience. For others, consciousness is affected and they are confused when the seizure ends. A seizure may involve the whole brain (generalised seizure) or part of the brain (partial or focal seizure).

Generalised seizures

There are several types of generalised seizures:

• Tonic-clonic seizure – the muscles suddenly stiffen and the person may fall. Rhythmic jerking follows. The person may bite their tongue or become incontinent. They are often confused afterwards.
• Absence seizure – these occur mostly in children. The person will ‘go blank’ for a brief time during which they may stare and the eyelids may flicker. These seizures are often not noticed by other people.
• Tonic – the body stiffens and the person may fall, sometimes causing injury. Recovery is usually quick.
• Atonic – a sudden loss of muscle tone causes the person to fall, sometimes causing injury. Recovery is usually rapid.
• Myoclonic – involves brief, shock-like jerks of a muscle or a group of muscles, usually in the upper body.

Partial seizures

Only part of the brain is affected during a partial seizure. The signs and symptoms will depend on which part of brain the seizure occurs in, and which body functions are controlled by that part of the brain. Signs and symptoms can vary from person to person.

• Simple partial – the person remains completely conscious, but they may have unusual sensations or movements, pins and needles, have unpleasant smell or taste hallucinations, feel nauseated or experience deja vu.
• Complex partial – may be preceded by a simple partial seizure but not always. This type of seizure only affects one part of the brain, but the person’s conscious state is altered rather than lost. The person may often appear confused and dazed and may do strange and repetitive actions like fiddling with their clothes, making chewing movements or uttering unusual sounds. These behaviours may also be described as trance-like or robot-like and are called automatisms. The seizure usually lasts for one to two minutes, but the person may be confused and drowsy for some minutes to several hours afterwards and have no memory of the seizure or the events just before or after it. At times, complex partial seizures can spread to become secondarily generalised tonic-clonic seizures.

Cause of seizures and epilepsy

The cause of seizures is not always known. Known causes include:

• Brain injury
• Stroke
• Brain infection
• Structural abnormalities of the brain
• Genetic factors.

Seizures may appear to be triggered by factors such as lack of sleep or significant stress. However, these triggers alone do not explain why a person develops epilepsy. Tests are required to help identify an underlying cause. It appears that certain people are simply more prone to having seizures than others. This is sometimes referred to as having a ‘low seizure threshold’ and may be due to their genetic make-up. In many cases, despite investigation, the cause of the seizure cannot be explained.

Diagnosis of seizures and epilepsy

It is not always easy to confirm if a person has had a seizure, especially if no one else was present at the time to see what happened. Often, the test results are normal, but the doctor is confident the person has had a seizure based on their history and a detailed description of the episode.

A variety of tests and investigations may be used to diagnose the cause of seizures, including:

• Medical history, including a detailed account of the event
• Physical examination
• Pathology tests
• Electroencephalogram (EEG)
• Computed tomography (CT)
• Magnetic resonance imaging (MRI).

Although medical examinations may help identify the cause of a seizure, in many cases, the doctor is unable to identify a cause, which can make it more difficult for someone to accept the diagnosis.

Treatment for seizures and epilepsy

Medication can often prevent seizures from recurring. However, it is not prescribed for everyone who has a seizure. Whether or not to prescribe medication will depend on the risk of that person having further seizures.

Where people are considered to be at risk of recurring seizures and medication is prescribed, approximately 70 per cent are likely to achieve seizure control. Where several medications are tried and seizures are not controlled, surgery may be a treatment option in some cases, usually for people with partial or focal onset seizures.

Safety issues during a seizure

Although many people who witness a seizure fear that the person may be harmed by the event, the risk of brain damage or death from a seizure is low. Following a first seizure, the highest risk of having a recurrence is during the three months after the first seizure, although it can sometimes be much longer between the first and second seizure.

Following a seizure, the doctor will make recommendations in relation to driving, the use of dangerous machinery, working above ground level and general safety issues. The advice will be based on the person’s medical assessment.

Where there is a risk of a seizure, people are advised to swim with a companion or observer who is capable of rescuing them. Showers are recommended instead of baths and special care should be taken when using hot water or anything that can cause burns. Turning on the cold tap first in the shower, bath or basin and lowering the temperature of the hot water service are good safety hints for any home. Risks are minimised by following the recommended treatment plans and ensuring that accurate first aid information is available to those who might need it.

Seizure first aid

If you are with someone who has a tonic clonic seizure, you should try to:

• Stay calm and remain with the person.
• Time the seizure from the beginning until it has ended.
• Protect the person from injury – remove any hard objects that are near the person in preference to moving the person.
• Place something soft under their head and loosen any tight clothing at the neck.
• Gently roll the person onto their side as soon as it is possible to do so and firmly push the angle of the jaw forward to assist with breathing. A person cannot ‘swallow their tongue’, but the tongue can move back to cause a serious blockage to breathing. Establish communication with the person so you know they have regained consciousness.
• Reassure the person and minimise embarrassment during recovery.
• Stay with them until they recover – this may range from five to 20 minutes or longer.

If you are with someone who has a tonic clonic seizure, do not:

• Force anything into their mouth
• Restrain the person unless they are in danger
• Give pills, food or drink until recovery is complete.

If the person having a seizure is in a wheelchair

If the seizure occurs when the person is in a wheelchair, car seat or stroller, leave the person seated as long as they are secure and safely strapped in. Support their head until the seizure has ended. Sometimes they may need to be taken out of the chair at the end of the seizure, for example, if the airway is blocked or they need to sleep.

If there is food, water or vomit in their mouth, remove the person from their seat and roll them onto their side immediately. If it is not possible to move them, continue to support the person’s head to ensure it does not tilt backward and remove the contents of the mouth when the seizure is over.

If the person having a seizure is in water

If the seizure occurs in water, support the person in the water with their head tilted so it stays above the surface. When jerking stops, remove the person from the water and check to see if they are breathing. If they are not breathing, start CPR immediately, then call an ambulance.

Even if the person appears to be fully recovered, you should still call an ambulance. The person should have a full medical check-up as inhaling water can cause lung or heart damage. The person should not continue with swimming or water sports that day, even if they appear to be fully recovered.

You may need to call an ambulance

You should call triple zero (000) to call an ambulance if:

• The seizure lasts for five or more minutes or a second seizure quickly follows the first
• The person is not conscious within five minutes of the seizure stopping
• The person does not fully recover after the seizure or has trouble breathing
• The seizure occurs in water
• The person is injured
• The person is pregnant
• You believe it is the person’s first seizure or you do not know – this applies regardless of how long the seizure lasts
• You are in doubt.

First aid for all other types of seizures

Call an ambulance for any type of seizure lasting five minutes or longer, unless you have that person’s epilepsy management plan that gives other instructions.

Where to get help

• Your doctor
• In an emergency, call triple zero (000)
• Epilepsy Foundation of Victoria Tel. (03) 8809 0600
• Epilepsy Helpline Tel. 1300 852 853

Things to remember

• A seizure is a sudden disruption to normal brain activity, which causes unusual movements, odd feelings, changed behaviour or impaired consciousness.
• Many people will only ever have one seizure, but at least 30 percent will go on to have more seizures and be diagnosed with epilepsy.
• The cause, seizure type and treatment vary from person to person.
• If any seizure lasts for five minutes or longer, or you believe it is the person’s first seizure, call triple zero (000) for an ambulance, unless that person has an epilepsy management plan that gives you other instructions.

You might also be interested in:

• Nervous system.
  
• Neuromuscular system.
  

Want to know more?

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This page has been produced in consultation with and approved by:

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Epilepsy Foundation of Victoria Incorporated

Last reviewed: February 2013

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Epilepsy_seizures_explained?open">Epilepsy - seizures - Better Health Channel</a><br/>
Epilepsy involves recurring seizures - partial (or focal) and generalised. The most common generalised seizure is called tonic-clonic (previously called grand mal). There are two types of partial seizure: simple and complex. People often refer to simple partial seizures as warnings or auras because they remain completely aware during these seizures. Complex partial seizures involve impaired awareness and unusual behaviours.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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