Seizures and Epilepsy: The Basics

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What is a seizure?

A seizure is defined as a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous activity in the cells of the brain called neurons. There are many different types of seizures. Generally, different types of seizures are categorized based on which part of the brain is involved in a seizure. People might experience one type or more than one type of seizure. Seizures are divided into generalized seizures, which affect the entire brain, and focal seizures, which affect only a part of the brain. Each comprises a number of specific types of seizures, like tonic-clonic and absence seizures. Seizures can cause alteration of consciousness.1


Common symptoms during a seizure may include the following among many others:2


1) Focal seizures

     · Changes in vision and hearing 

     · Odd feelings

     · Staring

     · Familiar things suddenly seem unfamiliar

     · Trembling or jerking of one part of the body

     · Lip smacking and/or swallowing

     · Picking at clothes

     · Wandering

     · Senseless, clumsy movements

     · Lack of awareness or response to others

     · Repeating phrases

2) Generalized seizures

     · Convulsions

     · Sudden falls

     · Brief blackouts and staring

     · Sudden muscle jerks

What is epilepsy?

Epilepsy is a disease of the brain defined by any of the following conditions:


1. At least two unprovoked (or reflex) seizures occurring > 24 h apart 

2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years 

3. Diagnosis of an epilepsy syndrome


Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.3

How is epilepsy diagnosed?

The doctor will first find out if the patient is presenting seizures. Then the doctor will want to classify the type of seizure(s) or epilepsy syndrome that explains the event(s). To do this, several pieces of information are needed including details of the medical history, blood tests, electroencephalogram tests, and brain imaging tests such as CT and MRI scans. This will help to find information about the electrical activity of the brain and possible causes of the seizures.4 

What causes epilepsy in children?

There are many possible causes of epilepsy in children, including: problems with brain development before birth; lack of oxygen during or following birth; a head injury that leaves a scar in the brain; unusual structures in the brain; tumors; genetic disorders, or the after-effects of severe brain infections such as meningitis or encephalitis. In seven out of every ten cases, there is no known cause.2

How is epilepsy treated?

Childhood epilepsy is usually treated with seizure-preventing medicines called antiepileptic or anticonvulsant drugs. Whenever possible, we try to control seizures with one drug, but some children may require more than one drug if their seizures are hard to control. Depending on the case and the type of seizures, other modalities of treatment may include among others: surgery, special diets, or brain stimulation (i.e. vagus nerve stimulation). There are some epilepsy syndromes that are considered benign because most of the patients will outgrow their seizures by adolescence. An example includes the benign childhood epilepsy with centrotemporal spikes, also known as benign rolandic epilepsy. Some of these syndromes most of the time do not necessarily require medications.2 

What are the seizure first aids? 2

There are several kinds of seizures and they all look different. They need different kinds of first aid, too. The kind of seizure that most people have heard of makes a person fall, get stiff, and then shake for a short time. Breathing may be faint, and even stop briefly. After a minute or two, the shaking and jerking slows down and stops. Breathing starts again and slowly gets back to normal. This kind of seizure may be called different names, a convulsive seizure, a grand mal seizure, or the one the doctors use, a generalized tonic-clonic seizure.

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Here is what you do when someone has this kind of seizure:

• Keep the person from getting hurt while the shaking or jerking continues. 

• Put something flat and soft under the person’s head; loosen anything tight around his (her) neck. 

• Turn him (her) on one side so he (she) will not choke. 

• Look for any ID that says “epilepsy” or “seizure disorder.” 

• Keep track of the time. 

• As the jerking slows down, make sure the person is breathing normally. 

• Talk calmly and help the person get fully awake.

Here is what you don’t do:

• Don’t put anything in the person’s mouth. 

• Don’t hold the person down or restrain his (her) movements. 

• Don’t try to give medicine or anything to drink until he (she) is fully awake and aware.

When to call 911:

• First time a person has a seizure

• If the seizure last for more than 3-5 minutes in a person with a diagnosis of epilepsy

• If another seizure starts right after the first one ends

• The person has trouble breathing, seems hurt or in pain

• The person is not getting back to normal the way he (she) usually does

• If the person is pregnant

• If the person has diabetes

• If the person is injured in some way or appears ill


Another kind of seizure that many people with epilepsy have is quite different and it needs a different kind of first aid. This kind of seizure makes people lose touch with their surroundings. For a few minutes they will not know where they are or what they are doing. They seem to be in a daze. They cannot talk with you or follow instructions. They may look as if they are chewing. They may pick at clothes, or try to take them off. They may mumble or wander or do the same thing over and over. They may seem afraid, or upset.

Here’s what you do if you see someone having this type of seizure

• Stay calm. 

• Don’t shout or grab hold. 

• Block the way to any hazard, like a hot stove, stairs or busy street. 

• Speak softly and be reassuring. 

• Explain to others what is happening. 

• Offer help as the seizure ends. 

• Stay with the person until he or she is completely awake and aware again.

References (Information was adapted from the following sources):

  

1-Fisher, R. et al. (2017). Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4):522–530.

2- Epilepsy Foundation Northwest: https://www.epilepsynw.org/resources/brochures-english 

3- Fisher, R. et al. (2014). A practical clinical definition of epilepsy. Epilepsia,55(4):475–482. 

4- Epilepsy Foundation: https://www.epilepsy.com/