A Seizure is an abnormal discharge of nerves in the brain, something like a short-circuit. It can be caused by a wide variety of brain and other diseases (see the mnemonic Vowel TIPS for the many possibilities). There are various kinds of Seizures (see below).
Epilepsy is a disease in which a person has recurrent seizures for no outside reason. Presumably a microscopic abnormality in the brain is responsible. There are many uncommon genetic conditions which may cause Epilepsy, but most patients have it all by itself. Statistically, people with epilepsy are calculated to live 2 years less than those without; however, this factors in patients with rare types who may die significantly sooner. As such, most people with epilepsy can expect to live normal life spans. The term “seizure disorder” is synonymous with “epilepsy”.
Bystanders a frequently scared when someone has a seizure, and tend to withdraw. Children with seizures may sadly be ostracized (community education is essential). In ancient Greece and other societies, people with epilepsy were considered holy; oracles at the Temple of Delphi were thought to see the future during their seizures.
The vast majority of seizures last 1-2 minutes, then transition into a period of confusion, until the person gradually regains conscious awareness over 15-30 minutes. “Status Epilepticus” refers to non-stop seizures, which can be life-threatening. It’s defined as a seizure lasting over 5 minutes, or a second seizure that recurs before the person has fully regained consciousness.
Types of Seizures
Classification of seizures is now fairly complex. The terms used here are old and out-of-date; but are simple and useful. Current categories serve mainly neurologists; most health professionals are unfamiliar with them. The following are seizure types which most clinicians would know of.
Generalized Seizure (“tonic-clonic”; “Grand Mal”) — This is the classic event we think of when we hear of a seizure. The person turns stiff, falls, arms and legs shake. Eyes roll back or jerk to a side, mouth foams, person may bite their tongue or be incontinent. Afterwards there’s the period of confusion, called post-ictal, until fully regaining consciousness. The person has amnesia for the entire event. There may be weird sensations just before the seizure (an aura) which might be recalled. There may be partial or even full paralysis on one side of the body afterwards (“Todd’s Paralysis”), which may last over a day (usually less), goes away, and should not be confused with a stroke.
Complex-Partial Seizure — Begins with facial movements like grimacing, lip-smacking, chewing, teeth-grinding. They the person begins random actions which may seem purposeful, but the person performs them completely unconsciously. One blind patient of mine, accompanied by a health worker, walked to the clinic in the midst of a complex-partial seizure without the health worker even realizing anything abnormal. Complex-partial seizures usually last less than 4 minutes, but the coming-to phase may be as long as 1-2 hours. Sometimes a complex-partial seizure my turn into a generalized one.
Absence Seizures (“Petit Mal”) — brief spells of blank staring, lasting under 30 seconds, but may keep recurring. More common among children.
Drop-Attacks — The body suddenly goes limp. Since this can recur, the danger is that the person may hurt themselves. Also more common in childhood, especially children with special neurologic conditions along with the epilepsy.
Myoclonic Seizures — Sudden jerks of one part of the body. Patients with this usually retain consciousness. If they begin in adulthood, they may be associated with brain tumors.
Febrile Seizures — Seizure with a fever, only in childhood. Most of the time it’s a single event, suggesting the seizure is not due to the fever, but to a viral infection that also affects the brain. Febrile seizures that recur in the future may simply be common epilepsy triggered by fever. The most important part of a first febrile seizure isn’t treating the fever nor the seizure, but to make sure it’s not all due to meningitis. Children with meningitis are sick; after the seizure resolves, they remain sick. A child who bounces around happily after a febrile seizure won’t have meningitis.
What to Do for Someone Having a Generalized Seizure
The most important thing is to do nothing, sort of. Bystanders trying to put stuff between the teeth get their fingers badly bitten. If we measure blood gas during a seizure, we find results incompatible with life, yet the person wakes up and recovers fully!
It’s good to cradle the person’s head, so they don’t bang it on the ground. The only time to try to protect someone is if they’re on the edge of a cliff or swimming pool, etc. Nothing more.
Actually, a witness should immediately check their watch / cellphone and write the time down. Seizures lasting over 5 minutes can be life-threatening, require medication to stop them. Nobody can know how long a seizure lasts without specifically timing it.
Filming the seizure with your cellphone might be useful for future specialists. You can find a way to send it to the person afterwards, or if an ambulance comes, have them alert an ER provider.
Should you call an ambulance if you see a stranger seize? It would be common sense to, but some people with epilepsy may not want to receive expensive bills. Before you call, check the person for a med-alert necklace or bracelet which might give an instruction.
We order a brain MRI just to see if there’s a tumor present, even though seizures usually have nothing to do with them. The main test used is the electroencephalogram (EEG), which can find abnormal brain waves. The EEG is always positive during a seizure, and usually there’s some abnormality all the time, but sometimes not. Neurologists may order tests like a portable continuous EEG. or admitting a patient to the hospital for a continuous EEG and simultaneous video recording. In rare cases, it may be necessary to surgically insert an EEG probe deep in the brain to find abnormal nerve impulses.
There are many anti-epileptic drugs (a.k.a. anti-convulsants) available, often prescribed in combination. If the first choice or choices don’t work, Neurologists go on to try others, and draw blood levels to be sure there’s enough of the medication in the body at all times. The most extreme treatment, for people completely incapacitated by seizures, is to remove a lobe of the brain. That sounds brutal, but is well-tolerated, and may allow a patient to lead a normal life.