What is Seizure?

A seizure is a sudden interruption to the brain’s normal function when an abnormal level of the neurons’ electrical activity occurs.

Epilepsy is the term given to describe a condition where someone is predisposed to recurrent, unprovoked seizures. However, anyone can have a seizure, given the circumstances, not just people with epileptic seizures.

Tonic-clonic seizures are convulsive seizures where the body stiffens (tonic phase) followed by general muscle jerking (clonic phase) and involves the whole brain. The person loses consciousness, their body stiffens and their limbs jerk. These seizures generally last up to three minutes. There are many other types of seizures.

Different Types of Seizures

Generalised Seizures

Generalised onset seizures are one primary type of seizure. They are characterised by the regions of the brain they affect, namely, both sides of the brain.

Several terms help describe how generalised seizures affect a person and their body:

• Tonic Seizures – Stiffening of the muscles occurs in the body.
• Atonic seizures – When the muscles in the body relax.
• Myoclonic seizures are when parts of the body experience short jerking movements during seizures.
• Clonic seizures are more extended periods when body parts shake or jerk around.

Types of Generalized Seizures

• Absence Seizures are the first type of generalised seizure, also known as petit mal seizures. This type causes the person to blink or stare into space for several seconds rapidly. It is mainly due to unusual electric activity in an area of the brain, which could cause a loss of awareness or consciousness.
• Tonic-clonic Seizures – Also known as grand mal seizures. This type of seizure has people crying out, falling on the ground, jerking around, experiencing muscle spasms, and generally losing consciousness. This is accompanied by fatigue afterwards.

Focal Seizures

Focal onset seizures are another primary type of seizure where it is only located in one part of the brain. These are also known as partial seizures. In some cases, people experience a focal-aware seizure wherein they can feel it is about to happen. They may also feel things like deja vu and vision changes.

Here are some types of focal seizures:

Simple Partial Seizures

• The person remains fully conscious and aware.
• This type of seizure affects a small portion of the brain. People experiencing it twitch and experience changes in taste and smell.
• Symptoms may include sensory changes (e.g., tingling, visual flashes), motor symptoms (e.g., jerking movements), or autonomic changes (e.g., sweating or nausea).
• It may serve as an aura, a warning of a more severe seizure to follow.

Focal Impaired Awareness Seizures (Complex Partial Seizures)

• The person experiences altered awareness or confusion and cannot answer any questions for several minutes.
• Symptoms may include repetitive movements (e.g., lip-smacking, blinking) and loss of interaction with the environment.
• This seizure affects one area of the brain and travels to another area. 

Common Causes of Seizures Other than Epilepsy:

• Head Trauma, a head injury or a brain injury
• Drug or alcohol intoxication
• Fever (febrile convulsions)
• Brain tumours or other medical conditions that could be affecting the brain
• Lack of sleep or sleep deprivation
• Certain prescribed drugs, such as some anti-depressants
• Abnormalities in blood sugar
• Infection
• Photo-sensitive epilepsy can be triggered by flashing lights in TV shows or video games.
• Seizures during or shortly after pregnancy can be a symptom of eclampsia.

Management – DO:

• Most Important is to stay calm
• Stay with the casualty
• Look at the time to see how long the seizure lasts for
• Move any bystanders and any objects out of the way that could injure the casualty, especially the head
• Once the seizure has stopped, follow DRS ABCD
• If unconscious and breathing, or if fluid/vomit/food in the mouth, roll the casualty into the recovery position
• Maintain casualty’s privacy and dignity
• They will likely be exhausted, so let them rest and stay with them for reassurance
• If the casualty has injured themselves during the seizure, attend to their injuries once it has finished

Management – DO NOT:

🗵 Do not put anything into their mouth

🗵 Do not restrain the casualty

🗵 Do not move the casualty unless they are in danger

🗵 Do not give them anything to eat or drink until they have fully recovered

You need to seek medical assistance (Call 000) if:

• The casualty injures themselves badly during a seizure
• The casualty is having difficulty breathing after the seizure (this should be distinguished from normal laboured breathing because the casualty is puffed out)
• If a second seizure follows the first seizure
• If the seizure lasts longer than 5 minutes (if the standard time is not known), or if the seizure lasts longer than usual (the casualty may have a bracelet or card in their wallet which outlines the usual time they last)
• If the casualty is not known to have epilepsy

Seizures (Febrile Convulsions)

A high fever in a child may trigger a convulsion/seizure known as a febrile convulsion or febrile seizures. This may occur in children aged from six months to five years. The convulsion can last a few seconds or up to 15 minutes and is often followed by a brief period of drowsiness.

Signs and Symptoms:

• Loss of consciousness
• Muscles may stiffen, jerk or twitch
• The face may go pale or blue
• Difficulty in breathing
• Moaning, crying
• Vomiting
• Foaming at the mouth
• Staring off and lip-smacking

Management – DO:

✓ Most Important is to stay calm and remain with the child
✓ Look at the time to see how long the seizure lasts for
✓ Lay the child onto a soft surface or the floor with a blanket underneath
✓ Remove any object which could injure the child
✓ Move the child only if they are in a dangerous location
✓ Loosen tight clothing and if possible, remove or open clothes from the waist up

Management – DO NOT:

• Do not put anything into their mouth
• Do not restrain the child
• Do not put the child into a bath
• Do not give them anything to eat or drink

Once the convulsion has stopped:

• Roll the child into the recovery position whilst drowsy
• Place cool washcloths on the neck and forehead
• Using tepid water (not cold), sponge the rest of the child’s body
• Contact professional medical help (Call 000) if:
  The convulsion lasted more than 5 minutes.
  The child does not wake up.
  The child had more than one convulsion in a short period.
  The child has been injured or appears quite ill

• Contact a local family doctor if:
  o Convulsion lasted less than 5 minutes
  The child had a previous illness before the convulsion

Diagnosing Seizures

Seizures are tricky because if someone has experienced one, they may not realise it. If one suspects this is the case, though, make no mistake; it is a medical emergency that must be addressed. That is why monitoring and noting any possible seizure activity and seeking a medical diagnosis is essential.

When visiting a professional healthcare facility, a physical and neurology test needs to be taken, such as: 

• Electroencephalogram (EEG): Measures abnormal brain activity.
• Brain Imaging: MRI or CT scans help identify structural abnormalities or injury.
• Blood Tests: Detect metabolic imbalances or infections.
• Video-EEG Monitoring: Records seizures for closer analysis.

Treatments and Improvements

Specialists can help treat seizure disorders. Anti-seizure medications can be assigned. Speaking to medical professionals and specialists is crucial to understand potential side effects. 

Potential treatments for epilepsy-related seizures include:

• Doctors may recommend a ketogenic diet, characterised as a high-fat and low-carbohydrate diet. While this diet has mixed results, it may be worthwhile asking about it.
• Epilepsy surgery is also an option. These surgeries are recommended if two or more medications do not work. For improved control during seizures, nerve stimulation devices can also be placed within the body via surgery.
• Vagus nerve stimulation (VNS) involves delivering electrical pulses to the left side of the vagus nerve, which connects directly to the brain, to help reduce the frequency of seizures.
• Responsive Neurostimulation (RNS) is a system in which a device monitors ongoing epileptic activity in the brain and delivers targeted electrical stimulation to the area causing the seizures. Over time, the RNS device can help reduce the frequency of seizures.

Finally, those who wish to learn more about epilepsy and seizures can reach out to the Epilepsy Foundation for more education and training. Taking a first aid course will also provide the right skills and knowledge to handle seizures.

Conclusion

Seizures are a complex but manageable condition. With accurate diagnosis and appropriate treatment, many people with seizures lead full and active lives. If you or a loved one experiences seizures, consult a healthcare provider for guidance on diagnosis and treatment options tailored to your specific needs. Early intervention can significantly improve outcomes and quality of life.