Epilepsy affects over two million Americans, with over 150,000 new cases diagnosed each year. When you think about epilepsy, you may think it involves a major seizure, but epilepsy can vary in its severity and there are many different kinds of seizure. So what causes epilepsy, what are the symptoms, and how can it be managed?
What is epilepsy?
Our brains function by sending electrical impulses, but in epilepsy patients this activity sometimes goes into ‘overload’ and creates sudden intense bursts of activity that causes physical symptoms known as seizures. Epilepsy can be caused by a brain injury, or other conditions such as a stroke or infection, but two thirds of cases have no specific cause.
An epileptic seizure (also known as a fit or convulsion), can be a momentary loss of consciousness or may last for several minutes and be accompanied by muscle jerking. Not all seizures are caused by epilepsy—for example, febrile convulsions can occur in small children who are running a high fever. Adults can also have a one-off seizure, but epilepsy is generally only suspected after someone has had two or more fits separated by at least 24 hours.
There are two kinds of epileptic seizure: partial seizures and generalized seizures.
Partial epileptic seizures
During a partial seizure, the patient remains conscious. Partial seizures can be simple or complex.
Simple partial seizures
In a simple seizure, the person experiences relatively minor symptoms such as tingling, stiffness or twitching in one body part, or a sudden change in emotion. Often this is described as an ‘aura’ and can be a warning sign that a larger seizure is imminent, giving the patient time to prepare.
In a complex partial, seizure the patient loses their awareness of what’s going on around them and may do repetitive actions like rubbing their hands or plucking at clothing. They don’t remember this afterwards.
Generalized epileptic seizures
There are six forms of generalized seizure, during which the person loses consciousness.
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1. Absence seizures
In an absence seizure, there’s a loss of consciousness for up to 15 seconds. The person may seem frozen, but be unaware of this once they return to consciousness. Although these absences may be brief, they can occur many times in a day, which can have a significant effect on day-to-day living – for example, a child’s education can be hugely disrupted by frequent absence seizures.
2. Myoclonic seizures
Myoclonic seizures are also brief, and consist of fractional jerking of the body that may be almost unnoticeable to those around the patient. However, these can also cause major disruption to everyday life.
3. Clonic seizures
Clonic seizures cause bodily jerking for up to two minutes, but the patient doesn’t always lose consciousness completely.
4. Atonic seizures
In an atonic seizure, all the patient’s muscles relax suddenly, causing a collapse. This kind of seizure happens without warning, and without proper precautions patients can injure themselves as they fall.
5. Tonic seizures
Tonic seizures cause the body to stiffen rather than relax. This can be for a few seconds, or can last longer.
6. Tonic clonic seizures
This kind of seizure produces the symptoms most commonly associated with epilepsy. First, the body stiffens, and then the patient often collapses to the floor. The body twitches, the patient loses consciousness, and sometimes functions such as bladder control are affected.
How is epilepsy treated?
Epilepsy can’t be cured but there are medications that can help control the symptoms. However, in around 30% of cases, medication fails to manage the symptoms effectively, and patients must adapt to their symptoms by taking precautions like wearing protective headgear, or recognizing the onset so they can find a safe place to go before the seizure strikes.
Brain surgery has sometimes proved effective, but this is only considered if other treatments have failed and if the patient’s quality of life is severely affected.
How to manage an epileptic seizure
If you see someone suffering a seizure, clear the area around them so they can’t injure themselves, and protect the head by cushioning it or holding it gently. Once the seizure has ended, put them into the recovery position. If you know the person has epilepsy, wait until they return to consciousness, but if the seizure lasts a long time, or you’re in any doubt, call the emergency services.