What is an epileptic seizure?
Epileptic seizures can vary in their presentation and which part of the brain they occur. In some people, seizures are very obvious and involve loss of consciousness with jerking and stiffness, which are classified as tonic-clonic seizures. However, other types of seizures, such as absence seizures, may be much more difficult to notice and present as blankness or unresponsiveness without visibly appearing to be unconscious. Seizures are typically categorized through where in the brain they begin and whether the patient is aware of their surroundings or if other signs such as muscle contractions and jerking occur.
What categorizes a seizure as epileptic?
Epileptic seizures are seizures that start in the brain. Seizures can be a symptom of other underlying conditions such as hypoglycemia, a young child overheating, Lyme’s Disease, and, as we have recently witnessed in the media with the interest in drink spiking in the UK, seizures can indicate the presence of a toxin or poison in someone’s system. Although these can all be classed as seizures, because the brain is not the place of onset, they are not epileptic seizures.
Focal onset seizures: the causes and symptoms
Focal onset seizures begin in one part of the brain and only affect that side. Within the broader category of focal onset seizures, there are seizures where the person may be aware (which are also commonly referred to as simple partial seizures or focal aware seizures) and seizures which affect awareness (focal impaired awareness seizures or complex partial seizures). These types of seizures can also be broken down into whether they present with physical movement or not to help a medical team determine what treatment is needed. The physical movements that would be presented with focal onset seizures include spasms, muscle contraction and relaxation, and excessive movement or what could be perceived as fidgeting. In cases of non-motor onset focal seizures, the patient may not move at all and seem to be staring or experience cognitive and emotional symptoms such as not being able to speak properly or having emotional outbursts.
Generalized seizures: the causes and symptoms
Generalized onset seizures originate in both sides of the brain simultaneously and begin very suddenly. Similar to focal onset seizures, generalized onset seizures can be separated into motor symptoms and non-motor symptoms. A commonly missed non-motor type of generalized seizure is an absence seizure, where the patient may appear to still be conscious and may be able to continue walking but is not able to respond and is unaware of their surroundings.
Can doctors always classify seizures?
Often doctors may struggle to decipher what the specific onset of a patient’s seizure is, especially if they happen very irregularly or the patient has only ever had one seizure. While awaiting further investigation, doctors may describe someone as having unknown onset seizures as they are unsure where in the brain the seizure originates, yet this can still be categorized into the motor or non-motor presentation. Unclassified is another term that doctors can use to describe a patient whose seizures have a unique presentation or whose witnesses are unable to describe the symptoms.
How can doctors treat epileptic seizures?
Those who regularly suffer from epileptic seizures may go through a period of trialing different anti-epileptic drugs after they have been diagnosed through an electroencephalogram, a scan that detects the electrical signals in the brain so it can record a seizure. Anti-epileptic seizures (AEDs) are effective in roughly 7 out of 10 people with epilepsy and they control seizures by changing the chemical balance of the brain. If doctors are unable to treat the seizures with AEDs, and the precise type of seizure is diagnosed, surgical options to remove a small section of the brain can help to prevent seizures. Although more invasive options such as surgery and the implantation of a small electrical device can be used, lifestyle options such as a ketogenic diet have also been noted to help those with epilepsy.
What is the first aid for an epileptic seizure?
- Ensure the person is not in danger from their surroundings (i.e. traffic or electricity).
- Support their head and prevent injury to it through padding.
- Loosen anything restricting around their neck to keep their airway open (i.e. a collar).
- Once the seizure has stopped, place them in the recovery position. Recovery position is when the person is on their left side with their arms out horizontally and right leg at a right angle to their body.
- Record the start and finish time of the seizure while staying with them to reassure them as they come round.
- If the person has never had a seizure before, an injury is obtained during a seizure, or they do not regain consciousness, call an ambulance.
Note: One seizure lasts for over 5 minutes.
Sophie Farr, Youth Medical Journal 2022
References
Epilepsy Foundation, “Types of Seizures”, Last Accessed 29/10/21 from: https://www.epilepsy.com/learn/types-seizures
Epilepsy Society, “Epileptic Seizures”, Last Accessed 29/10/21 from: https://epilepsysociety.org.uk/about-epilepsy/epileptic-seizures
NHS England “Epilepsy Treatment”, Last Accessed 29/10/21 from: https://www.nhs.uk/conditions/epilepsy/treatment/
NHS England, “What to do if someone has a seizure (fit)”, Last accessed 29/10/21 from: https://www.nhs.uk/conditions/what-to-do-if-someone-has-a-seizure-fit/
Youth Medical Journal 