Epilepsy
What Is Epilepsy?
Epilepsy is a physical condition occurring when there are sudden, brief changes in brain functions. When brain cells are not working properly, a person's consciousness, movements or actions may be changed for a short time. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder.
What Causes Epileptic Seizures?
The brain is the control center for the body. Normal electrical signals between cells make the brain and body work correctly. The cells work like little switches, automatically turning electrical charges on and off. But sometimes it is as if some cells get stuck in the "on" position. This affects other cells and spreads to other parts or through all of the brain. It blocks out our usual awareness of things around us, or may change the way the world looks, or may make our bodies move automatically. Sometimes it may cause a convulsion. These seizures usually last a short time (from a matter of seconds to up to two to three minutes), and then end naturally as special chemicals in the brain bring cell activity back to normal.
What Kinds of Seizures Do People with Epilepsy Have?
Seizures can be of two major types - convulsive or non-convulsive. The following are the most common forms of the disorder.
Convulsive Seizures
A convulsive seizure (also grand mal or a generalized tonic clonic seizure) happens when the whole body is suddenly swamped with extra electrical energy.
It often starts with a hoarse cry caused by air being suddenly forced out of the lungs. The person may fall to the ground unconscious. The body stiffens briefly, and then begins jerking movements. Bladder or bowel control is sometimes lost. The tongue may be bitten. A frothy saliva may appear around the mouth, caused by air being forced through mouth fluids. Breathing may get very shallow and even stop for a few moments. Sometimes the skin turns a bluish color because the lower rate of breathing is supplying less oxygen than usual. The jerking movements than slow down, and the seizure ends naturally after a minute or two. After returning to consciousness the person may feel confused and sleepy. In some cases only a very short recovery period is required, and most people can go back to their normal activities after resting for a while.
Non-Convulsive Seizures
Non-convulsive seizures may take the form of brief staring spells, or automatic behavior, or unusual movements of the body. Awareness is affected in the first two of these types; in the third the person is awake and aware, but cannot control body movements. A fourth type of non-convulsive seizure produces changes in the way the person who is having the seizure experiences the things around him or her. For a brief time, things may look, taste, smell, sound or feel different from what they really are.
Short periods of staring, or "blanking out" spells, are non-convulsive seizures called absence or petit mal. They last only a few seconds and are most often seen in children. A child having this kind of seizure is momentarily completely unaware of people and things around him or her, but quickly returns to full consciousness without falling or loss of muscle control. Some children will stumble and fall if they have this kind of seizure while running around. These little seizures happen so quickly that the child (and sometimes other people around him or her) may not notice that anything has happened. Often parents and teachers think the child is being inattentive or is daydreaming. Sometimes these seizures also produce blinking or chewing movements, turning of the head, or waving the arms.
Non-Convulsive Seizure With Automatic Behavior
A non-convulsive seizure with automatic behavior is called a complex partial seizure, or a psychomotor or temporal lobe seizure. In this kind of seizure the extra brain activity stays in just one part of the brain. While the seizure is happening the person looks as if he or she is in a trance and goes through a series of movements over which he or she has no control. Although the kind of movements may vary from person to person, there is usually a pattern of behavior that each person follows every time a seizure happens.
A typical seizure of this type will start out with a strange sensation - a feeling of fear, perhaps, or a sudden sick feeling in the stomach, or even seeing or hearing something that is not really there. The person stares blankly, and may make chewing movements with his or her mouth. He or she may move an arm, pull at clothing, get up and walk around, all the time looking as if he or she is in a daze. Although not aware of things and people around him or her in a usual sense, a person having this kind of seizure may follow simple directions if they are given in a calm, friendly voice.
Although the seizure lasts for only a minute or two, full awareness of the surroundings may not return for some time afterwards. Confusion and irritability may follow, and the person will not remember what happened or what he or she did while the seizure was going on. This type of epilepsy does not appear very often in younger children but is common in teenagers and adults.
Simple Partial or Jacksonian Seizure
A third type of non-convulsive seizure, called a simple partial or Jacksonian seizure, is different from those described above in that the person knows what is going on during the seizure, but still cannot control movements. These movements usually involve a trembling or jerking of an arm or leg. Sometimes the movements start in a finger and then slowly "march" upwards until the while hand and arm are shaking.
Another type of simple partial seizure produces unusual feelings in the person who is having the seizure. Things may look strange, or the person may "see" people or things that are not there. He or she may "hear" strange sounds or have a feeling that what is happening around him or her has somehow happened before (deja vu). The reason for these sensations (which may be frightening and upsetting to someone who doesn't know what is causing them) is that the seizure activity is taking place in parts of the brain that control seeing, hearing, or memory.
Is There Any Danger Of A Person Dying During A Seizure?
A seizure is very seldom a cause of death, although there is more danger involved if the person has a seizure in water, near heights, or while driving a car. Occasionally, a person may fall in such a way that breathing is blocked, or may suffer a heart attack as a result of the stress of the seizure. In very rare cases breathing may not start again when a convulsive seizure is over, in which case artificial respiration should be given. Most cases of death involving epilepsy happen as a result of a series of nonstop seizures that may last for hours if not treated in a hospital. People suffering more than one convulsive seizure in a short period of time should always receive immediate medical care.
What Should You Do If Someone Has A Convulsive Seizure?
First aid for epilepsy is basically very simple, and is designed to protect the safety of the person until the seizure stops naturally. These are the key things to remember:
- Keep calm and reassure other people who may be nearby.
- Clear the area around the person of anything hard or sharp.
- Loosen ties or anything around the neck that may make breathing difficult.
- Put something flat and soft, like a folded jacket, under the head.
- Turn the person gently onto his or her side. This will help keep the airway clear. Do not try to force the mouth open with any hard implement or with fingers. It is not true that a person having a seizure can swallow his or her tongue, and efforts to hold the tongue down can injure the individual's teeth and jaw.
- Don't hold the person down or try to stop their movements.
- Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
- Stay with the person until the seizure ends naturally.
- Be friendly and reassuring as consciousness returns.
- Offer to call a taxi, friend or relative to help the person get home if he or she seems confused or unable to get home by themselves.
Should An Ambulance Be Called?
If you know the person has epilepsy, it is usually not necessary to cal an ambulance unless the seizure lasts for more than 10 minutes, another seizure begins soon after the first, or the person cannot be awakened after the jerking movements have stopped.
What Should You Do If Someone Has a Non-Convulsive Seizure?
There is no need for any first aid if a person has brief periods of staring or shaking of the limbs. If someone has the kind of non-convulsive seizure that involves a dazed state and automatic behavior, following are suggestions:
- Watch the person carefully and explain to others what is happening. Often people who don't recognize this kind of behavior as a seizure will think that the dazed person is drunk or on drugs.
- Speak quietly and calmly in a friendly way.
- Guide the person gently away from any danger, such as a steep flight of stairs, a busy highway, or a hot stove. Don't grab hold, however, unless some immediate danger threatens the individual. People having this kind of seizure are on "automatic pilot" so far as their movements are concerned, and instinct may make them struggle or lash out at the person who is trying to hold them.
- Stay with the person until full consciousness returns, and offer help in returning home.