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What is a seizure? If someone has a seizure, does that mean they suffer from epilepsy?
A seizure is a change in behavioral state which results from abnormal electrical activity in the brain. Given the right set of circumstances (e.g. - blow to the head, intoxication, high fever) anyone can experience a seizure. The occurrence of a seizure in the presence of some acute precipitating physiological disturbance does not mean that it will ever happen after the precipitating cause has resolved. When seizures recur without any obvious precipitant or cause, then a person may be considered to have epilepsy.
What happens during a seizure?
"Grand Mal" - Primary Generalized, Tonic-Clonic Seizures
- The true generalized seizure is characterized by sudden loss of consciousness, usually without warning. At onset there is usually a general stiffening of the body, often with forceful expiration of air (and a peculiar sound as this air passes through the throat). If the person having the seizure is standing when this happens, there can be a hard fall to ground or floor. This "tonic" phase of the seizure is generally very brief but is responsible for a number of things which often frighten witnesses. Because virtually all skeletal muscles in the body are forcefully contracting at the same time, there may be biting of the tongue, passage of urine, (rarely) defecation or vomiting, and sometimes a change in color to a purplish-blue (due to muscles of respiration being stuck in the tightened state). This phase generally lasts about 30 seconds.
- Immediately following the 'tonic' phase of a seizure, convulsing begins as forceful, rhythmic jerking of arms, legs, head and neck. This activity is variable in both its forcefulness and its duration, but it can last a couple of minutes, building up in intensity and then fading out while the frequency of shaking remains relatively constant. Skin/lip/nail bed color generally returns to normal during this period.
- After the convulsing ceases, there is usually a state of deep sleepiness. During this period, all the muscles that were convulsing are deeply relaxed. If a person in this state is in a position which makes it hard for them to breathe, they may NOT change their own position (see following section). The folklore about people with seizures "swallowing their tongue" actually relates to the possible airway obstruction which can occur in a person who is on their back with their head flexed forward during the very sleepy period after a major convulsion.
- As the sleepiness lightens, a person recovering from a seizure may initially be confused or even hard to engage in conversation beyond a few words. The confusion more often than not passes over minutes, but the desire for a retreat to bed to sleep for a while sometimes lasts for quite a while.
- If a generalized convulsion is prolonged (5 minutes or more) or if it is followed by a second seizure before complete recovery (person is awake and interactive), it is time to seek medical assistance.
"Temporal Lobe Epilepsy" - Complex Partial Seizures (often erroneously labeled 'petit mal')
- The second most common form of seizure in adults is "partial" (i.e.-the electrical 'storm' involves some but not all of the brain) "complex" (i.e.- disturbance of consciousness). Usually the area of brain involved in the seizure activity is the temporal lobe. But other parts of the brain can give rise to seizures which fall under this heading. What most of these seizures have in common is:
- Some form of warning or "aura" with an awareness that something is about to happen. This may take the form of a mental picture, a noxious odor, an unusual sensation in the stomach, the perception of a voice or music, even a particular recollection;
- Loss of awareness without collapse/unconsciousness (as if 'auto-pilot' takes over);
- Duration of minutes during which there may be automatisms -- repetitive, non-purposeful acts -- (eg.- lip smacking, swallowing, picking at things, garbled or semi-random speech, aimless walking or manipulation of objects);
- A period of confusion lasting minutes after the episode, possibly with sleepiness (but not the profound somnolence that generally follows a major convulsion). The person in this state may walk around, as if with purpose. Rarely, aggression may be manifest during this phase - especially if someone is attempting to passively restrain/direct movement. This aggression, when manifest, is not well-focused, not 'thought-out' and can often be avoided by leaving the person alone for a few minutes.
- There is actually quite a bit of variety in the behavior individuals with this type of seizure exhibit. But once a seizure of this type has expressed itself in an individual, any subsequent episode generally has the same aura and outward behavioral appearance as the first one. There is total amnesia for the period of the seizure and variable amnesia for events just preceding and following it. Sometimes, in some persons, this type of seizure precedes a generalized convulsion (see above) as the electrical signal spreads out from one part of the brain to the entire brain.
"Focal Fits" - Simple Partial Seizures
Seizures which involve only part of the brain ("partial") without alteration of awareness ("simple") can occur in persons who have had injury to the brain (as from trauma, stroke, hemorrhage, malformation, tumor). Most commonly, they involve rhythmic (2-3 cycles/second) twitching of face, hand/arm, and/or leg on the side of the body opposite to the side of brain from which the seizure emanates. Generally, this type of seizure lasts minutes. In some individuals, it forms the prelude to a generalized convulsion. Occasionally, it can go on for a very long time (hours-days). The longer it lasts, the greater the associated fatigue. Extremely prolonged versions of this seizure type can interfere with sleep, cause muscle pain and lead to exhaustion.
From the Northeast Rehabilitation Health Network. Reprinted with permission. All rights reserved. www.northeastrehab.com.