Seizure Types

Tonic-Clonic

The most common sort of generalized seizure - used to be known as ‘Grand mal’.

Tonic phase - The muscles contract, the body stiffens and then - Clonic phase - jerks uncontrollably. You may let out a cry as air is forced out of the lungs and the lips may go blue due to lack of oxygen.

You lose consciousness - when you come round you cannot remember anything. You will need time to recover - from minutes to, in some, hours.

What To Do

Do not try to restrain the person. Clear away possible risks - sharp edged furniture etc.

Cushion the person’s head when they fall and, when the limbs stop jerking, put the person in the recovery position.

Do not put anything in the person’s mouth.

Do not try to give the person anything to drink until they have recovered consciousness.

Be quietly reassuring and stay with them until they have recovered.

Do not call for medical help unless the seizure lasts more than 5 minutes.

Absence

This generalized seizure is literally an absence - a momentary lapse in awareness - used to be called "Petit Mal’.

More common in children and teenagers.

You stop what you are doing, stare, blink or look vague for a few seconds before carrying on with what you were doing. Onlookers may think you were just daydreaming or may not notice.

These seizures used to be called petit mal, which roughly translated means small illness. This name makes them sound fairly harmless and, for many, they are little more than an occasional nuisance. However, then they occur frequently they can make life very confusing.

During an absence seizure it can appear to onlookers that the person is daydreaming or switching off, something we all do when we are bored or distracted. However, in an absence seizure the person cannot be alerted or woken up; they are momentarily unconscious and therefore totally unaware of what is happening around them.

Absence seizures are rare in adults, most commonly beginning in childhood, particularly between the ages of six and twelve. Girls are more prone to absences than boys. Most children will respond to anti-epileptic drug treatment, often being able to stop the treatment after a few years. Some children may go on to experience tonic-clonic seizures later in life; other 'grow out' of their epilepsy. Like many generalized seizures, doctors can rarely say why a child develops absences, although between 25 and 40 per cent of children with absences have relatives who have experienced similar seizures.

Because most children tend to daydream or wander off into a world of their own, absences can be very hard to spot. Parents and teachers tend to lose patience with children unless it becomes obvious that something more serious is happening. In the worst cases, children can be having hundreds of very brief absence seizures a day, effectively preventing them learning and participating in school or family activities. These children are missing out on tiny pieces of information; they might hear the first part of a sentence but not the end; hear the instruction to go out play but not be back in ten minutes. This can be easily misinterpreted as misbehavior.

What To Do

Do not try to ‘wake up’ the person.

Tell them what has happened while their seizure was happening - particularly important for children during lessons.

Tell the child’s parents if they do not know the child has this type of seizure.

Simple Partial

Occurs in just part of the brain - type of symptoms depend on the area of the brain involved.

Symptoms include one or more of the following: twitching, numbness, sweating, dizziness, nausea, disturbances to hearing, vision, smell or taste, strong déja vu etc.

These symptoms last for several seconds and then go away. You remain fully aware.

These seizures often progress to other types of seizure and can therefore act as a warning or ‘aura’.

WHAT TO DO

Do not try to restrain the person.

Stay with the person and be reassuring until the symptoms go away.

Be aware that the person may go on to have another type of seizure - be ready to move any sharp objects, furniture etc.

Complex Partial

This common form of seizure includes temporal lobe epilepsy and psychomotor seizures.

You may behave strangely - plucking at your clothes, smacking lips, swallowing repeatedly or wandering around as if drunk - these actions are called automatisms. Other symptoms are similar to simple partial seizures but you may not remember them afterwards.

You are not aware of your surroundings or of what you are doing.

WHAT TO DO

Do not try to restrain the person but try to steer them away from any unsafe situations.

Do not try to ‘wake’ them.

Stay with the person, being gently reassuring, until the person has recovered.

The person may need to rest for a while.

Sleep Seizures

Some people only experience seizures during their sleep. They can often be missed if nobody witnesses them.

You may find this type of seizure less troublesome than those occurring during the day.

WHAT TO DO

Do not try to restrain the person, but put them in the recovery position after the seizure to ensure that they can breathe.

Do not put anything in their mouth.

Be sure to tell the person that they have had a seizure during the night.

Other Generalized Seizures

These include atonic seizures (drop attacks) and myoclonic seizures which cause brief forceful jerks.

WHAT TO DO

Atonic seizures can cause injury - an increased awareness of safety is vital if this type of seizure occurs regularly.

Gelastic Seizures

Gelastic seizures are brief outbursts of emotion, usually in the form of a laugh or a cry. They may be accompanied by forced eye movements, chewing or grinding the teeth, tonic posturing, and clonic jerking. The person may appear confused and/or dazed during and after an episode. Gelastic seizures usually last 5 to 60 seconds. The person may remember them clearly or may be completely unaware of what occurred.

Gelastic seizures are both unpredictable and unprovoked by the person's surroundings. They are abrupt in onset and quickly over. Gelastic seizures may occur nocturnally, waking the person from sleep and leaving them exhausted.

Research shows that gelastic seizures often occur in people who have an (often maternal) family history of migraines.

Dextroamphetamine, primidone, and phenobarbital, sometimes in combination, may be prescribed to control gelastic seizures

(Information obtained from Epilepsy Ontario)

Myoclonic Seizures or Jerks

Most people have experienced a sudden jerk as they are falling asleep or have jumped when someone leaps out as them unexpectedly and this is similar to the jerks experienced by someone who has myoclonic seizures.  Caused by a sudden contraction of the muscles, it can affect the whole body but it is usually restricted to one or both arms and sometimes the head.  As in absence seizure, the person is not conscious, but the seizure is so brief that the person appears to remain fully conscious.

Myoclonic jerks occur most frequently in the morning.  Although the seizures are brief, they can be extremely frustrating, resulting as they often do in spilt drinks or similar 'accidents'.

Tonic and Atonic Seizures

Tonic seizures result in all the muscles contracting.  The body stiffens and the person will fall over if unsupported.

Atonic seizures (also called 'akinetic' seizures) are, in a way, the opposite of tonic seizures.  Instead of the body going stiff, all muscle tone is lost and the person simply drops to the ground, hence their other name 'drop attacks'.  Although the person falls heavily, they are usually able to get up again straight away.  When the body goes limp it inevitably falls forward and the person's head can get a serious knock if the seizures occur frequently.

For those who have frequent tonic or atonic seizures, extra safety precautions - such as protective headgear - make sense. 

Secondary Generalized Seizures

Sometimes, the activity that starts as a simple partial or complex seizure can spread to the whole brain resulting in a tonic-clonic seizure. This is known as a secondary generalized seizure. Often the person will experience the simple partial seizure as an 'aura' or warning but sometimes the spread of epileptic activity can be so quick that the person appears to go straight into a tonic-clonic seizure. This can cause problems with diagnosis of the seizure type until the necessary tests are done and the specialist can see where the activity first occurs.

Non-epileptic Seizures

Not all seizures are epileptic in origin. This is why, when making an initial diagnosis doctors will conduct various tests to rule out other causes. People with epilepsy can experience non-epileptic seizures as well. This section looks at cases where the non-epileptic seizures appear regularly and similarly to those in a person with epilepsy.

Non-epileptic seizures are also sometimes referred to as pseudo-epileptic seizures, pseudoseizures, psychogenic seizures or Non-Epileptic Attack Disorder. These seizures are identical to epileptic seizures, but the difference is that they are not epileptic in nature.

Non-epileptic seizures can be symptoms of various psychological factors, specific to the person concerned. The management of non-epileptic seizures will therefore need to be considered on an individual basis and the options discussed with the epilepsy specialist.

It is important to take notes of all the circumstances surrounding undiagnosed seizures, together with careful descriptions of what happens, how long the seizure lasts, how the person feels etc. Every piece of information can help the doctor make an accurate and informed diagnosis and this, in turn, ensures that the patient receives the correct treatment.

INFORMATION COURTESY OF THE BRITISH EPILEPSY ASSOCIATION

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