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What Is Epilepsy?

Epilepsy is a common neurological disorder caused by disturbances in the normal electrical functions of the brain. In normal brain function millions of tiny electrical charges pass from nerve cells in the brain to all parts of the body. In patients with epilepsy, this normal pattern is interrupted by sudden and unusually intense bursts of electrical energy, which may briefly affect a persons consciousness, bodily movements, or sensations. These physical changes are called epileptic seizures. There are 2 categories of seizures: partial seizures, which occur in one area of the brain, and generalized seizures, which affect nerve cells throughout the brain.

Epilepsy may result from a brain injury before, during, or after birth; head trauma; poor nutrition; some infectious diseases; brain tumors; and some poisons. However, in many cases the cause is unknown. Attacks of epilepsy may be preceded by a feeling of unease or sensory discomfort called an aura, which indicates the beginning of the seizure. Signs of an impending epileptic seizure, which vary among patients, may include visual phenomena such as flickering lights or "sunbursts."

The many forms of epilepsy include: grand mal, Jacksonian, myoclonic progressive familial, petit mal, Lennox-Gastaut syndrome, febrile seizures, psycho-motor, and temporal lobe. Individuals predisposed to seizures may have an increased risk for having a seizure following stress, sleep deprivation, fatigue, insufficient food intake, or failure to take prescribed medications.

The most common treatments for epilepsy are anticonvulsant medications that prevent or control seizures. Surgery, which is another treatment option, is generally not performed unless drug treatment has failed. For some, other treatments may include a ketogenic diet (high in fats and oils, low in carbohydrates) and biofeedback.

With medication, most patients with epilepsy who are otherwise healthy are able to live full and productive lives. However, some patients lives are devastated by frequent, uncontrollable seizures and/or associated disabilities.

Source: National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892

Topic Overview

Epilepsy is a nervous system disorder that produces sudden, intense bursts of electrical activity in the brain. This abnormal electrical activity in the brain causes seizures, which may briefly upset a person's muscle control, movement, speech, vision, or awareness.

People with epilepsy have repeated seizures that usually occur without warning and often for no clear reason. If epilepsy is not treated, seizures may occur throughout a person's life, becoming more severe and more frequent over time in some cases.

Not everyone who has a seizure has epilepsy. Sometimes seizures occur as a result of injury, illness, or another medical condition that is not related to epilepsy. In these cases, the person does not have any more seizures once the condition improves or goes away. This is not epilepsy. Epilepsy is a long-term, ongoing (chronic) disorder that causes repeated seizures if it is not treated (and sometimes despite treatment).

Although epilepsy is sometimes the result of another condition, many cases have no known cause. Epilepsy most often begins in childhood or after the age of 60, but it can develop at any age.

Types of epilepsy

There are 2 basic types of seizures caused by epilepsy:

Partial seizures begin in a specific location in the brain. Partial seizures may affect awareness or one side or part of the body only, but they may also progress to affect the entire body.

Generalized seizures begin over the entire surface of the brain and may affect the entire body. In people who have generalized seizures, it is impossible to pinpoint a specific location in the brain that is the source of the seizure.

The difference is important because partial seizures and generalized seizures may be treated with different drugs or methods. The distinction is thus a key factor in guiding treatment.

There are many types of epilepsy that can cause partial or generalized seizures. Classifying the types of epilepsy is hard. Different types can have more than one cause, cause more than one type of seizure, and affect different people in different ways. Epilepsy that causes partial seizures, for instance, can take on an endless number of forms, depending on which part of the brain is affected.

Several types of epilepsy with predictable seizure patterns and treatment outcomes are listed below. (You can learn more about the different seizure types in the Symptoms section.)

Benign focal childhood epilepsy

Childhood and juvenile absence epilepsy

Infantile spasms (West syndrome)

Juvenile myoclonic epilepsy

Lennox-Gastaut syndrome

Temporal lobe epilepsy, the most common type of epilepsy in adults

Epilepsy is not a form of mental retardation or mental illness. Although a few forms of childhood epilepsy are associated with below-average intelligence and problems with physical and mental development, epilepsy does not cause these problems. Seizures may look scary or strange, but they do not make a person crazy, violent, or dangerous.

Epilepsy and the seizures it causes can upset a person's independence, self-esteem, and quality of life.

Some people with epilepsy may have trouble getting a driver's license.

For women with epilepsy, pregnancy may be complicated.

Children with epilepsy may have trouble in school.

Adults with epilepsy may find their career choices limited because they cannot do certain kinds of work.

Children and adults may face discrimination in their school, work, and social lives because of others' fears and misconceptions about epilepsy.

Luckily, treatment allows many people to control their seizures and have a better quality of life.

Who is Affected

Epilepsy affects 1.5 to 2.5 million people in the United States and 40 to 50 million people worldwide. The greatest number of cases are among young children and people over 60. It affects men slightly more often than women.

© 1999, by Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.

Epilepsy

What Is the Difference between Seizures and Epilepsy?

Seizures are characterized by a sudden change in movement, behavior, sensation or consciousness produced by an abnormal electrical discharge in the brain. Epilepsy is a condition of spontaneously recurring seizures. About 1% of all Americans have uncontrolled epilepsy.

What Causes Epilepsy?

In about half of the cases, no one knows the cause. In the remainder, there has been evidence that some portion of the brain has been injured by infection, severe trauma, stroke, tumor, lack of oxygen, or other causes. Epileptic seizures occur when large numbers of brain cells "fire" (send electrochemical messages) rhythmically and in unison. It is this simultaneous "firing" of large numbers of brain cells which disrupts normal behaviors and causes the shaking, confusion, and other signs and symptoms of seizures.

Can Epilepsy Be Controlled?

In some people, epilepsy is a chronic condition with seizures recurring at unpredictable times over many years. In others epilepsy can be controlled completely. Some patients, especially children, can even outgrow epilepsy.

Is There More Than One Type of Seizure?

There are two major types of seizures. The first type, known as a generalized seizure, begins on both sides of the brain at about the same time. Full "grand mal" convulsions and brief staring episodes are examples of generalized seizures. The second type, known as a partial seizure, originates in one region of the brain.

In a simple partial seizure, the seizure related brain messages remain very localized so that one experiences a feeling, sensation, movement, or other symptom without any change in the level of awareness. However, people who experience the most common type of a partial seizure, called a complex partial seizure,may suddenly become confused, fumble, wander or repeat inappropriate words or phrases. This appears to be due to spread of the seizure to wider areas of the brain. There are many other less common types of seizures.

What Can't People with Epilepsy Do?

First we would like to stress what people who have seizures can lead normal and active lives - with only a few restrictions.

Driving is prohibited in people with uncontrolled seizures. Each state's motor vehicle administration has regulations stating what minimal period of freedom from seizures is required before you are allowed to drive. You should contact your state's motor vehicle bureau to notify them of your epilepsy and find out the process(i.e., forms, interview) of determining whether you can drive.

You should avoid working from heights or around dangerous machinery and under water. We also recommend showers instead of tub bathing because of the risk of drowning during a seizure. If you are in a pool or lake, others around you should be aware of your seizures and be attentive to you while you are in the water. There should be someone present who can rescue you and perform first aid in the event of a seizure.

What Should I Know about My Anticonvulsants?

Anticonvulsants are the main form of treatment for epilepsy. There are a number of anticonvulsant drugs. The right drug, used in the right way can be very effective in treating seizures. It is important that you take the medication daily in order to maintain a constant level in the blood. After starting an anticonvulsant, a blood test is done to measure the amount of drug in your blood stream. If the medicine level is too high, you may have side effects(i.e. dizziness, double vision, upset stomach). If the level is too low, you may be at risk for seizures. It is important that you keep track of the frequency of your seizures and notify the doctor or nurse of medication side effects so that your medication can be adjusted properly.

There are some interactions that may occur between anticonvulsant and other prescription or over-the-counter medications. For example some anticonvulsants can lower the effectiveness of birth control pills. This can sometimes be corrected if a higher dose pill is prescribed. Also, the prescription drugs erythromycin and propoxyphene (Darvon) can cause an increase in the Tegretol level. Aspirin taken with valproic acid (Depakote)may cause thinning of the blood. There are many other examples. It is important to tell any doctor prescribing medication for you that you are also taking anticonvulsants.

We've included some information about the most common anticonvulsant drugs. Keep in mind that these are just the highlights. Other information is available if you would like to know more.

Benzodiazepines: Diazepam (Valium), Iorazepam (Ativan), Clorazepate (Tranxene), Clonazepam (Klonopin) Carbamazepine (Tegretol)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lamotrigene (Lamictal)
Phenobarbital
Phenytoin (Dilantin)
Primidone (Mysoline)
Valproic acid (Depakene, Depakote)
Vigabatrin (Sabril)

Can I Drink Alcohol?

In some people, alcohol can increase the risk for seizures. In others, alcohol and anticonvulsants can combine to make them less alert. However, in many people a small amount of alcohol (one beer, one glass of wine) will not cause a problem.

Can Women With Epilepsy Have Children?

Most women with epilepsy can become pregnant and have healthy children. Planning for the pregnancy is the best thing you can do to help insure that you have a healthy baby. Because of seizures and/or anticonvulsants, there is a slightly increased risk for birth defects. The amount and kinds of risk depend upon the medication(s) you are taking and you should ask your doctor about your own situation. The major risk of birth defects occur during the first three months of pregnancy. Therefore, your doctor may want to adjust or change your medication before you become pregnant. It usually is a good idea to begin taking at least 1mg a day of folic acid before becoming pregnant; you should speak with your doctor about the dose to use in your case. Ideally this change should be done months before conception. Anticonvulsant medication does not seem to increase the risk of birth defects in the children of men with epilepsy.

How Can I Take Care of a Person Who Is Having a Seizure?

For a tonic-clonic seizure (grand mal, convulsion): Help the person to a lying position and turn him or her onto one side. Place something soft under the head. Loosen tight clothing. Do not restrain the arms or legs. Do not put anything into the mouth. Forcing something in to the mouth may cause more harm than good. The seizure itself should only last a few minutes. Afterwards the person may be very sleepy and confused and should be talked to in a calm and quiet manner. A trip to the hospital is usually not necessary unless there has been an injury (not counting the sleepy, confused period after the seizure), if the seizure itself lasts for more than ten minutes, or if one seizure goes into another without recovery.

If a person has a complex partial seizure, stay with the person, talk calmly, and protect him or her from self-injury. Do not restrain. The person may be able to respond to simple commands such as "sit down". After the seizure, explain where you are and what has happened if this is necessary.

Epilepsy and Types of Seizures

One out of every hundred people in this country has epilepsy. Their seizures stem from overly active nerve cells (neurons) in the brain.

The strong and rapid bursts of electrical signals emitted from these hyperactive neurons temporarily disrupt normal functioning, much as a lightning storm can disrupt electrical power in a neighborhood.

The hallmark of epilepsy is recurring seizures -- sometimes as many as several hundred a day -- under normal circumstances. Anyone can develop a seizure if given the right bodily insult, such as poisoning or a lack of sugar in the brain brought on by diabetes.

But in people with epilepsy, seizures can be triggered by something as minor as lack of sleep or the flickering of a light. What causes epilepsy in all cases is not known.

In some people it results from brain damage from head injuries, brain tumors, lead poisoning, meningitis, encephalitis, or measles. Lack of oxygen to the fetus during pregnancy, labor, or delivery may cause epilepsy to develop during childhood.

Brain damage incurred by a stroke is a common cause of epilepsy in people over 65.

Epilepsy can first appear at any age, although three-quarters of all cases surface during childhood.

Types Of Seizures

There are more than 20 different types of epileptic seizures, ranging from the dramatic "grand mal" seizure to the slight few-seconds loss of consciousness (known as an absence seizure) that often goes unnoticed. A person with epilepsy can have more than one type of seizure.

Accurate diagnosis of the specific types of seizures is critical to determining appropriate therapy. The kind of seizure depends on where in the brain the electrical signaling has gone awry, and how far that "brainstorm" has spread.

If only the portion of the brain controlling movement of a limb is involved, that limb may tremble or jerk uncontrollably.If the affected brain area spreads, more of the body may begin to move erratically. If the brain section governing hearing or vision is involved, the person may experience auditory or visual hallucinations.

Sometimes the emotional centers of the brain are the hardest hit during a seizure and a person starts to cry for no apparent reason, or becomes angry or afraid. These seizures are termed partial because only part of the brain is involved.

Many people mistake a person undergoing a partial seizure as drunk or mentally ill. A complex partial seizure, for example, may cause the person to be dazed, unresponsive and clumsy, and to mumble, pick at clothing, or make chewing movements.

In contrast, during a generalized seizure such as a grand mal seizure (also known as a generalized tonic-clonic seizure), the whole brain is suddenly swamped with extra electrical energy so the entire body undergoes convulsions and the person loses consciousness.

Another type of generalized seizure called atonic causes abrupt loss of muscle tone, and the person falls to the ground.

Sometimes people, particularly those with complex partial seizures, experience a distinctive warning sign before a seizure, called an aura.

The aura is itself a form of partial seizure, but one in which the patient retains awareness. It may be a peculiar odor, "butterflies" in the stomach, or a sound. One man with epilepsy, an ardent racetrack gambler, always hears the roar of a crowd followed by the name of a favorite racehorse just before falling unconscious. Another person hears rock music. Although the average individual seizure doesn't appear to have any lasting effects, repeated seizures may be associated with damage such as memory loss.

A person may also be injured in a seizure-induced fall. Rarely, a person who has had a convulsive seizure may need resuscitation if breathing does not resume automatically.

Although seizures rarely cause death, they can be life-threatening if they occur in hazardous situations, such as while driving or swimming. Most cases of death from epilepsy stem from a series of seizures in a short span of time, or a seizure that lasts longer than a half hour.

Both conditions can deprive the brain of oxygen or cause heart or kidney failure. People experiencing such seizures should receive immediate hospital care.

Source: FDA Consumer

Epilepsy As A Consequence Of Brain Injury

Epilepsy is far more common than most people believe. As many as two and a half million Americans are affected by epilepsy.

The name epilepsy is derived from a Greek word, meaning to possess, seize or hold, and there are different forms of epilepsy other than those more commonly recognized by the general public, such as grand mal or petit mal (convulsive seizures).

Generally a person is not born with epilepsy but develops this neurologic disorder as a consequence of another condition such as a blow to the head, resulting in a brain injury, a brain infection or tumor, high fever, an allergic reaction to a drug or a severe medical condition such as stroke, kidney or liver failure. Most epilepsy is treatable and can be controlled with medication.

The central nervous system is a very complex computer, packed with neurons, a type of nerve cell in the brain. A seizure occurs when a large group of neurons misfire or short circuit, temporarily. In traumatic brain injury misfires can occur as a result of damage in the brain which interrupts the normal flow of cell firings.

For some persons with epilepsy, seizures can be triggered by insufficient sleep, not eating right, and even stress.

Types of Epilepsy

Within the brain there is a network of cells, neurons that communicate with one another by sending small electrical charges much like information sent from one point to another over telephone lines. When a seizure occurs, it means that neurons either fired when they shouldn't or didn't fire when they should.

Seizures are divided into two categories, generalized, an uncontrolled electrical discharge affecting several parts of both sides of the brain and focal seizures, when the electrical discharges affects only an isolated part of the brain. It is often difficult for doctors to diagnose which of the 20 kinds of epilepsy a patient is experiencing without clinical evaluations and sophisticated testing.

Generalized-onset seizures are the most common. Neurons discharge in one area of the brain and then spread throughout the brain causing, twitching, rigidity, convulsions, salivation, and other symptoms which may result in a brief loss of consciousness. Under the category of generalized-onset seizure is Tonic-clonic, which is more commonly called grand mal, the seizure is tonic if the body stiffens, and clonic if it jerks; however, it can also be tonic-clonic if the body stiffens and then jerks.

Observation is very important to proper diagnosis. In petit mal (also called absence seizures), another form of generalized onset seizures, the part of the brain that maintains awareness briefly lapses. It may cause a short term loss of muscle control or repetitive motions such as chewing. It can be best described as appearing spaced out.

People, experiencing petit mal seizures are often accused of not paying attention.

Myclonic seizures affect the motor cortex of the brain and are frequently seen in youngsters when observed while sleeping. They may have slight involuntary movements or jerking of the arms or legs.

Atonic seizures occur with total loss of muscle tone and the individual would be expected to fall to the floor. Status epilepticus occurs when a seizure or a series of several closely spaced seizures lasts 30 minutes or longer. It then becomes a medical emergency.

Partial Seizures

Partial seizures are a very common consequence after traumatic brain injury and often appear some months or years after the insult to the brain. They take several forms but are generally less severe than generalized seizures. Partial seizures occur when an abnormal electrical discharge affects a small area of the brain (the focus area) and does not spread to other parts of the brain.

When this discharge occurs without a change in consciousness it can be called a simple partial seizure, a Jacksonian, or focal seizure. When experiencing a simple partial seizure the individual may complain of smelling foul odors, seeing flashing lights, feeling tingly, and/or hearing voices.

A complex partial seizure, also called psychomotor or temporal lobe seizures, will cause an individual to have a change in the level of consciousness, but with no loss of consciousness. The individual may lose touch with the environment, hear things, behave strangely, grate teeth, fidget with an object, and/or move around randomly in a restless manner. Afterwards there is usually a period of confusion and often an inability to carry a conversation about the episode.

Diagnosing Epilepsy

The most commonly used diagnostic tool for determining epilepsy is the electroencephalograph (EEG). This test causes no discomfort. While the individual reclines comfortably, a technician attaches small sensors, called electrodes, to various areas of the individuals scalp with a paste like substance which is washed off after completing the test. The EEG measures electrical activity in the brain.

The sensors record activity in different areas of the brain and when abnormal activity is discovered it helps determine what kind of seizures are occurring. Waking EEG testing does not always pick up abnormalities in the brain waves because the electric currents are very small and may not misfire during a short testing period. For that reason, when seizure activity is suspected, the doctor may order a 24 hour continuous EEG.

This test can be done in a hospital or at home with little inconvenience to the patient and it provides more conclusive evidence over the extended period of time. The doctor may order other neurologic tests before arriving at a diagnosis of epilepsy but EEG testing is the most commonly used test.

Controlling Epilepsy

Most epilepsy can be controlled with aniticonvulsant medication and good health habits. As is the case with any pharmacological preparation, all anticonvulsants have side effects.

It is important for the individual and the doctor to determine which anticonvulsant preparation is best for the type of seizures being treated. Persons using anticonvulsants must use caution in the use of alcohol, other medicines, such as antibiotics and birth control pills.

Your doctor should always be informed about any other drugs or medication being used, even over the counter headache, cough and cold preparations. It is important to be aware of your states laws governing issuance of driving licenses for persons diagnosed with seizure disorders.

For further information about epilepsy, assistance with medication, access to support groups in your area, and referral to appropriate physicians, contact the

Epilepsy Foundation of America
4351 Garden City Drive
Landover, MD 20785
Telephone 1-800-332-1000

Reference: The Parke-Davis Manual on Epilepsy, The KSF Group, New York. 1993.

Epilepsy Today

Overview

Epilepsy, a physical condition caused by sudden, brief changes in how the brain works, is estimated to affect one percent of the U.S. population -- about 2.5 million people. In about half of all cases no cause can be found, but head injuries, brain tumors, lead poisoning, problems in brain development before birth, and certain genetic and infectious illnesses can all cause epilepsy.

Epilepsy occurs when nerve cells in the brain fire electrical impulses at a rate of up to four times higher than normal. This causes a sort of electrical storm in the brain, known as a seizure. A pattern of repeated seizures is referred to as epilepsy. Medication controls seizures for the majority of patients, who are otherwise healthy and able to live full and productive lives. On the other hand, at least 200,000 Americans have seizures more than once a month. Their lives are devastated by frequent, uncontrollable seizures or associated disabilities.

This past decade has seen a dramatic increase in our knowledge about epilepsy, but there remains much tragedy in the lives of many people with the disorder. To brighten tomorrow's outlook for those who must live with seizures, the epilepsy research community continues to concentrate its efforts on:

Finding the causes of epilepsy. Basic research aims to identify viral, genetic or other factors that cause epilepsy. These findings provide the basis for developing new and improved methods of prevention and therapy.

Improving diagnostics. Scientists are using promising new technologies such as positron emission tomography (PET) and magnetoencephalography to diagnose epilepsy and pinpoint seizure location.

Developing new drugs. The goal of modern neurological research is to develop safe, well-tolerated drugs that control seizures. Basic research has brought some of the now more commonly prescribed anticonvulsant drugs to the market. Scientists are also developing ways to test new and better drugs in patients.

Improving and developing new surgical techniques. This form of treatment, performed at epilepsy clinical research centers, is now an option for more people with epilepsy, including children. For patients whose seizures cannot be controlled with drugs, surgery can turn the dream of a seizure-free life into a reality. Improved technology has made it possible to identify more accurately where seizures originate in the brain and to what extent surgery may affect vital functions, such as smell and speech. As a result, investigators estimate that 2,000 to 5,000 new patients in the United States might be suitable for surgery each year.

Hope for better treatments, a cure, and, ultimately, prevention of epilepsy lies in neurological research. The National Institute of Neurological Disorders and Stroke (NINDS), one of the 17 National Institutes of Health (NIH) located in Bethesda, Maryland, is the nation's largest supporter of research on the brain and nervous system and a lead agency for the congressionally designated Decade of the Brain. The Institute conducts and supports a broad program of basic and clinical investigations aimed at increasing our understanding of more than 600 neurological disorders, including epilepsy. The Institute also studies the structures, activities, and vulnerabilities of the human brain. Most NINDS-supported research is conducted by scientists at public and private institutions, such as universities, medical schools and hospitals.

Scientists in the Institute's laboratories and clinics also conduct a wide range of research studies. At the Institute's Bethesda, Maryland facilities, patients with epilepsy volunteer for extensive testing using exciting, new imaging technologies, participate in trials of new anticonvulsant medications or undergo surgical treatment.

Source: National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, MD 20892

General Information

DEFINITION

A disturbance in the normal electrical functions of the brain characterized by sudden seizures, brief attacks of inappropriate behavior, change in one's state of consciousness or unusual movements. There are several different categories: mild types that can go almost unnoticed and severe types that can cause serious harm if they are not treated. Not all seizures are convulsions. A convulsion involves the nerves that control movement. Convulsions cause jerking, spastic muscle movement, altered consciousness and sometimes, loss of consciousness.

BODY PARTS INVOLVED

Nervous system.

SEX OR AGE MOST AFFECTED

Both sexes; all ages. Seizures usually begin between ages 2 and 14.

SIGNS & SYMPTOMS

Simple partial seizures: Tingling sensation in arm, finger or foot. Perception of a bad odor. Sees flashing lights. Remains conscious.

Complex partial seizures: Remains conscious, but sits motionless. Strange, repetitive or inappropriate movements or behaviors.

Generalized convulsive seizures: Sense or aura preceding the seizure. May cry out and fall to the ground unconscious. Loss of urinary and bowel control. Muscle spasms; may bite tongue. Thrashing movements; jerking of limbs. Deep sleep after the convulsion; awakens with headache and lack of memory about the episode.

Generalized nonconvulsive (absent) seizures; (most common in children): Remains conscious. Stares into space; appearance of daydreaming. Rhythmic blinking. Unawareness of the seizure.

CAUSES

More than 50 brain disorders, but the organic cause can be determined in only 25% of cases. Common causes include: Brain damage at or before birth; lack of oxygen during pregnancy, labor or delivery. Severe head injury; stroke; brain infection; brain tumor or an expanding lesion that compresses the brain (occasionally). Lead poisoning. Meningitis; encephalitis; measles.

Risk increases with family history of seizure disorders. Breech-birth (slightly).

HOW TO PREVENT

No specific preventive measures. Avoid head injuries.

WHAT TO EXPECT--DIAGNOSTIC MEASURES

Medical history and exam by a doctor. Laboratory blood studies, EEG (See Glossary), x-rays of the head, CT or MRI scan.

APPROPRIATE HEALTH CARE

Doctor's treatment; counseling. Rarely, when all else fails, brain surgery. POSSIBLE COMPLICATIONS Continuing seizures (despite treatment). Seizures can be life-threatening if they occur in hazardous situations (driving or swimming).

PROBABLE OUTCOME

Epilepsy is incurable, except in relatively rare cases where epilepsy is caused by treatable brain damage, tumors or infection. However, anticonvulsant drugs can prevent most seizures and allow a near-normal life. Newer drugs are helping many patients who have not responded to standard treatments.

HOW TO TREAT--GENERAL MEASURES

Wear a Medic-Alert (See Glossary) bracelet or pendant that shows you have epilepsy. Avoid any circumstance that has triggered a seizure previously. In event of seizure, loosen clothing, lay person flat and protect from injury. Although frightening, seizures are rarely harmful in themselves.

MEDICATION

Your doctor will prescribe anticonvulsant drugs. Your response to treatment will be monitored. Medication changes or adjustments are often necessary. Learn as much as you can about your medication. The drugs used cause significant side effects, in addition to suppressing seizures. Drugs may be withdrawn gradually after freedom from seizures for a period of time. Many people (especially children) can then stay free of seizures without medication.

ACTIVITY

No restrictions. Most states allow persons with epilepsy to drive a vehicle after being seizure-free for 1 year.

DIET

Usually no special diet. Don't drink alcohol. Some patients, mainly children, whose seizures aren't controlled by drugs, may be prescribed a ketogenic (very high-fat) diet. It is not always effective.

Epilepsy Facts & Resources

Conditions such as auras, altered consciousness, weird reveres, flashing lights in your head, metallic taste in your mouth, smelling fragrances that others do not smell, or hearing music that others do not hear, convulsions, muscle spasms or twitching, feelings of disembodiment or observing yourself from afar, vague longing or yearning, raging, crying or laughing for no apparent reason might signify seizure activity. In such cases you might want to pursue a seizure assessment.

Your doctor and/or the organizations below can refer you to services in your area where you can obtain such an assessment.

WHAT IS A SEIZURE?

If someone has a seizure, does that mean they suffer from epilepsy? Briefly stated a seizure the result of abnormal electrical activity in the brain. Given the right set of circumstances, or precipitants (e.g. - blow to the head, intoxication, high fever, etc) anyone can experience a seizure.

A single seizures caused by the above 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.

"Is there anything other than medication that can be done to help prevent seizures?"

Seizure activity can be evoked from any brain given the right combination of circumstances. The concept of a "seizure threshold" is based upon the fact that with enough physiological or pharmacological 'stress', seizures can happen in any mammal (including humans). Individuals differ in what constitutes "enough" of a stress. Some of the factors which influence seizure threshold include genetics (family history), brain trauma (especially "open" or penetrating wounds to brain), a number of medications and drugs (including things not often thought of as "drugs"), body temperature, sleep deprivation and a host of metabolic variables (for example: blood sugar, blood oxygen level, blood minerals, hormones).

There are a number of frequently-overlooked habits which can have a bearing upon seizure risk.

Caffeine (found in coffee, tea, over-the-counter 'stay-awake' pills and many carbonated beverages) lowers seizure threshold. This doesn't mean that all persons with or at risk for seizures should abstain completely from anything with caffeine in it. It just means that moderation is probably wise here, especially if prevention of recurrent seizure is proving difficult.

Alcohol makes it easier to have a seizure. It does so both as its level rises in the blood stream and as it later falls. It also tends to interact with just about every drug used to treat or prevent epilepsy. Because of its complex effects upon metabolism, body water and mineral balance, sugar metabolism and even sleep, alcohol use should probably be avoided in anyone who has had or is at special risk of seizure.

Sleep-deprivation (as in changing from day-shift to nightshift work, or staying up all night to work on a term paper, etc.) might lower your seizure threshold. Combinations of the above are, can increase the likelihood of seizure activity.

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 automatism's -- 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.

Other Seizure Types

The true "petit mal" seizure type (also known as "Absence Attacks" or technically, "Primary Generalized Seizures - Absence Type") is observed almost exclusively in children. It is mentioned in this section only to assist in the campaign for accurate terminology.

Absence seizures are characterized by abrupt and brief interruption of consciousness without convulsion. During the typical, seconds-long episode there is "loss of contact", "spacing out" rarely with chewing, swallowing, or blinking automatism's. Sometimes an individual continues doing whatever they were doing at seizure onset, though in an automatic way. During the episode, interaction is not possible. These episodes can be very brief, subtle and easily missed by a nearby observer. Normally, whatever activity a child was engaged in before the seizure is continued following it. Sometimes children with these seizure types are misdiagnosed with learning or behavioral problems.

There are a host of seizure types which are seen only in children or infants.

Epilepsy (Seizure Disorder)

Definition

Epilepsy (also known as seizure disorder) is a neurological condition with symptoms which vary from a momentary lapse of attention to convulsions. Damage to brain cells can disrupt the normally smooth-running pattern of electrical activity in the brain by causing an electrical overload. This can create a seizure, which causes a sudden change in the individual's consciousness and/or change in motor activity.

Facts

Epilepsy affects people of all ages, races and nationalities. According to the Epilepsy Foundation of America, about two and a half million people in the United States have a seizure disorder. It can develop at any time in life. Approximately two-thirds of the 125,000 persons who are newly diagnosed each year are adults. The symptoms, frequency, intensity and types of seizures vary greatly from person to person.

Those whose condition is controlled by medication may not experience seizures at all. In many cases, the cause of epilepsy is unknown. It can occur as a result of an infection, head injury, brain tumor, hydrocephalus, toxic reaction to drugs and alcohol, or other conditions which injure the brain and damage brain cells. Genetic factors may contribute to the development of a seizure disorder, but are not a primary cause. It may also be associated with other neurological conditions such as cerebral palsy.

Symptoms

There are two basic types of seizures: generalized and partial. These refer to how much of the brain experiences the abnormal electrical activity. The form, intensity and duration of the seizures are related to the number and type of brain cells which are affected. In a Generalized (or Grand Mal)

Seizure the whole brain is affected. The individual may experience lapse of consciousness and convulsions. Motor function and bladder or bowel control may also be affected.

In a Partial Seizure, abnormal electrical activity occurs in only a part of the brain. There is a loss of consciousness, although with "simple partial" seizures there is usually a decrease in consciousness. However, specific effects depend on the part of the brain involved. Common effects may include: a dazed state, automatic, purposeless behavior such as lip-smacking, or jerking movements in a certain part of the body.

Seizure activity is sometimes preceded by sensations involving the five senses, such as a sound, an unpleasant odor or taste, a sinking or rising feeling in the stomach or head, or spots before the eyes. This is referred to as the "aura." Some people may be able to train themselves to recognize the aura as a warning sign and prepare themselves for the oncoming seizure by taking preventative measures to protect themselves from possible injury.

Diagnosis

Diagnostic examinations will vary according to the needs of each individual. Diagnosis usually involves a thorough physical and neurological examination, a detailed medical history, analysis of blood and other bodily fluids, an electroencephalogram (EEG), and a computerized tomography (CT) or magnetic resonance imaging (MRI) scan. The pattern of seizures must be measured, including types, frequency and duration.

Treatment

There is no known cure for epilepsy. According to the Epilepsy Foundation of America, in about 85% of the cases, seizures can be successfully controlled by appropriate medication and treatment. Drugs that are used to treat seizures are called anti-epileptics or anti-convulsants. They act by minimizing or blocking the spread of excess electrical discharge to other parts of the brain.

Treatment methods may also consist of surgery or a special diet. Treatment of epilepsy is aimed at controlling seizures as well as treating their underlying cause if it is known. Certain types of seizures are difficult to control even with medication. In some cases, surgery may be indicated in order to remove the epileptic focus, or that part of the brain which produces the seizures. A person with epilepsy can potentially be seizure-free, work and participate in most activities. Since stress or emotional upset may lower the seizure threshold or raise the risk of experiencing seizures, treatment should include attention to social, emotional, psychological and vocational needs.

If a person has a generalized (Grand Mal) seizure, the following guidelines should be remembered:

Remain calm.
Remove sharp objects from the area.
Loosen clothing around the neck to help the person breathe.
Place something soft under the person's head.
Turn the person on his/her side to keep air passage clear.
Do not attempt to force open the person's mouth or to insert any objects into the mouth.
Do not try to hold the person down or stop his/her movements.
Do not attempt CPR, unless the person does not start breathing again after the seizure has stopped.
Remain with the person until the seizure has ended.
Reassure the person as consciousness returns.
Offer to call a friend, relative or taxi to help the person get home if he/she seems confused.

Recommended Readings

The Legal Rights of Persons with Epilepsy, 1992, available from the Epilepsy Foundation of America

Epilepsy, Frequency, Causes and Consequences, W. Allen Hauser, M.D. and Dale C. Hesdorffer, Demos Publications, 156 Fifth Ave., New York, NY.

Taking Control of Your Epilepsy: A Workbook for Patients and Professionals, Joel Reiter, et al., 1987, The Basics Publishing Company, available from the Andrews/Reiter Epilepsy Research Company, Inc., 550 Doyle Park Drive, Santa Rosa, CA 95405.

Epilepsy: Part of Your Life Epilepsy: You and Your Treatment

Families with Epilepsy: Psychosocial Aspects are three pamphlets available from the Epilepsy Foundation of America.

Credits

Questions and Answers About Epilepsy, 1993 and Epilepsy Facts & Figures, 1993, Epilepsy Foundation of America, Landover, MD. Lechtenberg, Richard, 1984, Epilepsy and the Family, Harvard University Press, Cambridge, MA

Seizures and Epilepsy - "Frequently Asked Questions"
James A. Whitlock, Jr., MD Staff Neurologist Northeast Rehabilitation Hospital, Salem, NH

USA Contents
"Grand Mal" - Primary Generalized, Tonic-Clonic Seizures
"Temporal Lobe Epilepsy" - Complex Partial Seizures
"Focal Fits" - Simple Partial Seizures
Other Seizure Types--If I see someone having a convulsion, what can I do?

A couple of unusual situations:

What observations about a seizure might be important to a physician?
First Seizure Recurrent Seizure Recurrent Seizure--Different from Previous Ones Should an extra dose of anticonvulsant be given after a seizure?
Does one take an anticonvulsant for life?
Is there anything other than meds that can help prevent/control seizures?
Sources of additional information
Evaluate this monograph

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 'autopilot' takes over);

Duration of minutes during which there may be automatism's -- 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.

Other Seizure Types

The true "petit mal" seizure type (also known as "Absence Attacks" or technically, "Primary Generalized Seizures - Absence Type") is observed almost exclusively in children. It is mentioned in this section only to assist in the campaign for accurate terminology.

Absence seizures are characterized by abrupt and brief interruption of consciousness without convulsion. During the typical, seconds-long episode there is "loss of contact", "spacing out" rarely with chewing, swallowing, or blinking automatisms. Sometimes an individual continues doing whatever they were doing at seizure onset, though in an automatic way. During the episode, interaction is not possible. These episodes can be very brief, subtle and easily missed by a nearby observer. Normally, whatever activity a child was engaged in before the seizure is continued following it. Sometimes children with these seizure types are misdiagnosed with learning or behavioral problems.

There are a host of seizure types which are seen only in children or infants.

If I see someone having a convulsion, what can I do?

First, what NOT to do--

DO NOT TRY TO PUT ANYTHING IN THE PERSONS MOUTH; There is no place for the "tongue blade" at the bedside or in the home. In fact, it is dangerous. Many sticks, teeth, and other things have been broken by persons attempting to prevent "swallowing of the tongue". The same applies to fingers - never place anything in the mouth of a person who is actively seizing/convulsing. It is sometimes appropriate to place an oral airway after the seizure has ended, but only if you've been trained in its use (and there happens to be one present). There is another way to deal with the airway during the profound sleepiness which sometimes follows a seizure -- (read on).

DO NOT TRY TO RESTRAIN THE CONVULSING LIMBS; Soften the surface, remove obstacles/furnishings, get the person to a safe spot, cushion head with your hands, YES. Restrain, NO.

IF A PERSON KNOWN TO HAVE 'CONVULSIVE' EPILEPSY SHOWS A COLOR CHANGE TOWARD BLUE IN FACE, LIPS, NAIL-BEDS AT THE ONSET OF A SEIZURE- COUNT TO 60; The cyanosis (bluing of lips, nails, skin) that may accompany what in essence is a brief "respiratory arrest" at the beginning of a convulsion is caused by contracted and 'stuck' respiratory muscles. It is not something that can be altered by any bystander/caregiver. It should pass relatively quickly, with improvement in color as the convulsion proceeds. If the above state lasts beyond a minute, OR if it is followed by relaxation (instead of convulsive movements) with persistent bluish color, it would probably be wise to assume that this IS a respiratory arrest and NOT a seizure. [In which case the proper response would be Basic Life Support].

DO NOT ATTEMPT TO GIVE THE PERSON MEDICATION/FLUIDS WHILE THEY ARE NON-INTERACTIVE; The person should be talking before any attempt is made to give anything by mouth. Now, what TO do. (Sometimes the most important things are the simplest) - Especially if this is the first seizure you've ever witnessed, or if you don't know anything about the person's medical history, feel for the carotid pulse. Feeling this should provide the necessary reassurance that the individual is not experiencing a cardiac arrest.

Hopefully, you can relax enough to remember the following tips - Create the safest possible environment for the seizure. Position away from objects which threaten injury. Provide a soft surface, if possible. Cushion head with hands to prevent banging of head against the ground/floor. As the seizure ends and a state of deep relaxation ensues, place the person in the "recovery position" (as illustrated below).

Never should the individual be left flat on their back - that position invites airway obstruction (by a relaxed/swollen tongue dropping to the back of the throat, blood from a bitten tongue, or vomitus). If, after positioning the person as illustrated there is any sign of ineffective breathing (loud snoring type sound, little/no air moving to/from mouth/nose), ensure that there is nothing in the mouth by sweeping your finger through, removing any debris as you do so

[NOTE WELL- The seizure has stopped at this point and the person looks as if deeply asleep].

If there are dentures, this is the time to remove them. If after doing the foregoing there is still a loud snoring sound, try extending the neck a bit more. Other options to help open the airway include use of an oral airway or a performance of a "jaw thrust maneuver" (illustrated here).

Recovery should proceed over minutes, though significant fatigue is likely. If there has not been any injury (eg.- no significant cuts to skin or tongue or concern regarding injurious effects of a fall to ground/floor), the person should be allowed to fulfill their desire to rest.

Seek medical/hospital treatment if their is any concern about significant injury or if this is the individual's first seizure.

A couple of unusual situations--

[Author's note: I doubt that it would be possible to address every contingency pertaining to responses to seizure in any document - even in the ultimate hyperlinked Web-work. Hopefully, the most common scenarios will ultimately be well addressed in these pages.]

There are a couple of unusual circumstances that are worth noting, especially because awareness can have a major impact upon outcome in particularly dangerous situations.

Seizure in water (e.g. - swimming). No one should swim alone. Persons known to have epilepsy of any type should not swim without their escort realizing that a seizure in water can be a particularly dangerous thing. During the forced expulsion of air at seizure onset, a seizing person would tend to sink quite rapidly. Then, with onset of the convulsive activity, water would tend to be drawn into the lungs.

In non-convulsive seizure disorders, the impairment of awareness or movement control could pose some difficulty to a rescuer, but should not be dangerous as long as the head is kept above the water.

Bottom-line? Consider the depth of water used during recreation as well as use of device which add some buoyancy.

Concern about possible neck injury in fall during a seizure. Fortunately, it seems to be remarkably rare for serious injuries to accompany seizures. Still, occasionally the fall at seizure onset is a hard drop to a hard surface. Especially in medical settings, such an occurrence tends to reflexively result in taking extra precautions with respect to possible neck injury. This means applying traction to the head in such a way as to minimize flexion/extension movements, especially after the convulsion ends. There is still a need to move the person into the recovery position, the difference being that someone has to continuously hold the head in such a way as to keep the spine straight. This can pose a bit of difficulty for one attendant if the person who had the seizure is having difficulty breathing. This situation calls for a "jaw thrust", with the caveat that the neck should not be extended. Seizures which are prolonged or which occur one after another... are a special circumstance in that they may hurt the brain. Emergency medical attention should be sought immediately.

What observations about a seizure (or what I think was a seizure) might be important to my physician?

The observations of a witness are generally key to diagnosing the various forms of seizure and in distinguishing seizures from episodes that can be confused with them (such as faints, various forms of tremor, and a host of unusual causes of episodic behavioral phenomena). While patients can often provide key information (or all the information necessary when there is no interruption of consciousness), a witness/observer is the only one who can provide the information which leads to an accurate diagnosis. Specific observations have particular relevance depending upon the whether this is a person's first seizure, a recurrent seizure or an episode differing from past seizures. In general, it might be good to write down your observations soon after the episode while memory is fresh, using the following as a guide. [Some questions would best be directed to the person who had the episode, others to a witness]

First Seizure--What was the person doing immediately before the episode?

Has there been any traumatic loss of consciousness in the recent (or remote) past? [Be able to provide details].

Has there been any recent illness (fever, "flu")? Did the person seem to have a feeling that something was about to happen before the episode? Was it even more specific than a 'feeling'?

As the seizure began, what did you see first?

Was there any color change in skin, lips or nail-beds? Were there movements of eyes to one side? If so, which side? Did one side of the face twitch before the other? Did one limb start jerking before another? [In general, if any movements or postures were seen more on one side than another, it can be helpful to know which side did what.] In non-convulsive episodes, a description of exactly what the person did/said during and shortly after the episode would be helpful.

Note the duration of the spell; between onset and resolution of any confusional period which follows. Was there passage of urine? of stool? Any vomiting? Was there any bleeding in the mouth? How long did the jerking part of the episode last? After the episode, what did the person do?

Recurrent Seizure--Did this seizure look the same as prior ones?

Was it longer or shorter than average? Have there been any recent medication changes or missed doses of medication? Has there been any recent change in sleep habit (eg.- up all night preceding the day of the seizure)? How much (if any) recent alcohol, caffeine, marijuana, or cocaine has been used? When was it last used in relation to the time the episode/seizure happened? Are there any new medications (prescription or nonprescription) being taken? Any herbal remedies? Have there been any unusually stressful events in life recently? Has there been any major change in weight since the last seizure? [Occasionally, a significant weight change may be associated with a change in blood anticonvulsant level in an individual who had long shown a stable blood level].

Recurrent Seizure, but Different from Previous Seizures

In addition to answers to questions, from the above section ("Recurrent Seizure") please consider the following: Exactly how was the episode different from previous ones? Was there a different 'warning' or "aura"? Did the spell involve a different part or side of the body? Did it start differently? Has there been any recent illness, new symptom of a possible illness? Any recent injury - especially blow to the head? "Should an extra dose of anticonvulsant be given as soon as possible after a seizure?" In someone who is taking anticonvulsant/anti-epileptic medication, a "breakthrough" seizure may be a sign of a blood anticonvulsant level which has fallen too low.

But occasionally (uncommonly) a seizure can be a manifestation of toxicity from too much anticonvulsant in the system. Thus, unless there have been prior directions from a physician covering this contingency, or it is known that a scheduled dose of medication was missed, it is probably most wise to seek direction from your physician/neurologist before giving any extra medication. "I haven't had a seizure in years but I still take medication to prevent seizures. Am I supposed to take this for the rest of my life?" It is easier for a physician to provide well-grounded advice regarding starting an anticonvulsant when a seizure disorder has developed or when a person is at unusually high risk for having seizures.

Providing advice regarding when to discontinue medication in the absence of seizures is much more difficult. There needs to be a reasoned weighing of ongoing risk of seizure recurrence against factors such as medication side-effect(s), cost of medications, potential drug interactions, willingness to defer driving during and for a while after the withdrawal of anticonvulsant.

These are matters best discussed with your physician/neurologist. "Is there anything other than medication that can be done to help prevent seizures?" Seizure activity can be evoked from any brain given the right combination of circumstances. The concept of a "seizure threshold" is based upon the fact that with enough physiological or pharmacological 'stress', seizures can happen in any mammal (including humans). Individuals differ in what constitutes "enough" of a stress.

Some of the factors which influence seizure threshold include genetics (family history), brain trauma (especially "open" or penetrating wounds to brain), a number of medications and drugs (including things not often thought of as "drugs"), body temperature, sleep deprivation and a host of metabolic variables (for example: blood sugar, blood oxygen level, blood minerals, hormones). There are a number of frequently-overlooked habits which can have a bearing upon seizure risk. Caffeine (found in coffee, tea, over-the-counter 'stay-awake' pills and many carbonated beverages) lowers seizure threshold.

This doesn't mean that all persons with or at risk for seizures should abstain completely from anything with caffeine in it. It just means that moderation is probably wise here, especially if prevention of recurrent seizure is proving difficult. Alcohol makes it easier to have a seizure. It does so both as its level rises in the blood stream and as it later falls. It also tends to interact with just about every drug used to treat or prevent epilepsy. Because of its complex effects upon metabolism, body water and mineral balance, sugar metabolism and even sleep, alcohol use should probably be avoided in anyone who has had or is at special risk of seizure.

Sleep-deprivation (as in changing from day-shift to nightshift work, or staying up all night to work on a term paper, etc.) probably does much to lower seizure threshold. Combinations of the above are, more likely than not, additive in there effects. "What are some good sources of additional information regarding seizures and epilepsy?" Your friendly neighborhood physician/neurologist.

The Epilepsy Foundation of America (Telephone: 1-800-332-1000) - a trove of educational resources, including bibliographic lists, videotapes, brochures and pamphlets. Engel, J. Seizures and Epilepsy. Philadelphia: FA Davis, 1989. Menkes, JH and Sankar, R: Paroxysmal Disorders.

In Textbook of Child Neurology, 5th edition. Baltimore: Williams and Wilkins, 1995. What is a seizure? Thanks to Carl Billian, MD, Greg Lipshutz, MD and J. Prochilo for their critical reviews of this work and to N. Druke for kindly helping with illustrations.

Copyright © James Whitlock, MD

Epilepsy Online Information

Epilepsy Foundation Of America--4351 Garden City Drive, Landover, MD, 20785-2267. Telephones: 301-459-3700 / 800-332-1000. Provides information and referrals to patients with epilepsy/seizure disorders, their families, health professionals, and the general public. e-mail:[email protected]

American Academy of Neurology--1080 Montreal Avenue, St. Paul, MN 55116--Telephone: 615-695-1940. Provides information to both medical professionals and to the public. Included are fact sheets and brochures on a variety of neurological conditions and procedures, the American Academy of Neurology (AAN) Patient Information Guide, general Neurology information, membership information, and current news.

Charlie Foundation--501 10th Street, Santa Monica, CA 90402--Telephones: 800-367-5386. Promotes the use of the ketogenic diet through awareness and training.

The British Epilepsy Association--Anstey House, 40 Hanover Square, Leeds, England Tel: +44 (0)113 243 9393 -- Freephone Information line (within UK): 0800 309030.

National Society for Epilepsy--Created by physical therapy Master's degree students to assist physical therapists and others to find helpful patient education and prevention sources.Chalfont St. Peter, Gerrards Cross, Buckinghamshire, SL9 0RJ, UK. Telephone: 01494 601400.

Medic Alert Foundation--2323 Colorado Ave. Turlock, CA 95382 Telephone: 209- 668-3333 - Offers Medic Alert bracelets/necklaces, which can inform emergency medical personnel of medical complications. Mental Health Net -- Self-help resources including symptoms and treatments. Many of these resources are targeted at the lay person, but professionals may find them useful as well.

Assistance Dogs International, Inc.--c/o Canine Partners For Life, 334 Faggs Manor Rd. Cochranville, PA 19330, Telephone: 610- 869-4902. Setting Standards For The Assistance Dog Industry Since 1987. The three types of Assistance Dogs are guide dogs for the blind and the visually impaired, hearing dogs for the deaf and hard of hearing and service dogs for the physically disabled and/or mobility impaired.

Australian Support Dogs -- P.O. Box 644, Mona Vale N.S.W 2103, Australia, Telephone: 612-9979-6986 Fax: 612-9979-6827; email: [email protected].

Canine Companions for Independence -- P.O. Box, Santa Rosa, Santa Rosa, CA 95402-0446 Telephone: 707-577-1700 (v); 707-577-1756 (TDD); email: [email protected].

Japan Guide Dog Assn. -- Tsujido, Eastcost 2-4-24, Fujisawa City, Japan, Telephone: 81-466-35-7524; Fax: 81-466-35-7524; email: [email protected]

Scenter Line Kennels--Sservice and seizure alert dog information.