Recognizing a Seizure
There are many kinds of seizures, some more common than others. Some are still being classified. What can make labeling difficult is that symptoms may be subtle and difficult to detect. An example is an absence seizure described below. Symptoms may also represent other medical or psychological conditions and not epilepsy. For example, they may be associated with diabetes—a consequence of abnormal level of insulin or blood sugar—and not epilepsy. Thus, it can be very helpful to know beforehand whether a person has a chronic medical condition.
Seizures can occur in many forms because events can vary in anatomic location*, magnitude, duration, and frequency. More common types are described below. Keep in mind as you read the following descriptions that when most of these occur, the main thing for you to do is keep the person comfortable, remove things that might harm them, offer reassurance, and wait for the seizure to pass. Exceptions to this general rule are noted.
*Seizures caused by brain injury may originate at the site of the greatest tissue damage. For this reason, penetrating injuries (e.g., gunshot or knife wound) produce a higher incidence of subsequent seizure than whole-brain injuries).
There are two kinds of generalized seizures, so-named because most or all of the brain is involved from the start. The first below is typically associated with epilepsy. The second is less well known.
Generalized Tonic-Clonic (GTC)
This is the form often referred to as grand mal seizure. It begins with a stiffening of the limbs (tonic phase) and a cry or moan as breath is expelled. If standing, the person will fall. This phase is quickly followed by rhythmic jerking of limbs and face (clonic phase). Typically such convulsing lasts 1-3 minutes during which breathing may be temporarily suspended or labored, skin may appear pale/blue, and bowel/bladder control lost. The person is unconscious during this time and will not recall the event later. After they have experienced such seizures more than once, they will likely recognize they have had a seizure by remembering how they felt before or after they lost consciousness.
When convulsing stops, the person will resume normal breathing but feel tired and perhaps confused for several hours. If there are also focal areas involved (e.g., speech or muscle control), the person may not be able to speak, stand or move as well as usual while recovering.
What to Do: Observers can assist the person during the seizure by turning him or her to their side, placing something soft under the head, removing glasses, loosening tight-fitting garments, and clearing the area of objects that present a safety risk. It is important to stay with the person until he or she is fully alert. While the person may bite the lips or tongue during this time, do not put anything into the person’s mouth. Do not force the person’s position, other than gently rolling them to one side.
It is not necessary to call 911 if the person experiences one generalized seizure as described above, unless the person is known to have diabetes or is pregnant or if it is known that it is a first time seizure. The instructor should report the seizure to a family member, friend, or institutional representative who can help determine whether a doctor should be seen to evaluate the seizure. Immediate medical follow-up is necessary for a first-time seizure.
It is necessary to obtain emergency medical help if the convulsive phase of a seizure lasts five minutes or more or the following event occurs:
This name describes persistent or recurring seizures of the GTC type. It is a medical emergency because prolonged and repetitive seizure activity will endanger the person’s life and likely cause new brain injury. There may be several minutes of quiet between recurring seizures, during which the person is not fully conscious.
What to Do: In addition to making the person safe and comfortable, it is important to note the time convulsing begins and ends and to stay with a person until she or he is fully alert and oriented, in order to (1) determine how long a seizure lasts and (2) observe any subsequent seizures. Once convulsing reaches 5 minutes without interruption or a second seizure begins, 911 should be called. Observations should be reported to the person taking the call. If additional seizures occur before help arrives, be sure to report them.
This type is often labeled petit mal seizure because it is brief and significantly less dramatic than a GTC. It is, however, a generalized seizure during which the person is not conscious of self or environment. It begins and ends abruptly and during its short duration, the person may appear to stare and to demonstrate non-purposeful eye movements such as blinking, chewing or rolling the eyes. It is more common in children. When the seizure ends, there is no memory of it, but also no confusion. The person is able to resume what he or she was doing.
Symptoms of an absence seizure may be interpreted as inattention or daydreaming. An instructor can discern the difference by trying to get the person’s attention when they appear “absent” and noting any facial movement or non-responsiveness that suggests a seizure of this type.
What to Do: Investigate the person’s medical history by asking the student or someone close to the person or by requesting permission to obtain a medical record. If no history of seizure disorder is reported, refer the student to a physician for assessment.
These are focal seizures, because they involve specific areas of the brain. The person experiencing them does not completely lose consciousness. Partial seizures are the most common type of seizure. A wide range of movements, emotions, and sensory experiences may be associated with them. Symptoms vary by the anatomic region from which they originate; but for most people with recurring partial seizures, the form they take becomes typical for that person.
Complex Partial Seizure
A complex partial seizure can last up to three minutes during which the person is not fully alert and aware. Communication is compromised. The person is unlikely to fall and he or she may even walk around. Movements are purposeless and repetitive and can take a variety of forms—for example, a blank stare, mumbling, grimacing, fumbling with the hands. The person may show strong emotions such as fear and may even hallucinate. The event will be followed by mild to moderate confusion and fatigue, and the person will typically not remember it clearly.
Symptoms such as these can be misconstrued as drug or alcohol intoxication, a mental disorder, or disorderly conduct, placing the person at risk of harm or arrest. The confusion and amnesia (lack of memory) that follow a complex seizure do not permit the person to account for his or her behavior. It is a good idea for someone who has such seizures (and other forms of epilepsy) to wear an identification bracelet or card to indicate the medical condition. Unfortunately, some teenagers and adults are unwilling to do so.
What to Do: Speak calmly and reassuringly to the person, guide him or her gently away from hazards, and stay with them until they are completely aware of the environment. In most cases it would be appropriate to help them get home or in a safe place.
Simple Partial Seizure
These typically last no more than 1½ minutes and there is no loss of awareness or memory for the event. Symptoms are of two main types:
- Motor involvement: In one case there is sudden, uncontrollable jerking in part of the body, usually a limb, and the person is fully aware of it. It is not to be confused with restless movement the person can control. Following the uncontrolled phase, the person may experience weakness or numbness in the affected part; but they are typically able to proceed with what they were doing.
- Sensory involvement: In the other case, senses and feelings are distorted in one form or another—e.g., the environment feels unreal; the person smells or hears things that are not there they experience unexplained fear, sadness, anger or joy, or even nausea or a “funny feeling” in the stomach. Unless the person says something to indicate a change, others may be unaware a seizure of this type is occurring.
What to do: no immediate action is required, though giving the person a chance to express his or her feelings and offering reassurance may be helpful.
- Common Features: You have been introduced to several different kinds of partial seizures. It is important to remember they all have in common these features:
- They don't last long. Most last only a minute or two, although people may be confused and need a lot more time afterwards to fully recover.
- They end naturally. Except in rare cases, the brain has its own way of bringing the seizure safely to an end in a short time.
- You can't stop them. In an emergency, a healthcare provider may use drugs to bring a lengthy or repetitive seizure to an end. However, the average person should wait for the seizure to run its course and try to protect the person from harm while consciousness is clouded.
- They are not dangerous to others. The movements produced by a seizure are almost always too vague, too unorganized and too confused to threaten the safety of anyone else.
Secondarily Generalized Seizure
A partial seizure can develop into a generalized tonic-clonic seizure (GTC) when a burst of electrical activity in a limited area (a partial seizure) spreads throughout the brain. The partial seizure can be brief, and the GTC evolves directly from it. At this point, the description and advice under GTC above applies. This phenomenon occurs in more than 30% of people with partial seizures but not all the time.
There are many more types of epileptic seizures, but the most common ones have been described in this section. All seizures involve one or more of the following:
- loss of awareness,
- loss of control over movements, which may include loss of muscle tone and numbness
- altered sensory experiences.