Epilepsy

Symptoms of epilepsy 

Brain cells and nerves normally conduct electrical signals in a controlled and coordinated way, when they are active. Seizures, caused by epilepsy, are due to abnormal uncoordinated electrical activity in the brain.

The type, frequency, duration and severity of seizures can differ from person to person. The symptoms experienced during a seizure depend on where the abnormal electrical activity in the brain is, and the extent to which it spreads. 

Seizures may lead to a person experiencing changes to:

• consciousness
• behaviour
• emotion
• muscle activity or sensation

Seizures can occur when you are awake or asleep.

Doctors classify seizures by how much of the brain is affected. There are:

• partial (or focal) seizures – where only a small part of the brain is affected
• generalised seizures – where most or all of the brain is affected

Some seizures do not fit into these categories and are known as unclassified seizures.

Partial seizures 

There are two main types of partial seizure.

Simple partial seizures

Simple partial seizures are where you stay fully conscious throughout.

Symptoms of a simple partial seizure can include:

• a general strange feeling that is hard to describe
• a ‘rising’ feeling in your tummy – sometimes likened to the sensation in your stomach when on a fairground ride
• an intense feeling that events have happened before (déjà vu)
• experiencing an unusual smell or taste
• a tingling sensation, or ‘pins and needles’, in your arms and legs
• a sudden intense feeling of fear or joy
• stiffness or twitching in part of the body, such as an arm or hand

These seizures can occur in isolation, but sometimes they can be a sign that another type of seizure is on its way, and are described as "warnings" or "auras". This can give a person experiencing them time to warn people around them and make sure they are in a safe place before suffering a complex seizure.

Complex partial seizures

Complex partial seizures are when you lose your sense of awareness and can’t remember what happened after the seizure has passed.

During a complex partial seizure, a person will be unresponsive and may display unusual and random bodily behaviour, such as:

• smacking their lips
• rubbing their hands
• making random noises
• moving their arms around
• picking at clothes
• fiddling with objects
• adopting an unusual posture
• chewing or swallowing repeatedly, though not eating anything

A person experiencing a seizure like this will not be able to respond to anyone else during the seizure, and will have no memory of the event afterwards.

Generalised seizures 

There are six main types of generalised seizure.

Absences

• Absence seizures, which used to be called ‘petit mal’, mainly affect children, but they also occur in adults
• They cause the person to lose awareness of their surroundings, usually for up to 15 seconds - the person will seem to stare vacantly into space, although some people will flutter their eyes or smack their lips
• The person will have no memory of the seizure
• Absences can occur several times a day - they may affect a child's performance at school, and can be dangerous if they occur at a critical time, such as crossing a busy road

Myoclonic seizures

• Myoclonic seizures cause a person’s arms, legs or upper body to jerk or twitch, as if they have received an electric shock
• The seizures often only last for a fraction of a second, and the person will normally stay conscious during this time
• Myoclonic jerks often happen in the first few hours after waking up and can occur in combination with other types of generalised seizures

Clonic seizures

• Clonic seizures cause the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to two minutes
• Loss of consciousness may also occur

Atonic seizures

• Atonic seizures cause all of the person’s muscles to suddenly relax, so there is a chance they may fall to the ground and there is a risk they could suffer an injury

Tonic seizures

Tonic seizures cause all the person’s muscles to suddenly become stiff, which can mean they lose balance and fall over. Like atonic seizures, there is a risk of injury.

Tonic-clonic seizures

Tonic-clonic seizures or convulsions, which used to be known as ‘grand mal’, have two stages.

• The body will at first become stiff and then their arms and legs will begin twitching
• They will lose consciousness -  sometimes the person will wet themselves or be injured while unconscious (seizures normally lasts a few minutes, but can last longer)

This type of seizure is what most people think of as an epileptic fit.

What to do if someone has a seizure 

If you see someone having a seizure, there are simple things you can do to help.

Tonic-clonic seizures

If you are with someone who has a tonic-clonic seizure:

• protect them from injury by removing any dangerous or potentially harmful objects nearby, and cushioning their head with your hands or soft material
• do not restrain them or try to move them (unless they are in immediate danger) and don't put anything in their mouth
• stay calm, and stay with them until they regain consciousness

When the convulsions have stopped, put them into the recovery position until they have recovered.

Other types of seizure

If someone is having one of the other types of seizure:

• protect them from injury by removing any dangerous or potentially harmful objects nearby, and cushioning their head with your hands or soft material
• only try to move them if they are in immediate danger
• stay with them and comfort them until they have fully recovered

When to seek medical help 

It will not usually be necessary to call an ambulance after a seizure. However, you should call 999 if:

• the seizure has not stopped after five minutes
• the person has more than one seizure without recovering in between
• you know it is the person's first seizure
• the person is injured, has breathing problems, or needs emergency medical attention for any other reason
• the person’s behaviour after a seizure is unsafe

Status epilepticus 

Status epilepticus is the name for any seizure that lasts longer than 30 minutes, or a series of seizures where the person does not regain consciousness in between for longer than 30 minutes. This is a medical emergency and requires treatment as soon as possible.

You can be trained to treat status epilepticus if you care for someone with epilepsy. However, if you haven't had any training, it is important to call 999 for an ambulance immediately if you suspect status epilepticus.

How epilepsy is treated 

For most people with epilepsy, treatment with medications called anti-epileptic drugs is recommended. These medications cannot cure epilepsy, but they are often very effective in controlling seizures.

It can take some time to find the right type and correct dose of anti-epileptic drugs before your seizures can be controlled.

In a few cases, surgery may be used to treat a specific area of the brain that is affected or to install an electrical device that can help control seizures.

Causes of epilepsy

Epilepsy can start at any age, but it most often begins during childhood.

It's often not possible to identify a specific reason why someone develops the condition, although some cases – particularly those that occur later in life – are associated with damage to the brain.

For example, epilepsy can be caused by strokes, brain tumours and severe head injuries.

Some cases of epilepsy may be caused by changes in the brain that occur as a result of the genes you inherit from your parents.

Living with epilepsy 

While epilepsy is different for everyone, there are some general rules that can make living with the condition easier.

It's important to stay healthy through regular exercise, getting enough sleep, eating a balanced diet and avoiding excessive drinking.

You may have to think about your epilepsy before you do things such as driving, using contraception and planning a pregnancy.

Advice is available from your GP or support groups to help you adjust to life with epilepsy.

• Find out more about epilepsy on the NHS website

More useful links

• Epilepsy action
• Epilepsy society
• How to use your health services