Epilepsy

Epilepsy


I have two types of seizures: grand mal and partial complex.

Grand mal seizure is caused by abnormal electrical activity throughout the brain, so signs and symptoms typically involve the entire body. In some cases, this type of seizure is triggered by other health problems, such as extremely low blood sugar or kidney failure. However, most grand mal seizures occur as a result of epilepsy.

Grand mal seizure affects all ages. This variety of seizure can occur just once or may recur throughout life. It takes at least two seizures to justify a diagnosis of epilepsy. Daily anti-seizure medications can control grand mal episodes for most peopleGrand mal seizures have two stages.

SYMPTOMS OF A GRAND MAL SEIZURE

* Tonic phase. Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down. A period of rigidity follows.
* Clonic phase. The muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes.

The following signs and symptoms occur in some but not all people with grand mal seizures.

* Aura. Some people experience a warning feeling (aura) before a grand mal seizure.
* Loss of bowel and bladder control. This may happen during or following a seizure.
* Unresponsiveness after convulsions. Unconsciousness may persist for a few minutes.
* Confusion. A period of disorientation often follows a grand mal seizure.
* Fatigue. Sleepiness is common after a grand mal seizure.
* Severe headache. Headaches are common but not universal after grand mal seizures.

Complications:

People with epilepsy should be supervised when they take baths or swim, because there is a real risk of drowning if a seizure occurs when you're in the water. Seizures also can produce injuries associated with falling, such as a head injury. Sometimes, the force of the seizure itself results in injury. In extreme cases, seizures can be fatal, particularly if medication is not taken consistently or properly.

A seizure that produces either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Many states have licensing restrictions related to your ability to control seizures. For children, seizure disorders may result in limitations on physical activities in school.




Complex partial seizures (psychomotor seizures) are called "complex" because they impair consciousness and "partial" because they begin in a limited area of the brain. Most complex partial seizures are associated with some automatic behaviors, termed automatisms.

The chance of bodily injury during a complex partial seizure is small. Single and brief complex partial seizures do not damage the brain. Prolonged or repetitive complex partial seizures may cause slight but persistent memory loss, but more serious brain injury is rare.

During a complex partial seizure, the person usually becomes motionless and stares or makes automatic movements such as fumbling movements of the hands. When someone has a complex partial seizure, speak quietly and in a reassuring manner, because some persons have only partial impairment of consciousness and can react to emotional or physical stimulation. Do not yell at the person, or restrain him or her unless absolutely necessary, which is rare. The most important aspect of first aid during a complex partial seizure is to keep the person safe from harm. For example, burns can occur when someone unknowingly touches or falls on a hot object. During and after some complex partial seizures, the person may walk or, in rare cases, run. When this occurs where there is dangerous equipment, on a busy city street, near train tracks, or near high places such as a construction site, there is a potential for serious injury.

Other behaviors during complex partial seizures may cause concern, but are not dangerous to the patient or other people. These include screaming, kicking, ripping up papers, disrobing, sexual-like movements, and, rarely, masturbation. If someone is known to have unusual automatisms, he or she should be led in a quiet and reassuring manner-not forcibly-out of public places, such as an office or store. Specific strategies should be devised to minimize the embarrassing effects for individuals with such unusual complex partial seizures.

The greatest danger of an unexpected seizure occurs when the person is driving a car or operating dangerous equipment. Those with seizures that impair consciousness or control of movement should avoid these activities as directed by their physician or state driving laws. In some cases, potentially dangerous equipment can be used safely if adequate precautions are taken.

If the seizure is prolonged (more than 5 to 10 minutes of impaired consciousness with automatisms), or if there are two or more complex partial seizures without return of consciousness between seizures, then medical help should be sought. If the patient is known to have a pattern of prolonged or recurrent complex partial seizures, rectal diazepam (Diastat) can be administered at home by family members to stop the seizures. First aid for someone having a complex partial seizure is simple: keep the person away from dangerous situations, use restraint only if it is necessary for his or her safety, and seek medical help for prolonged or recurrent seizures.

What are they like?

Here's a typical story: "Harold's spells begin with a warning; he says he's going to have a seizure and usually sits down. If I ask him how he feels, he just says 'I feel it.' Then he makes a funny face, a mixture of surprise and distress. During the seizure he may look at me when I call his name but he never answers. He just stares and makes odd mouth movements, as if he's tasting something. Sometimes he'll grab the arm of the chair and squeeze it. He may also pull at his shirt as though he's picking lint off of it. After a few minutes, when he's coming out of it, he asks a lot of questions. He never remembers his 'warning' or these questions. The seizures make him tired; if he has two in the same day, he often goes to sleep after the second one."

And another story: "Susan's seizures usually occur while she's asleep. She makes a grunting sound, as if she's clearing her throat. Then she'll sit up in bed, open her eyes, and stare. She may clasp her hands together. If I ask her what she's doing, she doesn't answer. After a minute or so, she lies down and goes back to sleep."

How long do they last?

They usually last between 30 seconds and 2 minutes. Afterward, the person may be tired or confused for about 15 minutes and may not be fully normal for hours.

Tell me more

These seizures usually start in a small area of the temporal lobe or frontal lobe of the brain. They quickly involve other areas of the brain that affect alertness and awareness. So even though the person's eyes are open and they may make movements that seem to have a purpose, in reality "nobody's home." If the symptoms are subtle, other people may think the person is just daydreaming.

Some people can have seizures of this kind without realizing that anything has happened. Because the seizure can wipe out memories of events just before or after it, however, memory lapses can be a problem.

Some of these seizures (usually ones beginning in the temporal lobe) start with a simple partial seizure. Also called an aura, this warning seizure often includes an odd feeling in the stomach. Then the person loses awareness and stares blankly. Most people move their mouth, pick at the air or their clothing, or perform other purposeless actions. These movements are called "automatisms" (aw-TOM-ah-TIZ-ums). Less often, people may repeat words or phrases, laugh, scream, or cry. Some people do things during these seizures that can be dangerous or embarrassing, such as walking into traffic or taking their clothes off. These people need to take precautions in advance.

Complex partial seizures starting in the frontal lobe tend to be shorter than the ones from the temporal lobe. The seizures that start in the frontal lobe are also more likely to include automatisms like bicycling movements of the legs or pelvic thrusting.

Some complex partial seizures turn into secondarily generalized seizures.

Who gets them?

Anybody can get them. They may be more likely in people who have had a head injury, brain infection, stroke, or brain tumor but most of the time the cause is unknown.

What's the outlook?

As for many other kinds of seizures, the outlook depends on whether the cause is known. They may be outgrown or controlled with medication. If medication is not effective, some can be eliminated by epilepsy surgery.