Epilepsy

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from Epilepsy Action, UK, a community of people committed to a better life for everyone affected by epilepsy. Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

What is epilepsy?

If you have epilepsy, it means you have a tendency to have epileptic seizures. But what are epileptic seizures?

Electrical activity is happening in our brain all the time, as networks of tiny brain cells send messages to each other. These messages control all our thoughts, movements, senses and body functions. A seizure happens when there is a sudden, intense burst of electrical activity in the brain, which causes the messages between cells to get mixed up. The result is an epileptic seizure.

How a seizure affects you depends on what area of the brain is involved in this intense electrical activity. You might lose consciousness, or you might stay aware of what's happening around you. You might have strange sensations, or movements you can't control. Or you might go stiff, fall to the floor and shake.

Some people only have one type of seizure, and some people have more than one type.

Seizure classification

There are many different types of epileptic seizure. Seizure classification is a way of naming different types of epileptic seizures and putting them into groups. It's important for healthcare professionals to all use the same names for seizures to avoid confusion. Being able to recognise and name a seizure accurately is also important, because some medicines and treatments can help some seizure types but not others.

How has seizure classification changed?

The International League Against Epilepsy (ILAE) is a world-wide organisation of epilepsy professionals. In 2017 they announced a different way of organising and naming seizures. Many of the names for seizures are the same as before. But the ILAE has also introduced some new names for seizures, for example focal aware instead of simple partial. The new names don't change what happens during seizures, but they do give doctors a more accurate way to describe them.

How does the new seizure classification work?

To name a seizure using the new classification, doctors look at 3 things:

• Where in your brain the seizure starts
• Your level of awareness during the seizure
• Whether the seizure involves movement or not

1. Where the seizure starts (the onset)

Seizures can be either focal onset, generalised onset, or unknown onset:

Focal onset: Focal onset means the seizure starts in just one side of the brain. These seizures used to be called partial seizures. Sometimes, a seizure can start as a focal seizure and then spread to involve both sides of the brain. When this happens, it's called a focal to bilateral tonic-clonic seizure.

Generalised onset: Generalised onset means the seizure affects both sides of the brain from the start.

Unknown onset: Unknown onset means the beginning of the seizure is not clear. As doctors get more information about the seizure, they may be able to decide if it is focal or generalised in onset.

Rarely, doctors might be sure that someone has had an epileptic seizure, but can't decide what type of seizure it is. This could be because they don't have enough information about the seizure, or the symptoms of the seizure are unusual. When this happens, it's called an unclassified seizure.

2. The level of awareness

Focal onset seizures can be put into one of 2 groups depending on what level of awareness you have during the seizure:

Focal aware: During a focal aware seizure, you stay fully aware of what's happening around you, even if you can't talk or respond. These seizures used to be called simple partial seizures.

Focal impaired awareness: If your awareness is affected at any time during a focal seizure, it's called a focal impaired awareness seizure. This replaces the term complex partial seizure.

Generalised onset seizures almost always affect your awareness in some way, so the terms 'aware' or 'impaired awareness' aren't used for them.

3. Whether the seizure involves movement or not

Seizures can also be split into motor seizures, which means they involve movement, or non-motor seizures, which means they don't involve movement:

Motor seizures: A motor seizure is any seizure that involves a change in your movement. For example, a tonic-clonic seizure – where all your muscles go stiff before making rhythmic jerking movements – is a type of motor seizure.

Focal seizures can also be motor seizures if the main symptom involves movement, for example automatic behaviour like plucking at clothes or repeated swallowing.

Non-motor seizures: A non-motor seizure is any seizure that doesn't involve changes in movement. A focal seizure where your main symptom is a change in vision, smell or hearing is a type of non-motor seizure. Absence seizures are also non-motor seizures.

Additional information

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the National Health Service (NHS), the public health services in the United Kingdom. Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Epilepsy is a common condition that affects the brain and causes frequent seizures.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. They can cause a wide range of symptoms.

Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong but can sometimes get slowly better over time.

Symptoms of epilepsy

Seizures can affect people in different ways, depending on which part of the brain is involved.

Possible symptoms include:

• Uncontrollable jerking and shaking – called a "fit"
• Losing awareness and staring blankly into space
• Becoming stiff
• Strange sensations – such as a "rising" feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or legs
• Collapsing
• Sometimes you might pass out and not remember what happened.

The main symptom of epilepsy is repeated seizures. These are sudden bursts of electrical activity in the brain that temporarily affect how it works.

Seizures can affect people in different ways, depending on which part of the brain is involved.

Some seizures cause the body to jerk and shake (a "fit"), while others cause problems like loss of awareness or unusual sensations. They typically pass in a few seconds or minutes.

Seizures can occur when you're awake or asleep. Sometimes they can be triggered by something, such as feeling very tired.

Types of seizures

Simple partial (focal) seizures or 'auras'

A simple partial seizure can cause:

• A general strange feeling that's hard to describe
• A "rising" feeling in your tummy – like the sensation in your stomach when on a fairground ride
• A feeling that events have happened before (déjà vu)
• Unusual smells or tastes
• Tingling in your arms and legs
• An intense feeling of fear or joy
• Stiffness or twitching in part of your body, such as an arm or hand

You remain awake and aware while this happens.

These seizures are sometimes known as "warnings" or "auras" because they can be a sign that another type of seizure is about to happen.

Complex partial (focal) seizures

During a complex partial seizure, you lose your sense of awareness and make random body movements, such as:

• Smacking your lips
• Rubbing your hands
• Making random noises
• Moving your arms around
• Picking at clothes or fiddling with objects
• Chewing or swallowing

You won't be able to respond to anyone else during the seizure and you won't have any memory of it.

Tonic-clonic seizures

A tonic-clonic seizure, previously known as a "grand mal", is what most people think of as a typical epileptic fit.

They happen in two stages – an initial "tonic" stage, shortly followed by a second "clonic" stage:

Tonic stage: You lose consciousness, your body goes stiff, and you may fall to the floor.

Clonic stage: Your limbs jerk about, you may lose control of your bladder or bowel, you may bite your tongue or the inside of your cheek, and you might have difficulty breathing.

The seizure normally stops after a few minutes, but some last longer. Afterwards, you may have a headache or difficulty remembering what happened and feel tired or confused.

Absences

An absence seizure, which used to be called a "petit mal", is where you lose awareness of your surroundings for a short time. They mainly affect children, but can happen at any age.

During an absence seizure, a person may:

• Stare blankly into space
• Look like they're "daydreaming"
• Flutter their eyes
• Make slight jerking movements of their body or limbs

The seizures usually only last up to 15 seconds and you won't be able to remember them. They can happen several times a day.

Myoclonic seizures

A myoclonic seizure is where some or all of your body suddenly twitches or jerks, like you've had an electric shock. They often happen soon after waking up.

Myoclonic seizures usually only last a fraction of a second, but several can sometimes occur in a short space of time. You normally remain awake during them.

Clonic seizures

Clonic seizures cause the body to shake and jerk like a tonic-clonic seizure, but you don't go stiff at the start. They typically last a few minutes and you might lose consciousness.

Tonic seizures

Tonic seizures cause all your muscles to suddenly become stiff, like the first stage of a tonic-clonic seizure. This might mean you lose balance and fall over.

Atonic seizures

Atonic seizures cause all your muscles to suddenly relax, so you may fall to the ground. They tend to be very brief and you'll usually be able to get up again straight away.

Status epilepticus

Status epilepticus is the name for any seizure that lasts a long time, or a series of seizures where the person doesn't regain consciousness in between.

It's a medical emergency and needs to be treated as soon as possible.

You can be trained to treat it if you look after someone with epilepsy. If you haven't had any training, call for an ambulance immediately if someone has a seizure that hasn't stopped after five minutes.

Seizure triggers

For many people with epilepsy, seizures seem to happen randomly.

But sometimes they can have a trigger, such as:

• Stress
• Lack of sleep
• Waking up
• Drinking alcohol
• Some medications and illegal drugs
• In women, monthly periods
• Flashing lights (this is an uncommon trigger)

Keeping a diary of when you have seizures and what happened before them can help you identify and avoid some possible triggers.

_______________________________________________________________________________________________________________________

Are you a healthcare practitioner who enjoys patient education, interaction and communication?

If so, we invite you to criticise, contribute to or help improve our content. We find that many practicing doctors who regularly communicate with patients develop novel and often highly effective ways to convey complex medical information in a simplified, accurate and compassionate manner.

MedSquirrel is a shared knowledge, collective intelligence digital platform developed to share medical expertise between doctors and patients. We support collaboration, as opposed to competition, between all members of the healthcare profession and are striving towards the provision of peer reviewed, accurate and simplified medical information to patients. Please share your unique communication style, experience and insights with a wider audience of patients, as well as your colleagues, by contributing to our digital platform.

Your contribution will be credited to you and your name, practice and field of interest will be made visible to the world. (Contact us via the orange feed-back button on the right).