Introduction

Seizures happen when the electrical system of the brain malfunctions. Instead of discharging
electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of
energy through the brain, causing unconsciousness and contractions of the muscles.

If only part of the brain is affected, it may cloud awareness, block normal communication, and
produce a variety of undirected, uncontrolled, unorganized movements.

Most seizures last only a minute or two, although confusion afterwards may last longer. An
epilepsy syndrome is defined by a collection of similar factors, such as type of seizure, when
they developed in life, and response to treatment.

The Brain and Epilepsy

The human brain is the source of human epilepsy. Although the symptoms of a seizure may
affect any part of the body, the electrical events that produce the symptoms occur in the brain.
The location of that event, the extent of its reach with the tissue of the brain, and how long it
lasts all have profound effects.

Types of Seizures

There are many different types of seizures. People may experience just one type or more than
one. The kind of seizure a person has depends on which part and how much of the brain is
affected by the electrical disturbance that produces seizures. Experts divide seizures into
generalized seizures (absence, atonic, tonic-clonic, myoclonic), partial (simple and complex)
seizures, nonepileptic seizures and status epilepticus.

Epilepsy Syndromes

Classifying epilepsy by seizure type alone leaves out other important information about the
patient and the episodes themselves. Classifying into syndromes takes a number of
characteristics into account, including the type of seizure; typical EEG recordings; clinical
features such as behavior during the seizure; the expected course of the disorder; precipitating
features; expected response to treatment, and genetic factors. Find out more about epilepsy
syndromes.

Causes of Epilepsy
Seizures are symptoms of abnormal brain function. With the exception of very young children
and the elderly, the cause of the abnormal brain function is usually not identifiable. In about
seven out of ten people with epilepsy, no cause can be found. Among the rest, the cause may be
any one of a number of things that can make a difference in the way the brain works. Head
injuries or lack of oxygen during birth may damage the delicate electrical system in the brain.
Other causes include brain tumors, genetic conditions (such as tuberous sclerosis), lead
poisoning, problems in development of the brain before birth, and infections like meningitis or
encephalitis. Find out more about causes of epilepsy.

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Seizure Triggers

Some people who have epilepsy have no special seizure triggers, while others are able to
recognize things in their lives that do affect their seizures. Keep in mind, however, that just
because two events happen around the same time doesn't mean that one is the cause of the other.
Generally, the most frequent cause of an unexpected seizure is failure to take the medication as
prescribed. That's the most common trigger of all. Other factors include ingesting substances,
hormone fluctuations, stress, sleep patterns and photosensitivity.

Types of Seizures
can prescribe the right treatment, he or she must figure out which type (or types) you have. That's
the purpose of all the tests discussed in the Diagnosis sectionnot just to tell whether you have
epilepsy but also to tell what kind.

There are so many kinds of seizures that neurologists who specialize in epilepsy are still
updating their thinking about how to classify them. Usually, they classify seizures into two types,
primary generalized seizures and partial seizures. The difference between these types is in how
they begin:

Primary generalized seizures

Primary generalized seizures begin with a widespread electrical discharge that involves both
sides of the brain at once. Hereditary factors are important in many of these seizures.

Partial seizures
Partial seizures begin with an electrical discharge in one limited area of the brain. Some are
related to head injury, brain infection, stroke, or tumor, but in most cases the cause is unknown.

One question that is used to further classify partial seizures is whether consciousness (the ability
to respond and remember) is "impaired" or "preserved." The difference may seem obvious, but
really there are many degrees of impairment or preservation of consciousness.

Identifying certain seizure types and other characteristics of a person's epilepsy like the age at
which it begins, for instance, allows doctors to classify some cases into epilepsy syndromes. This
kind of classification helps us to know how long the epilepsy will last and the best way to treat it.

Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of
the seizure. They produce loss of consciousness, either briefly or for a longer period of time, and
are sub-categorized into several major types: generalized tonic clonic; myoclonic; absence; and
atonic.

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Prolonged or Serial Seizures
(Status Epilepticus)

Convulsive status epilepticus is a medical emergency.

10 percent of patients who develop epilepsy have status as their first seizure
25 percent of status occurs in patients with epilepsy

15 percent of persons with epilepsy experience status epilepticus

Most seizures end after a few moments or a few minutes. If seizures are prolonged, or occur in
a series, there is an increased risk of status epilepticus. The term literally means a continuous
state of seizure.

Status epilepticus is usually defined as 30 minutes of uninterrupted seizure activity. However,

the Epilepsy Foundation advises parents and
the public to call for emergency assistance Precipitants of Status Epilepticus in
when a convulsion continues for more than 5 Children and Adults
minutes without signs of stopping. The
experts who comprise the Foundation's
Working Group on Status Epilepticus have Children <
Adults
recommended that emergency room 16 years
physicians treat as status epilepticus if seizure (Percent)
(Percent)
activity has continued for more than 10
minutes.
Fever/Infection 35.7 4.6
Convulsive status epilepticus is a medical
emergency. An estimated 42,000 deaths and
Medication
thousands more instances of brain damage per 19.8 18.9
year follow episodes of status. The majority of Change
these episodes occur in people who do not
have epilepsy but have other acute medical Unknown 9.3 8.1
illnesses, such as brain tumors or infections,
craniocerebral trauma, or cerebrovascular
disease. Ingestion of cocaine or other illegal Metabolic 8.2 8.8
drugs, and toxic or metabolic disorders, can
also trigger a status episode.
Congenital 7.0 0.8
Death or brain damage from status seizures
(as opposed to death from the underlying
Anoxia 5.3 10.7
cause) is most likely to result from:

Direct damage to the brain caused by CNS Infection 4.8 1.8

the injury that causes the seizures
Stress on the system from repeated
generalized tonic clonic seizures Trauma 3.5 4.6

Injury from repeated electrical

discharge in the brain. Cerebrovascular 3.3 25.2

About 25 percent of status epilepticus cases

Ethanol/Drug-
occur in people who have been diagnosed 2.4 12.2
with epilepsy. At some point in their lives, 15 related
percent of people with epilepsy will
experience an episode of status epilepticus. Tumor 0.7 4.3
The most common precipitating factor in these
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cases in adults is withdrawal from medication or noncompliance with the regimen. There
may,however, be no obvious cause for the episode. Ten percent of people who later progress
to epilepsy experience their first seizure as a status episode.

Status epilepticus is most common in the very young and the very old, with the lowest
incidence at ages 15-40. In the very young, febrile seizures are a leading cause of status
epilepticus. In middle-aged adults, single, unprovoked episodes of status are common; later in
life, stroke is a common cause.

In all cases, prompt treatment is the key to preventing serious outcomes. The goal of treatment
is to stop the seizure activity as quickly as possible and treat any underlying precipitant.
Mortality in children and adults is minimized when status lasts less than one hour. After an
hour it increases slightly in children but jumps dramatically to close to 38% in adults.

Any type of epileptic seizure can progress to status epilepticus, but convulsive status has the
greatest potential for long-term damage. Nonconvulsive status includes continuous absence
seizures and partial status epilepticus, including status involving simple partial seizures (called
epilepsia partialis continua). Nonconvulsive status can present in various ways, including loss
of speech, automatisms, and alteration of consciousness.

While not generally viewed as being as damaging as convulsive status, nonconvulsive status
involves repeated excessive electrical discharges in the brain and should also receive prompt
treatment.

Hospital treatment of convulsive status epilepticus generally includes use of such drugs as
diazepam, lorazepam, phenytoin and phenobarbital, administered in a planned sequence.

Rectal diazepam gel (Diastat) may be prescribed for at-home or non-hospital use to stop bouts
of prolonged seizures or clusters of acute repetitive seizures in people with a history of this
type of seizure.

Partial Seizures

Partial seizures are the most common type of seizure experienced by people with epilepsy.

In partial seizures the electrical disturbance is limited to a specific area of one cerebral
hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in
which consciousness is retained); and complex partial seizures (in which consciousness is
impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the
classification category is partial seizures secondarily generalized.

Partial seizures are the most common type of seizure experienced by people with epilepsy.
Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure,
including complex visual or auditory hallucinations.

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Simple Partial Seizures

'People who have simple partial seizures do not lose consciousness. However, movement,
emotions, sensations, and feelings can be affected.'

People who have simple partial seizures do not lose consciousness during the seizure.
However, some people, although fully aware of what's going on, find they can't speak or move
until the seizure is over.

They remain awake and aware throughout. Sometimes they can talk quite normally to other
people during the seizure. And they can usually remember exactly what happened to them
while it was going on.

However, simple partial seizures can affect movement, emotion, sensations, and feelings in
unusual and sometimes even frightening ways.

Figure at left: A simple partial seizure with motor symptoms. Here the neuronal discharge
begins in the motor strip in the right hemisphere of the brain, affecting first one muscle then
another on the left side of the body as it spreads. In (a) first the fingers then the hand and arm
are jerking. In (b) it has spread to the upper shoulder. In (c) the woman's head is drawn
towards her shoulder. In (d) the leg is drawn up. The woman remains conscious but unable to
prevent her muscles' response to the excessive stimulation they are receiving from her brain.

Movement: Uncontrolled movements can occur in just about any part of the body. Eyes may
move from side to side; there may be blinking, unusual movements of the tongue, or twitching
of the face.

Some simple partial seizures start out with shaking of a hand or foot which then spreads to
involve an arm or a leg or even one whole side of the body.

Emotions: A sudden feeling of fear or a sense that something terrible is about to happen may
be caused by a simple partial seizure in the part of the brain which controls those emotions.

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In rare cases, partial seizures can produce feelings of anger and rage, or even sudden joy and
happiness.

Sensations: All five senses -- touch, hearing, taste, smell, and sight -- are controlled by
various areas of the brain.

Simple partial seizures in these areas can produce odd sensations such as a sense of a breeze
on the skin; unusual hissing, buzzing or ringing sounds; voices that are not really there;
unpleasant tastes; strange smells (also usually unpleasant); and, perhaps most upsetting of all,
distortions in the way things look.

For example, a room may suddenly seem narrower, or wider, than it really is. Objects may
seem to move closer or get farther away. Part of the body may appear to change in size or
shape.

If the area of the brain involved with memory is affected, there may be disturbing visions of
people and places from the past.

Sudden nausea or an odd, rising feeling in the stomach is quite common. Stomach pain also
may, in some cases, be caused by simple partial seizures.

Episodes of sudden sweating, flushing, becoming pale, or having the sensation of gooseflesh
are also possible.

Some people even report having out of body experiences during this type of seizure. Time
may seem distorted as well.

In many ways, our usual, comfortable sense of familiar things and places may be disrupted by
a simple partial seizure.

Well-known places may suddenly look unfamiliar. On the other hand, new places and events
may seem familiar or as if they've happened before, a feeling called dj vu.

Simple partial seizures can also produce sudden, uncontrolled bursts of laughter or crying.

Complex Partial Seizures

First Aid for Complex Partial Seizures

Do not restrain the person.
Remove dangerous objects from the person's path.

Calmly direct the person to sit down and guide him or her from dangerous situations. Use
force only in an emergency to protect the person from immediate harm, such as walking
in front of an oncoming car.
Observe, but do not approach, a person who appears angry or combative.
Remain with the person until he or she is fully alert.

'During a complex partial seizure, a person cannot interact normally with other people.'

Complex partial seizures affect a larger area of the brain than simple partial seizures and
they affect consciousness.

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During a complex partial seizure, a person cannot interact normally with other people, is not in
control of his or her movements, speech or actions; doesn't know what he or she is doing; and
cannot remember afterwards what happened during the seizure.

Although someone may appear to be conscious because he or she remains standing with eyes
open and moving about, it will be an altered consciousness - a dreamlike, almost trancelike state.

A person may even be able to speak, but the words are unlikely to make sense and he or she will
not be able to respond to others in an appropriate way.

Although complex partial seizures can affect any area of the brain, they often take place in one of
the brain's two temporal lobes. Because of this, the condition is sometimes called "temporal lobe
epilepsy."

"Psychomotor epilepsy" is another term doctors may use to describe complex partial seizures.

Typically, a complex partial seizure starts with a blank stare and loss of contact with
surroundings.

This is often followed by chewing movements with the mouth, picking at or fumbling with
clothing, mumbling and performing simple, unorganized movements over and over again.

Sometimes people wander around during complex partial seizures. For example, a person might
leave a room, go downstairs and out into the street, completely unaware of what he or she was
doing.

In rare cases, a person might try to undress during a seizure, or become very agitated, screaming,
running or making flailing movements with his arms or bicycling movements with his legs.

Other complex partial seizures may cause a person to run in apparent fear, or cry out, or repeat
the same phrase over and over again.

Actions and movements are typically unorganized, confused and unfocused during a complex
partial seizure.

However, if a complex partial seizure suddenly begins while someone is in the middle of a
repetitive action like dealing cards or stirring a cup of coffee he or she may stare for a
moment then continue with the action during the seizure, but in a mechanical, unorganized kind
of way.

Safety Issues

Partial seizures take many forms and medical treatment does not always control them. People
who live with frequent complex partial seizures may face many challenges. One involves
personal safety.

Things like fire, heat, water, heights, certain machinery and sharp objects are all potential
hazards when people are unaware of what theyre doing and dont feel pain.

However, there may be ways to reduce obvious risks. For example:

Using a microwave oven for cooking instead of a gas or electric range;

Taking plates to the oven or stove to serve oneself to avoid having to carry pans of hot
food or liquid;
Using a regular knife for carving, not an electric knife or, if possible, leaving the carving
to someone else;
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 Keeping electric mixers and other electric appliances far away from the sink or source of
water;
Setting the water heater low enough to prevent scalding during a seizure and taking sit
down showers if drop attacks are frequent;
Making sure open fires have guards and that electric or other space heaters cant be
tipped over;
Not smoking and not carrying lighted candles or hot ashes from the fireplace through the
house;
Limiting ironing as much as possible;
Padding sharp corners and carpeting floors.

Although some risks can be limited, others are accepted with partial seizures as part of living a
normal life.

Public Understanding

Every day, people living with this type of epilepsy go to work, take care of their children, take
part in sports, ride buses, cross busy streets, go on escalators, wait for trains and perhaps most
difficult of all risk having a seizure in front of a public that too often does not understand.

Dealing with the reactions of others may be the biggest challenge of all for people with complex
partial seizures. Thats because many people find it hard to believe or accept that behavior which
looks deliberate may not be.

Lack of public understanding has led to people with complex partial seizures being unfairly
arrested as drunk or disorderly, being accused by others of unlawful activity, indecent exposure
or drug abuse all because of actions produced by seizures.

Such actions may even be misdiagnosed as symptoms of mental illness, leading to inappropriate
treatment and, in some cases, commitment to an institution.

http://www.epilepsyfoundation.org/about/types/index.cfm

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