Q.  What is a seizure? If someone has a seizure, does that mean they have epilepsy?

     A.  Briefly stated, a seizure is the result of abnormal electrical activity in the brain. Seizures are sometimes referred to as "electrical storms". Given the right set of circumstances, or triggers, anyone can experience a seizure. A list of such "triggers" include: a blow to the head, intoxication, drug toxicity, missed medication doses, drug abuse, poor nutrition, high fever, colds, infections, illness, consumption of very large amounts of fluid, blinking or flashing lights, emotional stress, extreme fatigue, hyperventilation, hormone changes and imbalances, fear, hyperventilation, anxiety etc. A single seizure does not equal "epilepsy."  In fact, a single seizure caused by the above triggers does not mean that it will ever happen again. However, when seizures recur without any obvious triggers or cause, then a person may be considered to have epilepsy. These triggers or factors do not cause seizures, rather they are thought to lower the threshold so that seizures can occur.  A person does not cause seizures to occur at will. Nor can they consciously call up a seizure, nor control one that is already in progress. 

     Q.  Is there anything other than medication that can help prevent seizures?

     A.  Lifestyle management can go a long way toward reducing the incidence and frequency of seizures. A healthy diet, proper water intake, 64 oz. per day, regular rest breaks, avoidance of  alcohol, caffeine, stimulants, street drugs and substances, not to mention inhalants, extreme body temperatures, sleep deprivation and a host of metabolic variables (for example: blood sugar, blood oxygen level, blood minerals, hormones). Remember moderation in all things, when in doubt check with your doctor.

       Q.  What happens during a seizure?

    A generalized, convulsive seizure, also known as Grand Mal, is characterized by sudden loss of consciousness, usually without warning. At onset there is usually a general stiffening of the body, often with forceful exhalation, or breathing out, of air from the lungs, and a peculiar sound as this air passes through the throat. If the person having the seizure is standing when this happens, there can be a hard fall to ground or floor. This "tonic" phase of the seizure is generally very brief but is responsible for a number of things which often frighten observers. Virtually all muscles in the body are forcefully contracting at the same time, there may be tongue biting , passage of urine, (rarely) defecation or vomiting. Sometimes a change in color (purplish-blue) of skin, lips and fingernails due to involuntary holding of breath. This phase generally lasts about 30 seconds.

     Immediately following the "tonic" phase of a seizure, convulsing begins as forceful, rhythmic jerking of arms, legs, head and neck. This phase is variable in both forcefulness and duration, but it can last a couple of minutes, with increasing intensity and gradually subsiding. Skin, lip, fingernail color generally returns to normal during this period. 

     A state of deep sleep usually follows the tonic phase. During this period, all the muscles that were convulsing are deeply relaxed. If a person in this state is in a position which makes it hard for them to breathe, they may NOT change their own position (see following section). The folklore about people with seizures "swallowing their tongue" actually relates to the possible airway obstruction which can occur in a person who is on their back with their head flexed forward during the very sleep period after a major convulsion. 

     As the sleepiness lightens, a person recovering from a seizure may initially be confused or even hard to engage in conversation beyond a few words. The confusion more often than not passes over minutes, but the desire for a retreat to bed to sleep for a while sometimes lasts for quite a while. 

     If a generalized convulsion is prolonged (5 minutes or more) or if it is followed by a second seizure before complete recovery (person is awake and interactive), it is time to seek medical assistance. 

     Q.  Temporal Lobe Epilepsy - Complex Partial Seizures (often erroneously labeled 'petit mal') 

     The second most common form of seizure in adults is "partial" (i.e. the electrical 'storm' involves some but not all of the brain) "complex" (i.e. disturbance of consciousness). Usually the area of brain involved in the seizure activity is the temporal lobe. But other parts of the brain can give rise to seizures which fall under this heading. What most of these seizures have in common is:

     Some form of warning or "aura" with an awareness that something is about to happen. This may take the form of a mental picture, a noxious odor, an unusual sensation in the stomach, an unusual sensation of movement under the feet, the perception of a voice or music, even a particular recollection; loss of awareness without collapse unconsciousness (as if 'auto pilot' takes over).

     There may be a few minutes during  which there may be automatisms -- repetitive, non purposeful acts e.g..- lip smacking, swallowing, picking at things, garbled or semi-random speech, aimless walking or manipulation of objects. After the episode there may be a  period of confusion lasting few minutes, possibly with sleepiness, but not the deep sleep that generally follows a major convulsion. The person in this state may walk around, as if with purpose. Sometimes, aggressive behavior  may be apparent during this phase - especially if someone is attempting to passively restrain or direct movement. Such aggression,  is not well-focused, not 'thought-out' and can often be avoided by leaving the person alone for a few minutes. 

     There is total amnesia for the period of the seizure and possibly some amnesia, or loss of memory for events just preceding and following it. In some persons, this type of seizure precedes a generalized convulsion (see above) as the electrical signal spreads out from one part of the brain to the entire brain. 

     Q.  "Focal Fits" - Simple Partial Seizures

     Seizures that involve only part of the brain are known as "partial" seizures. Those that do not involve an alteration of awareness are known as, "simple seizures." Seizures commonly  follow brain trauma, such as stroke, hemorrhage, malformation, tumor. Most commonly, they involve rhythmic (2-3 cycles/second) twitching of face, hand/arm, and/or leg on the side of the body opposite the side of brain from which the seizure emanates. Generally, this type of seizure lasts for a few minutes. In some individuals, they signal the onset of a generalized or convulsive seizure. Occasionally, it can go on for a very long time hours or days.  The longer it lasts, the greater the resultant fatigue. Extremely prolonged versions of this seizure type can interfere with sleep, cause muscle pain and lead to exhaustion. 

     Q.   Other Seizure Types

     The true "petite mal" seizure type, also known as "Absence Attacks" or technically, "Primary Generalized Seizures - Absence Type," occurs almost exclusively in children. 

     Absence seizures are characterized by abrupt and brief interruption of consciousness without convulsion. During the typical, seconds-long episode there is "loss of contact", "spacing out" rarely with chewing, swallowing, or blinking automatisms. Sometimes an individual continues doing whatever they were doing at seizure onset, though in an automatic way. During the episode, interaction is not possible. These episodes
can be very brief, subtle and easily missed by a nearby observer. Normally, whatever activity a child was engaged in before the seizure is continued following it. Sometimes children with these seizure types are misdiagnosed with learning or behavioral problems. 

     There are a host of seizure types which are seen only in children or infants, for more information on these and other seizure types visit the following resources: