Introduction

Few experiences match the drama of a convulsive seizure. A person having a severe seizure may
cry out, fall to the floor unconscious, twitch or move uncontrollably, drool, or even lose bladder
control. Within minutes, the attack is over, and the person regains consciousness but is exhausted
and dazed. This is the image most people have when they hear the word epilepsy. However, this
type of seizure a generalized tonic-clonic seizure is only one kind of epilepsy. There are many
other kinds, each with a different set of symptoms.

Epilepsy was one of the first brain disorders to be described. It was mentioned in ancient
Babylon more than 3,000 years ago. The strange behavior caused by some seizures has
contributed through the ages to many superstitions and prejudices. The word epilepsy is derived
from the Greek word for "attack." People once thought that those with epilepsy were being
visited by demons or gods. However, in 400 B.C., the early physician Hippocrates suggested that
epilepsy was a disorder of the brain -- and we now know that he was right.

It is very important to recognize when the person has a seizure. You probably know some people
with epilepsy. Watching someone having an epileptic attack is very frightening. Everybody
should know more about seizures and symptoms. If a friend or family member has epilepsy, you
should know what to do in that situation. If you recognize someone having a seizure you can
help that person. Knowing what to do-and what not to do-when someone has a seizure is very
important. Seizures usually last only a few minutes and generally do not require medical
attention.

Seizures are paroxysmal episodes of sudden, involuntary muscle contractions and alterations in
consciousness, behavior, sensation, and autonomic functioning. The episodes may be partial
simple or complex or generalized absence, myoclonic, tonic, clonic, tonic-clonic and are labeled
epilepsy if they are recurrent.

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Epilepsy
Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes
signal abnormally. Neurons normally generate electrochemical impulses that act on other
neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the
normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and
behavior, or sometimes convulsions , muscle spasms, and loss of consciousness. During a
seizure, neurons may fire as many as 500 times a second, much faster than normal. In some
people, this happens only occasionally; for others, it may happen up to hundreds of times a day.

More than 2 million people in the United States -- about 1 in 100 -- have experienced an
unprovoked seizure or been diagnosed with epilepsy. For about 80 percent of those diagnosed
with epilepsy, seizures can be controlled with modern medicines and surgical techniques.
However, about 25 to 30 percent of people with epilepsy will continue to experience seizures
even with the best available treatment. Doctors call this situation intractable epilepsy. Having a
seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or
more seizures is he or she considered to have epilepsy.

Epilepsy is not contagious and is not caused by mental illness or mental retardation. Some people
with mental retardation may experience seizures, but seizures do not necessarily mean the person
has or will develop mental impairment. Many people with epilepsy have normal or above-
average intelligence. Famous people who are known or rumored to have had epilepsy include the
Russian writer Dostoyevsky, the philosopher Socrates, the military general Napoleon, and the
inventor of dynamite, Alfred Nobel, who established the Nobel Prize. Several Olympic medalists
and other athletes also have had epilepsy. Seizures sometimes do cause brain damage,
particularly if they are severe. However, most seizures do not seem to have a detrimental effect
on the brain. Any changes that do occur are usually subtle, and it is often unclear whether these
changes are caused by the seizures themselves or by the underlying problem that caused the
seizures.

While epilepsy cannot currently be cured, for some people it does eventually go away. One study
found that children with idiopathic epilepsy, or epilepsy with an unknown cause, had a 68 to 92
percent chance of becoming seizure-free by 20 years after their diagnosis. The odds of becoming
seizure-free are not as good for adults or for children with severe epilepsy syndromes, but it is
nonetheless possible that seizures may decrease or even stop over time. This is more likely if the
epilepsy has been well-controlled by medication or if the person has had epilepsy surgery.

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Causes of Epilepsy
Epilepsy is a disorder with many possible causes. Anything that disturbs the
normal pattern of neuron activity -- from illness to brain damage to abnormal
brain development -- can lead to seizures. Epilepsy may develop because of
an abnormality in brain wiring, an imbalance of nerve signaling chemicals
calledneurotransmitters, or some combination of these factors. Researchers
believe that some people with epilepsy have an abnormally high level
of excitatory neurotransmitters that increase neuronal activity, while others
have an abnormally low level of inhibitory neurotransmitters that decrease
neuronal activity in the brain. Either situation can result in too much
neuronal activity and cause epilepsy. One of the most-studied
neurotransmitters that plays a role in epilepsy is GABA, or gamma-
aminobutyric acid, which is an inhibitory neurotransmitter. Research on
GABA has led to drugs that alter the amount of this neurotransmitter in the
brain or change how the brain responds to it. Researchers also are studying
excitatory neurotransmitters such as glutamate.

In some cases, the brain's attempts to repair itself after a head injury, stroke,
or other problem may inadvertently generate abnormal nerve connections
that lead to epilepsy. Abnormalities in brain wiring that occur during brain
development also may disturb neuronal activity and lead to epilepsy.
Research has shown that the cell membrane that surrounds each neuron
plays an important role in epilepsy. Cell membranes are crucial for a neuron
to generate electrical impulses. For this reason, researchers are studying
details of the membrane structure, how molecules move in and out of
membranes, and how the cell nourishes and repairs the membrane. A
disruption in any of these processes may lead to epilepsy. Studies in animals
have shown that, because the brain continually adapts to changes in stimuli,
a small change in neuronal activity, if repeated, may eventually lead to full-
blown epilepsy. Researchers are investigating whether this phenomenon,
called kindling, may also occur in humans. In some cases, epilepsy may
result from changes in non-neuronal brain cells called glia. These cells
regulate concentrations of chemicals in the brain that can affect neuronal
signaling. About half of all seizures have no known cause. However, in other
cases, the seizures are clearly linked to infection, trauma, or other
identifiable problems.

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Symptoms of Seizure

Help required during seizures depends on: the type of the seizure, how long the seizure lasts,
how the seizure affects the person's consciousness and how severe it is.

A person watching an epileptic attack should carefully note the nature of the seizure in order to
tell the doctor. Symptoms of seizure can be motor, psychic and sensory. Motor symptoms
include recurrent involuntary muscle contractions of one body part (face, finger, hand, or arm)
that may spread to other or same-side body parts. Sensory symptoms are auditory or visual
hallucinations, paresthesias and vertigo. Psychic symptoms include sensation of deja vu,
complex hallucinations or illusions, unwarranted anger or fear, pupillary dilation and sweating.

Someone may have an aura before a seizure. An aura could include patting body parts, smacking
lips, aimless walking, picking at clothes, unintelligible muttering and staggering gait. The person
before seizure may have 1 to 2 minutes of loss of contact with surroundings, hallucinations.

Safety tips

Accidents can happen at any time to anyone. People take risks every day, but sometimes the risks
that people with epilepsy have to deal with can be different from those faced by others.

Studies show that only 1% of seizures actually result in injuries. With an awareness of potential
risks and ways in which these can be lessened, activities can be made much safer and most
people with epilepsy can live full and active lives.

Risks

Safety precautions should be sensible and relevant to the particular person involved, with a
balance between risk and restriction. The Epilepsy Association is able to provide support and
guidance to individuals, families and organisations so they can undertake sensible risk
management.

The risk of injury varies greatly and can depend on:

• Type of seizure - people who have more severe seizures, clusters of seizures or frequent
falls are at higher risk
• Frequency of seizures - someone who has many seizures a day is more at risk
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 • Age - infants, children and older persons are more susceptible to injuries and accidents
• Medications - people on multiple medications or very high doses may suffer side effects
such as drowsiness, double vision, and poor coordination
• High risk activities - participation in activities such as some sports(eg. Rock climbing)
with poor seizure control, drinking alcohol and taking drugs
• Other physical or neurological conditions - other health problems may increase individual
risk

Recreational activities are important for a healthy and happy lifestyle and people with epilepsy
should not be over protected. Some activities may need to be modified or limited for an
individual to ensure safety.

Take some time to consider your own seizure pattern and the need for modifications to activities,
and remember to enjoy life as much as you can.

How to recognize when someone is having a seizure?

Seizures may occur several times a day to one every few years. Emotional disturbances also may
cause seizures. Some people have odd visual effects (auras) before a seizure, but others have no
warning symptoms. Seizures can occur during sleep or after stimulation, as a blinking light or
sudden loud sound. Most epileptic attacks are brief. They may affect the entire body or a small
area. The muscles may contract and relax violently or only twitch slightly. Mental confusion can
last for several minutes or for hours or days. Petit mal attacks are marked by loss of
consciousness for several seconds and eye or muscle fluttering. Grand mal seizures are the
classic muscle contractions involving the entire body, loss of consciousness, and often loss of
bowel control. Seizures are often followed by drowsiness or confusion. Some seizures may
require basic first aid.

The person with generalized absence could have transient loss of consciousness, flickering of
eyelids or intermittent jerking of hands. The person with myoclonic seizures may have rapid,
jerky movements in extremities or over entire body, which may cause a fall. Someone with tonic
seizures could have sudden abnormal dystonic posture, deviation of eyes and head to one side.
The persone with clonic seizures may have symmetric jerking of extremities for several minutes
with loss of consciousness. The person with tonicclonic may have aura of epigastric discomfort,
outcry, loss of consciousness, cyanosis, fall; tonic then clonic contractions, then limpness, sleep,
headache, muscle soreness, confusion, and lethargy; loss of bowel and bladder control. The
person also could have irregular breathing and blue tinge around the mouth.

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What should you do when someone is having a seizure?

1. During seizure there are safety precautions to prevent injury, you should loosen
restrictive clothing, roll the person on side to prevent aspiration, place a small pillow
under the head and ease from a standing or sitting position to the floor.
Don't move the person unless he or she is in immediate danger.
2. If the person is unconscious, make sure nothing is obstructing the nose or mouth. When
you are watching an epileptic attack you should stay very calm and try not to panic.
3. You shouldn’t place a finger or other object into the person's mouth to protect or
straighten the tongue--it is unnecessary and dangerous.
4. Don't perform artificial respiration during a seizure, even if the person is turning blue.
Most seizures are over long before brain damage from lack of oxygen begins.
5. You shouldn’t try to hold the person still because you may injure the individual or
yourself.
6. If the person has vomited, you should roll the person on side so that any fluid can easily
flow out of mouth and not obstruct breathing.
7. If the person has a seizure may not hear you.
8. Don’t give the person anything to eat or drink until the person is fully recovered.
9. Don't give person medication by mouth until the seizure has stopped and he or she is
completely awake and alert.
10. You should be calmly reassuring.
11. Stay with the person until recovery is complete.
12. You should maintain a patent airway, note frequency, type, time, involved body parts,
and length of seizure.
It is important to monitor vital signs and neurologic status.

A person with epilepsy should wear a Medic-Alert tag.

What should you do when a seizure stops?

After a minute or two the seizure and jerking movements should stop.
After the seizure you should gently turn the person's head to the side to let the saliva flow out of
the mouth.
Let the person rest or sleep. After a seizure ends, most people sleep deeply.
Be reassuring, and calm as awareness returns.
When the person awakens, he or she may be disoriented for a while. You should repeat any
information the person has missed during the seizure.

Complications may occur as a result of the onset of seizure activity and can include injury from a
fall or from jerking, as well as airway occlusion and aspiration. You could help and prevent these
complications if you learn how.
You should know that a condition known as status epilepticus, in which motor sensory or
psychic seizures follow one another with no intervening periods of consciousness, is a medical

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emergency. Status epilepticus is usually convulsive. The seizures persist for 30 minutes or more.
The airway occlusion and aspiration combined with muscular contractions during a seizure puts
stress on the cardiovascular system. The lack of oxygen may lead to brain damage. If person
doesn’t get immediate treatment may have hypoxia, hyperthermia, hypoglycemia and acidosis.
That may cause a death. You could save someone’s life.

When to call a doctor?

Call doctor if you know it is the person's first seizure. If the seizure last more than fife minutes,
or one seizure follows another without the person regaining consciousness between them you
should call an ambulance. If the person is injured during the seizure you should call a doctor. If
the person is pregnant or has diabetes or high blood pressure you should find medical help. If the
person has a seizure in water, call a doctor.
When you help someone you will feel better. When you know how, you should always help
someone with health problem.

Conclusion
Many people with epilepsy lead productive and outwardly normal lives. Medical and research
advances in the past two decades have led to a better understanding of epilepsy and seizures than
ever before. Advanced brain scans and other techniques allow greater accuracy in diagnosing
epilepsy and determining when a patient may be helped by surgery. More than 20 different
medications and a variety of surgical techniques are now available and provide good control of
seizures for most people with epilepsy. Other treatment options include the ketogenic diet and
the first implantable device, the vagus nerve stimulator. Research on the underlying causes of
epilepsy, including identification of genes for some forms of epilepsy and febrile seizures, has
led to a greatly improved understanding of epilepsy that may lead to more effective treatments or
even new ways of preventing epilepsy in the future.

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Reference
http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.ht
m#158463109
http://www.epilepsy.org.uk/info/firstaid.html
http://epilepsy.about.com/od/faqs/a/firstaid.htm