Seizures and First Aid

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There are many types of seizures. The different types begin in different areas of the brain and they are grouped into two categories: partial and generalized.

Partial Seizures

A partial seizure occurs when the excessive electrical discharge is limited to one part of the brain. Partial seizures are the most common type of seizure in adults. Sometimes seizures begin as partial and then spread and become generalized. These are referred to as partial seizure secondarily generalized.

The two most common kinds of partial seizure are simple partial and complex partial. During a simple partial seizure, awareness remains intact. In a complex partial seizure, awareness is impaired.

SSimple Partial (formerly called focal)
During a simple partial seizure, the person remains aware. A simple partial seizure may involve sensory, motor, psychic, or autonomic symptoms. These symptoms result in the person experiencing an unusual sensation, feeling, or movement called an aura. The aura may be a distortion in sight, sound, or smell where a person sees, hears, or smells things that aren’t there, or it may be sudden jerky movements of one area of the body such as the arm, leg, or face that the person is unable to control. A person may experience a sudden overwhelming emotion such as joy, sadness, fear, or anger. Others may experience stomach upset, dizziness, a shiver, a tingling or burning sensation, pallor, or flushing. Occasionally there will be the experience of déjà vu during which the person has the sensation of having experienced something before.

The seizure usually begins suddenly and lasts seconds to minutes.

An aura is a simple partial seizure that may occur alone or may progress to a complex partial seizure or a generalized seizure. If the aura indicates the onset of a complex partial or generalized seizure, it can sometimes be used as a warning signal to allow a person to take the necessary precautions to avoid injury.

First Aid

no first aid is necessary unless it becomes a convulsive seizure
provide reassurance and emotional support

Complex Partial
(formerly called psychomotor or temporal lobe)
During a complex partial seizure, the person experiences altered awareness and may appear dazed and confused. A dreamlike experience may occur.

In some cases, the individual will be unable to respond or will do so incompletely or inaccurately. In other cases, the individual will lose contact.

The seizure often begins with an unusual sensation, feeling, or movement referred to as an aura. An aura can take many forms including a strange feeling in the upper abdomen, a feeling of fear, or an hallucination. An aura is a simple partial seizure that can occur alone or as the onset of a complex partial seizure. In a complex partial seizure, the aura often occurs just before awareness is altered and it is often used as a warning.

Random purposeless movements over which the individual has no control called automatisms often characterize the seizure. These may include movements such as chewing motions, mumbling, lip smacking, head turning, pulling at clothing, picking motions in the air, or random walking. Occasionally, there are more dramatic behavioral changes such as screaming, undressing, or laughing.

Once the pattern has been established, the same set of actions often occurs with each seizure.

The seizure usually lasts for between one and two minutes and is often followed by a postictal period of disorientation and confusion.

First Aid

speak calmly
explain to others what is happening
guide away from hazards
DO NOT try to restrain
stay with the person until complete awareness returns
offer help getting home

Generalized Seizures

A generalized seizure is characterized by the involvement of the whole brain. The excessive electrical discharge is widespread and involves both sides of the brain. The seizure may or may not be convulsive. A generalized seizure commonly takes one of two forms: absence (without convulsions) or tonic clonic (with convulsions).

Absence
(formerly called petit mal)
These seizures most often begin in childhood. In many children with absence seizures, the seizures stop during adolescence.

This type of seizure results in a blank stare usually lasting less than 10 seconds. The seizure starts and ends abruptly, and awareness is impaired during the seizure. A person may suddenly stop talking, stare blankly for a few seconds, and then continue talking without realizing that anything has occurred. Following the seizure, alertness is regained quickly.

These seizures are sometimes misinterpreted as daydreaming or inattentiveness. Rapid blinking may accompany the seizure and the eyes may roll upwards.

An individual may experience as many as several hundred absence seizures in a day. Although absence seizures are often outgrown, some people with absence seizures develop tonic clonic seizures. Absence seizures tend to run in families.

First Aid

no immediate first aid is necessary
mention to parents to ensure they are aware the seizure has occurred

Tonic Clonic
(formerly called grand mal)
The tonic phase of this seizure type typically involves a crying out or groan, a loss of awareness, and a fall as consciousness is lost and muscles stiffen. The second phase or clonic phase of the seizure typically involves a convulsion and there is jerking and twitching of the muscles in all four limbs. Usually the movements involve the whole body.

Urinary or bowel control may be lost and there may be shallow breathing, a bluish or gray skin color, and drooling.

The seizure usually lasts from one to three minutes. Awareness is regained slowly.

A postictal state often follows a tonic clonic seizure. This may involve fatigue and confusion and the person may experience a severe headache. Often the person will want to sleep.

These seizures may be primary generalized (meaning that the seizure begins on both sides of the brain simultaneously) or they may follow a brief partial seizure (secondarily generalized).

Although the tonic clonic seizure is the one most often associated with epilepsy, it is not the most common type of seizure. In adults, partial seizures are the most common type experienced.

First Aid

keep calm - let the seizure run its course
ease the person to the floor
loosen clothing
remove objects in the immediate area that may harm or injure the person
turn the person on their side so that saliva can flow from the mouth
check for medic alert identification
when the person regains consciousness and the seizure ends, help them become reoriented
if a seizure lasts more than 6 - 10 minutes or if they occur repeatedly, call an ambulance

Atonic
An atonic seizure is sometimes called a “drop attack.” The seizure involves a sudden loss of muscle tone. This can result in the person falling down or almost falling down, dropping objects, or nodding the head involuntarily. Typically, these seizures last for a few seconds. There tends to be no warning so the seizures can be dangerous because of injury.

First Aid

none needed unless individual was hurt during the fall

Myoclonic
A myoclonic seizure results in a sudden jerk of part of the body such as the arm or leg. The person may fall over. The seizure is very brief. People who do not have epilepsy sometimes experience a sudden jerk of the body when they are falling asleep. This is common and is known as benign nocturnal myoclonus. It is a not an epilepsy-related seizure.

First Aid

none needed

Status Epilepticus

A continuous seizure state, or status epilepticus, is a life-threatening condition. Seizures are prolonged or occur one after another without full recovery between seizures. Immediate medical care is necessary. The seizures may be convulsive or non-convulsive.

SUDEP

The cause of Sudden Unexplained Death in Epilepsy (SUDEP), where death occurs suddenly for no discernible reason, is unknown. This is rare.

There are many other types of seizures and epilepsies.
Please feel free to contact us for more information.