Epilepsy Ottawa Carleton

1. What causes epilepsy?

In many cases a specific cause for epilepsy cannot be found but some known causes include: head injuries, pre-birth trauma, chemical imbalances, certain infections in the brain, (e.g. encephalitis and meningitis), strokes and brain tumours. If both parents have a strong family history of epilepsy, their child may be at higher risk which means that one can inherit the tendency to have epilepsy.

2. How is epilepsy diagnosed?

If a person is experiencing the symptoms of epilepsy, a careful medical history will be taken. Having a single seizure does not necessarily mean a person has epilepsy. Epilepsy is diagnosed using an electroencephalograph (EEG) – a machine that records brain waves. Electrical signals from brain cells are recorded as wavy lines by the machine and abnormal patterns can assist the doctor in determining whether or not a person has epilepsy. In addition imaging devices such as computerized tomography (CT) and magnetic resonance imaging (MRI) scans can search for any abnormal physical conditions (scars, growths, etc) in the brain that may be causing seizures. Some research centers employ positron emission tomography (PET) which can identify areas of the brain producing seizures.

3. What are some of the myths around epilepsy?

Epilepsy is an underlying neurological condition that affects the delicate systems which govern how electrical energy behaves in the brain making it susceptible to recurring seizures. Epilepsy is not a disease, not contagious, nor is it a form of mental illness or impaired mental development. There is no such thing as an “epileptic”, there are individuals living with epilepsy conditions.

4. What is a seizure?

Epilepsy is characterized by the reoccurrence of sudden, brief seizures which vary from person to person in nature and intensity. A seizure is a temporary generation of excess electrochemical energy inside the brain cells –sometimes described as a “lightening storm” of the brain. For some people seizures are brief and infrequent and do not prevent them from leading normal lives – for others they are severely debilitating.

5. Are there different types of seizures?

Seizures are generally classified in two categories - partial and generalized seizures:

Partial Seizures begin in one place in the brain called the seizure focus and affect only part of the brain. Depending on where they start and which part of the brain they involve, partial seizures may (complex partial seizures) or may not (simple partial seizures or aura) alter consciousness or awareness. Seizures may begin as partial seizures and evolve into generalized seizures.

Complex Partial: Causes loss of awareness, staring, confusion. Person may wander or pick at clothing, smack lips, etc.
Simple Partial: Causes no loss of awareness. Person may have unusual feelings of fear or déjà vu and may have twitching on one side of the body.

Generalized seizures happen when abnormal excessive energy occurs throughout the whole brain at once with no apparent focal point of onset or warning beforehand. Consciousness is altered and these seizures can be convulsive or non convulsive.

Generalized Absence: Causes brief staring spells, (formerly called Petit Mal). Person may appear to be daydreaming and may lose awareness of their surroundings.
Generalized Tonic Clonic: Causes loss of consciousness, (formerly called Grand Mal). Person will fall to the ground if standing and experience muscle spasms/jerking and/or may become incontinent.

6. What is the first aid procedure for convulsive seizures?

Don’t panic! Convulsive seizures are usually startling to watch. You can help by following these steps:

Begin timing the seizure – on rare occasions, if a seizure goes on longer than 5 Minutes, or repeats without full recovery, call for an ambulance.Let the seizure take its course – normally seizures last two or three minutes.
Do not try to restrain the person.
Explain to people around that the person is having a seizure and that it will be over soon. Ask to be given some space so the person will have some privacy when they regain consciousness.
Protect from further injury if possible. Move hard or sharp objects away, but do not restrain or interfere with the person's movements. Place something soft and small such as a sweater under the head and loosen tight clothing, especially at the neck.
Roll the person on their side as soon as possible, to allow saliva or other fluids to drain away, helping to clear the airway. A person having a seizure may appear to stop breathing momentarily.
Do not put anything in the person's mouth. The old myth about a person swallowing their tongue during a seizure is not true! The person will not swallow their tongue during a seizure. Putting something in the mouth can cause gagging or cause a person to break their teeth or bite their cheeks.
On rare occasions, if a seizure goes on longer than 5 minutes, or repeats without full recovery, call for an ambulance.
Afterward,speak gently to the person. Following a seizure a person will be groggy, tired and disoriented. Be comforting and reassuring and stay with them until they become re-oriented.

7. What is the first aid procedure for complex partial non-convulsive seizures?

Don’t panic! Your job is to make sure the person is safe and comfortable. Many people turn away from a person having a seizure in public, whether out of embarrassment or sometimes mistaken assumptions about a persons’ seemingly strange behaviour. You can help by following these steps:

Explain what is happening. These seizures may look very unusual. Let others know what is happening so they will not be frightened or confused.
Do not restrain.
Do not try to stop the seizure, but let it take its course. The person will be unaware of his or her actions, and may or may not hear you.
Gently guide the person away from any danger. Do not try to restrain movements or wandering but do guide away from things they can trip on, traffic, stairs, etc. Move any dangerous objects out of the way.
Observe Carefully. Note different movements or behaviours – the person may want this information later.
Do not restrain.
Partial Seizures may spread to other areas of the brain. Do not be alarmed if a convulsive seizure follows – follow procedures for convulsive seizures.
Afterward, talk gently to the person, be comforting and reassuring and stay with them until they become re-oriented.

8. How do I know when to call an ambulance?

Not every seizure requires medical intervention.

Call for medical help immediately if:

it is a first time seizure
it happens in the water
it last longer than 5 minutes
the seizure repeats without a full recovery in between
the person has diabetes
the person is pregnant
regular breathing or full awareness doesn’t not resume after the seizure
an injury occurs

9. What is an aura?

An aura is a brief sensation/experience that sometimes comes before a seizure. A person experiencing an aura may notice unusual distortions of sight, sound, smell or emotion or have sudden jerking movements in the body. They will be quite conscious or aware but will have no control over what is happening.

10. What are the treatments for epilepsy?

Neurologists, pediatricians and neurosurgeons provide treatments for epilepsy. Normally after the appearance of symptoms, a person will be referred to a specialist by their family physician.

Each individual with epilepsy is affected in a different manner by seizures so what may help one person may not help another. Fifty percent of those people diagnosed with epilepsy are able to achieve control of their seizures with anti-convulsant medications, although drug trials and side effects often present new health and social challenges. Thirty percent of people with epilepsy still experience occasional seizures, even with medications. The remaining twenty percent are those people with intractable epilepsy.

Some people with untreatable seizures may be candidates for various surgical procedures which can sometimes control or partially control seizure activity. Many people with epilepsy also work to minimize the negative impacts of the condition by following very good health practices, (e.g. lots of sleep, balanced diets, exercise regimes, stress reduction, avoidance of alcohol, etc).

(For an excellent on-line course to learn more about Epilepsy please visit Epilepsy Toronto's Website).