Epilepsy/Seizures

Epilepsy refers to a chronic medical condition (sometimes called a seizure disorder) caused by temporary changes to the electrical functioning of the brain. Epilepsy is characterized by sudden seizures, muscle convulsions, and partial or total loss of consciousness. Both "epilepsy" and "seizure disorder" mean the same thing; that the normal flow of electricity to the brain has been interrupted and there will be an underlying tendency to experience seizures. However, the diagnosis of epilepsy means that seizures happen more than once and that there is no known treatable cause.  Most people are diagnosed with epilepsy before the age of 25. At least 50% of all cases begin in childhood. In 70% of all cases, there is no known cause. Possible causes include lack of oxygen during or following birth, poor development of the brain before birth, head injury, tumors, high fevers or severe brain infections such as meningitis or encephalitis. There is evidence of genetic factors and research is going on to find the genetic roots of epilepsy*.

There are seven types of seizures: Generalized Tonic Clonic (grand mal), Absence seizures (petit mal), Complex Partial Seizures (psychomotor or temporal lobe), Simple Partial Seizures (Jacksonian), Atonic (drop attacks), Myoclonic Seizures, and Status Epilepticus. Common behavioral characteristics as they relate to epilepsy include drowsiness, fatigue, embarrassment, changes in emotion, and alteration of perception.


1. Generalized Tonic Clonic (grand mal):
The Generalized Tonic Clonic is usually known as a grand mal seizure. This type of seizure is the least common form of epilepsy but probably the most frightening. An individual experiencing a grand mal seizure may cry out, fall, and experience a temporary loss of consciousness and muscular movements ranging from the twitching of eyelids to shaking of the entire body. These seizures usually last from one to three minutes.  Breathing may be shallow or temporarily suspended, the skin may turn bluish and there can be a loss of bladder and/or bowel control. One feature of a grand mal seizure that sometimes differentiates it from other seizures is the presence of an "aura."  An aura is an internal warning to an individual that a seizure is imminent. This involves an individual experiencing a particular taste, sound, feeling or vision prior to the seizure.
*The Epilepsy Foundation provided information about the causes of this disorder (www.efa.org).

2. Absence Seizures (petit mal):
In contrast to the Generalized Tonic Clonic or grand mal seizure, the Absence or petit mal seizure may be characterized by a momentary loss of contact with the environment or the stoppage of activity. This may take the form of fluttering of eyelids, a blank stare, chewing movements of the mouth, or the twitching of a limb. This type of seizure lasts for only a few seconds and can occur in succession within a short period of time.  Usually, the individual returns to full awareness once the seizure has stopped. In most instances the person does not realize that a seizure is occurring.

3. Complex Partial Seizures (psychomotor or temporal lobe):
This form of epilepsy usually begins with a blank stare, followed by chewing, or a random activity such as smacking of the lips, rubbing of hands, or picking of clothes.   The individual may seem dazed, unresponsive, and unaware of their surroundings.  They may run, appear afraid, struggle, or flail out at attempts to restrain them. Once the pattern of this seizure has been set within the brain, it will usually occur the same way with each seizure. These seizures may last a few minutes or several hours. Individuals may maintain consciousness but still engage in an activity such as the clothes picking, or chewing. Time will be distorted, the individual will not be aware of their surroundings, and will have no memory of what happened during the seizure.

4. Simple Partial Seizure (Jacksonian):
The Jacksonian form of epilepsy is similar to the grand mal seizure except that the person usually does not lose consciousness. This seizure is characterized by jerking movements that start in one part of the body and progress to the other side of the body resulting in a convulsive seizure. The individual experiences a distorted environment and may see or hear things that are not there. They may have unexplained sadness, fear, anger or joy. Some individuals may experience odd smells or nausea.

5. Atonic Seizures (drop attacks:)
A person experiencing this type of seizure will suddenly collapse and fall. Within a few seconds the individual recovers, regains consciousness, and can resume normal activity.

6. Myclonic Seizures:
Myclonic seizures are evidenced by sudden, brief massive muscle jerks. This type of seizure can be very mild and only affect part of the body or strong enough to involve the whole body and cause the individual to fall to the floor.

7. Statis Epilepticus:
This type of seizure continues for an extended period of time. The individual does not regain consciousness. Because this seizure is so severe, immediate medical attention is required.

CARING FOR A CHILD WITH A SEIZURE DISORDER

Some things such as strobe lights and/or loud, sudden noises can precipitate a seizure.  Therefore, it is important to adapt the environment as necessary.  Special dietary practices are sometimes used in conjunction with anti-convulsion drugs. In the majority of cases, epilepsy is controllable and people with this disorder live very normal lives.  

When caring for a child who has an epilepsy/seizure disorder, it is important to follow procedures outlined by the parent/guardian. Make sure you understand the individual's seizure pattern. Seizures are usually not harmful unless they are very prolonged or recur in rapid succession (such as the status epilepticus type). If breathing is frequently irregular, ceases, or the person does not regain consciousness within a couple of minutes medical assistance should be sought immediately. It is important to keep the individual on his or her side to prevent food from getting into the lungs should vomiting occur. It is not necessary to place anything in the mouth, as the tongue cannot be swallowed. Do not restrain movement, but remove hard objects in the area to prevent injury. Place a blanket or pillow under the head and loosen tight, restrictive clothing from around the neck. Assure the person by talking calmly and quietly to them during the seizure. Do not give medications or liquids during or immediately after the seizure.

If a child has a seizure while swimming, contact EMS and the parents / guardian immediately. Concerns include aspiration of water into the child's lungs.
If the child has no history of seizures or is not diagnosed with epilepsy and a seizure happens, seek medical help immediately and then contact the parent or guardian.


Respite providers should keep a record of seizures that describe:

  1. What part of the body the seizure started in.
  2. How long the seizure lasted. Try to check a clock or watch for accuracy.
  3. What occurred after the seizure stopped? Was the individual sleepy or disoriented? If the person slept, how long did they sleep?
  4. Whether or not medical assistance was necessary.
 

Funding for this program provided by the Department of Health and Human Services