The main symptoms of epilepsy are repeated seizures. There are many different types of seizure, depending on the area of the brain affected.
People with epilepsy can experience any variety of seizure, although most people follow a consistent pattern of symptoms known as an epilepsy syndrome.
Seizures can occur when you are awake or asleep (nocturnal seizures).
Doctors classify seizures by how much of the brain is affected. There are:
- partial seizures – where only a small part of the brain is affected
- generalised seizures – where most or all of the brain is affected
Some seizures do not fit into these categories and are known as unclassified seizures.
There are two types of partial seizure:
- simple partial seizure – where you remain fully conscious throughout
- complex partial seizure – where you lose your sense of awareness and can’t remember what happened after the seizure has passed
Symptoms of a simple partial seizure include:
- changes in the way things look, smell, feel, taste or sound
- an intense feeling that events have happened before (déjà vu)
- a tingling sensation, or ‘pins and needles’, in your arms and legs
- a sudden intense emotion, such as fear or joy
- the muscles in your arms, legs and face may become stiff
- you may experience twitching on one side of your body
The symptoms of a complex partial seizure normally involve apparently strange and random bodily behaviour, such as:
- smacking your lips
- rubbing your hands
- making random noises
- moving your arms around
- picking at clothes
- fiddling with objects
- adopting an unusual posture
- chewing or swallowing
During a complex partial seizure, you will not be able to respond to anyone else, and you will have no memory of the event.
Complex partial seizures are quite common and account for 2 in 10 of all seizures experienced by people with epilepsy.
In most cases, a person having a generalised seizure will be completely unconscious.
There are six main types of generalised seizure:
Absence seizures, sometimes called petit mal, mainly affect children. They cause the child to lose awareness of their surroundings for up to 20 seconds. The child will seem to stare vacantly into space, although some children will flutter their eyes or smack their lips. The child will have no memory of the seizure.
Absences can occur several times a day. Although they are not dangerous, they may affect the child's performance at school.
These types of seizures cause your arms, legs or upper body to jerk or twitch, much like if you have received an electric shock. They often only last for a fraction of a second, and you should remain conscious during this time.
Myoclonic jerks often happen in the first few hours after waking up and can occur in combination with other types of generalised seizures.
This causes the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to two minutes. Loss of consciousness may occur.
Atonic seizures cause all your muscles to suddenly relax, so there is a chance you will fall to the ground. Facial injuries are common with this type of seizure.
Unlike an atonic seizure, tonic seizures cause all the muscles to suddenly become stiff. You can lose balance and fall over, so injuries to the back of the head are common.
A tonic-clonic seizure, sometimes known as grand mal, has two stages. Your body will become stiff and then your arms and legs will begin twitching. You will lose consciousness and some people will wet themselves. The seizure normally lasts between one and three minutes, but they can last longer.
This is the most common type of seizure, and about 60% of all seizures experienced by people with epilepsy are tonic-clonic seizures.
Tonic-clonic seizures are what most people think of as an epileptic fit.
People who have epilepsy often get a distinctive feeling or warning sign that a seizure is on its way. These warning signs are known as auras, but they are actually simple partial seizures.
Auras differ from person to person, but some common auras include:
- noticing a strange smell or taste
- having a feeling of déjà vu
- feeling that the outside world has suddenly become unreal or dreamlike
- experiencing a sense of fear or anxiety
- your body suddenly feeling strange
Although this warning cannot prevent the seizure, it can give you time to warn people around you and make sure you are in a safe place.
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Status epilepticus is a seizure that lasts longer than 30 minutes or a series of seizures where the person does not regain consciousness in between. If a seizure lasts longer than five minutes, call 999 for an ambulance.
Prolonged seizures can be treated with diazepam given as an injection or through someone's rectum. However, if seizures continue because they are not quickly brought under control in this way, it is very important that the patient be transferred to hospital. In hospital, the airways will need to be closely monitored and a high level of sedation may be required to control the seizures.
An alternative treatment is a medication called buccal midazolam. This comes in liquid form and is administered by trickling the liquid onto the inside of your cheek. It is then absorbed into your bloodstream.
You do not have to be a healthcare professional to do this, but you do need the correct training as well as permission from the person who has epilepsy. If you care for someone with epilepsy, you can be trained to administer rectal diazepam or buccal midazolam in case status epilepticus occurs.
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