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Seizures
- Chavy Dworkind
- Oct 29, 2020
- 5 min read
Chavy Dworkind
Published Thursday, October 29, 2020
You may have observed someone having a seizure or you might know someone who suffers from epilepsy. It’s important to know what to do if you see someone having a seizure. In some cases, you can save the person’s life or prevent them from getting an injury as a result of their seizure. It’s also interesting to take a closer look at the biological mechanism involved in a seizure. A seizure is the misfiring of electricity in the brain. Since seizures occur in the brain, it won’t surprise you that there are multiple different classifications and types of seizures which have different presentations, since electricity can misfire in different parts of the brain.
Who can have a seizure? What are the different classifications and types of seizures? What do seizures look like? When does a seizure require immediate medical attention? Lastly, what can you, as a first aid provider do to help the person?
Who Can Have a Seizure?
In short, anyone can have a seizure under the right circumstances.
Commonly, people with epilepsy experience recurring seizures. Epilepsy is a (neurological) disorder of the central nervous system. Epilepsy causes recurrent seizures as a result of abnormal brain activity. People who don’t have epilepsy can have a seizure due to various factors. For example, high fever, infection, insufficient sleep, low blood sodium and taking certain medications. Other examples are a brain tumor, a stroke, using cocaine or amphetamines, bleeding in the brain as a result of a head injury, alcohol withdrawal or alcohol intoxication and the COVID-19 infection.
Types of Seizures and Their Presentation
First, there are two main seizure classifications; focal seizures and generalized seizures. Focal seizures, sometimes called partial seizures, occur in a specific part of one side of the brain. Depending on which part of the brain is affected, the effects can be emotional, physical and/or cause the person to hear, see or feel things that are not there. Generalized seizures are different from focal seizures because they affect both sides of the brain simultaneously. Generalized seizures tend to cause muscle spasms, unconsciousness, and/or falling.
There are six types of generalized seizures.
1. Tonic-clonic (grand mal) seizures
- Stiffening of muscles
- Loss of consciousness
- Collapse
- Possible biting of the tongue or inner cheek (causing bloody saliva)
- Jerking of limbs
- Possible loss of bladder or bowel control as muscles relax
- Possibile difficulty breathing
- Expected duration: 1-3 minutes
- Call 911 if a tonic-clonic seizure lasts over 5 minutes
2. Clonic seizures
- Regular and sustained repeated jerking movements
- Common in babies
- Expected duration: Seconds to 1-2 minutes
3. Tonic seizures
- Begins abruptly with strong movements
- Usually occurs during sleep
- Expected duration: Under 20 seconds
4. Atonic seizures
- Begins abruptly
- Loss of muscle tone/muscle control
- Person may lose consciousness and fall, regaining consciousness upon hitting the floor
- Entire body or part of the body becomes slack
- Usually occurs in children
- Also known as “drop seizure” or “drop attacks”
- Expected duration: Under 15 seconds
5. Myoclonic seizures
- Quick jerking(s) of a group of muscles or a singular muscle
- Easily mistaken for tremors or tics
- Expected duration: 1-2 seconds
6. Absence (petit mal) seizures
- Person appears to be spaced out for a short time
- Affects person’s awareness
- Absence seizures are often missed due to their brevity
- Expected duration: Under 10 seconds
There are three groups of focal seizures.
1. Focal onset aware seizures (previously simple partial seizures)
- Person is conscious
- Certain individuals can move and interact while experiencing a focal onset aware seizure, others cannot
- Symptoms may be motor, sensory, autonomic, or psychic
- Expected duration: Under 2 minutes
2. Focal onset impaired awareness seizures (previously complex partial seizures)
- Awareness is impaired
- There is often movement of the mouth
- Picking at things like the air or their clothing
- Involuntarily performing aimless acts
- Possible memory loss from just before or after the seizure
- Expected duration: 30 seconds - 3 minutes
3. Secondary generalized seizures
- A focal seizure followed by a generalized seizure
- Expected duration: A few minutes
From this list of the various types of seizures, it’s apparent that not all seizures require first aid or immediate medical attention. However, the types of seizures that involve convulsions, jerking, rapid forceful movements, possible difficulty breathing and collapsing to the floor might require first aid or immediate medical attention.
What to Do
Call 911 if…
The person has trouble breathing or regaining consciousness after the seizure
This is the person’s first seizure
The person is hurt due to the seizure
The seizure occurs in water
A second seizure quickly follows the first seizure with no recovery period between seizures (status epilepticus)
The seizure endures longer than 5 minutes (status epilepticus)
The individual has a serious health condition like diabetes or heart disease
The individual is pregnant
Providing first aid for generalized tonic-clonic seizures
Help the person to the floor
Gently turn the person on their side to facilitate breathing
Remove sharp/hard objects near the person to prevent injury
Set something that’s soft and flat beneath the person’s head
Loosen anything around the person’s neck that may impede breathing
Remove the person’s glasses
Again, call 911 if the tonic-clonic seizure lasts more than 5 minutes or if a second seizure follows the first with no recovery period between seizures (status epilepticus)
What Not to Do
Don’t put anything in the person’s mouth
Don’t attempt to hinder the person’s movements in any way (don’t hold them)
Don’t attempt to give mouth-to-mouth breaths
Don’t provide the person with food or drink until they are fully alert
Biology of Seizures
Let’s delve deeper into the neurobiology of epileptic seizures. There is more to it than “the misfiring of electricity in the brain.” A seizure is triggered by the disturbance of normal brain activity. The normal rate at which action potentials occur in is 80 action potentials per second but during a seizure, that number can go up to 500 action potentials per second. GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter. Studies on GABA indicate that it is a significant factor in epilepsy and in its treatment. For example, it has been discovered that GABA antagonists produce seizures while GABA agonists suppress them. In biochemistry, an antagonist is a substance that binds to a receptor and prevents the receptor from causing its usual effect in the cell. Conversely, an agonist is a substance which binds to a receptor and causes an effect to occur within the cell. Therefore, drugs that hinder the synthesis of GABA cause seizures. Glutamate, an excitatory neurotransmitter is also being studied in the context of epilepsy. Additionally, electricity travels between nerve cells in the brain via a network of ion channels. If ion channels are damaged, chemical imbalances in the brain can ensue, potentially causing seizures due to electrical misfire. On another note, studies have indicated the comorbidity of epilepsy and depression, among other things. A 2009 study discusses the comorbidity of epilepsy and stroke, bone health and fractures, depression, migraine and attention-deficit hyperactivity disorder (ADHD).
Conclusion
It’s important to be able to recognize a seizure and to know what to do when you observe someone having a seizure. 911 should be called in the case of status epilepticus; a seizure that lasts longer than 5 minutes or 2 seizures that occur consecutively with no recovery period between seizures.
References
Very informative! Thank you!!