Today March 26th annually, people in countries around the world are invited to wear purple and host events in support of epilepsy awareness. Purple Day is an international grassroots effort dedicated to increasing awareness about epilepsy worldwide.

Did you know that 50 million people have epilepsy world-wide and it is estimated that 1 out of every 100 people have epilepsy.

What is Epilepsy?

Epilepsy is a condition of the brain that is characterized by recurrent seizures. Approximately one in ten people will experience at least one seizure during a lifetime. A single seizure, however, is not epilepsy. Epilepsy is a condition that is defined by multiple seizures.

Epilepsy is a seizure disorder. It is not a psychological disorder nor a disease and it is not contagious.

Seizures cause a change in function or behavior. A seizure may take many different forms including a blank stare, muscle spasms, uncontrolled movements, altered awareness, odd sensations, or a convulsion. Seizures may occur rarely or as often as numerous times a day. If the condition is successfully controlled by medication, a person may be seizure free. Epilepsy is one of the most common chronic neurological disorders.

What is a Seizure?

A seizure is a brief, abnormal, excessive surge of electrical activity in the brain that produces a sometimes noticeable change in behaviour. There are many different types of seizures, which may reflect the area from which the seizure begins (seizure focus) and the pattern in which the abnormal electrical discharge spreads through the brain.

The person may experience body sensations such as “pins and needles”, smells, sounds, fear, depression, distortions of sensory stimuli, momentary jerks or head nods, staring with loss of awareness and convulsive movements.

Seizures usually last seconds to minutes, rarely longer. The period immediately after a seizure, called the “postictal period,” varies depending on the duration, intensity, and type of seizure. The most common symptoms that a person may experience immediately after a convulsive seizure are confusion, muscular ache, headache, and fatigue.

Some people experience what is called an aura.—an “early warning system” for seizures. An aura is a strange sensation or feeling that is in fact a simple partial seizure. Auras may consist of dizziness, an unusual feeling in the stomach, buzzing in the ear, a powerful emotion, or just about any sensation at all. Many people don’t realize they have an aura until they review their symptoms with a physician.

After you have a seizure, try to remember if you noticed anything unusual at the beginning, (such as an unexplained feeling or sensation) and write it down. After a while, if you notice a pattern, then you may have found an early warning system for your seizures.

Identifying an aura can be helpful. You may be able to take quick precautions to ensure safety for when the seizure occurs. Also, the symptoms experienced during an aura may help your physician “localize” your seizures.

Classification & Seizure Types

Generalized Seizures

Generalized seizures begin with a widespread, excessive electrical discharge simultaneously involving both sides of the brain (the whole brain). The principal types of primary generalized seizures are tonic-clonic seizures, absence seizures, myoclonic seizures, clonic seizures, atonic seizures, and tonic seizures.

1. a) Generalized Tonic-Clonic Seizures (formerly called called Grand Mal) begin with loss of consciousness, a tonic phase (body stiffening), a fall and often a cry caused by air forced through contracted vocal cords. The subsequent clonic phase consists of jerking of the upper and lower limbs. Breathing may be shallow and irregular; skin may become blue because of an arrest of breathing. Tonic-clonic seizures may last several minutes or even longer. Other symptoms which may occur during this kind of seizure include excessive saliva production, biting of the tongue or cheek, and loss of bladder or bowel control. Consciousness is regained slowly.

The postictal (post-seizure) symptoms may include headache, confusion, and fatigue lasting minutes to hours. Shortly after consciousness is regained the person will often fall asleep.

When tonic-clonic seizures last more than five minutes (not including the postictal phase) or the person has two or more in a row, medical attention should be obtained. When tonic-clonic seizures recur in a series of three or more seizures or last longer than 30 minutes the condition is known as Status Epilepticus. Status-epilepticus can be life-threatening. Immediate medical attention is necessary.

1. b) Absence Seizures (formerly called Petit Mal) consist of brief episodes of staring for a period of 5-30 seconds. Impairment of awareness begins without warning and ends suddenly, leaving the person alert and attentive. Usually associated with this seizure type are minor repetitive movements such as eye blinking. If the seizure lasts more than 10 seconds, brief mouth or hand movements may be seen.

A person may have 50 – 100 absence seizures a day. Without treatment, the seizures may interfere with learning. Absence seizures almost always begin in childhood (four to 14 years of age) and often resolve in late teenage years.

1. c) Myoclonic Seizures occur as brief, shock-like jerks of a muscle or group of muscles. Epileptic myoclonic seizures usually cause abnormal movements on both sides of the body at the same time. The neck, shoulders, upper arms, body and upper legs are usually involved. Movements resembling myoclonus may occur in healthy people who do not have epilepsy. For example, as many people fall asleep, their bodies suddenly jerk (referred to as “sleep starts” or “sleep jerks”).
2. d) Tonic Seizures usually last less than 20 seconds and are associated with sudden stiffening movements of the body, arms or legs, involving both sides of the body. They are most common during sleep.
3. e) Atonic Seizures usually begin in childhood (lasting for less than 15 seconds) and are associated with an abrupt loss of muscle tone that causes the eyelids to droop or the head to nod. The person may drop things or fall to the ground. Repeated injuries may occur as a result of this type of seizure.

Partial Seizures

Partial seizures begin with an abnormal burst of electrical activity in a restricted area of the brain. The signs and symptoms of a partial seizure depend on what part of the brain is involved during the seizure. Simple and complex partial seizures are the main types of partial seizures.

In this context, “simple” implies no loss of awareness. “Complex” means there is an impairment of consciousness. If a partial seizure spreads from a small part of the brain to involve both sides of the brain, it is called a partial seizure that becomes “secondarily generalized”. This seizure begins with subtle features but may become a tonic-clonic seizure when the abnormal electrical activity spreads to all of the brain.

1. a) Simple Partial Seizures leave the person alert and able to remember what happened afterward since consciousness is not impaired. A simple partial seizure may consist of nothing more than a strange sensation (tingling feeling in part of the body) or a rhythmic jerking of one limb, part of the limb, or the face. Any of the senses may be affected (touch, smell, taste, vision, and hearing). Simple partial seizures may last seconds to minutes and sometimes will precede a complex partial seizure or a secondarily generalized tonic-clonic seizure. Minor or vague symptoms may go unnoticed.
2. b) Complex Partial Seizures are the most common type of partial seizures in both children and adults. This seizure type is accompanied by impaired awareness and may be preceded by a simple partial seizure (the aura). The seizure may start with strange sensations such as fear, nausea, smell, taste, or deja vu, depending on where in the brain the seizure begins.

The person may look dazed and confused and make repetitive movements such as lip smacking, chewing, or hand and body movements. Sometimes the person may speak inappropriately or carry out semi-purposeful tasks. The person will not remember these events after the seizure.

A complex partial seizure may last from one to five minutes and may be followed by drowsiness or confusion. If the seizure spreads into other brain regions, a complex partial seizure may evolve to a generalized tonic-clonic seizure.

How common is epilepsy?

Researchers tell us that between 0.5 and 1% of the population suffers from epilepsy – an estimated 50 million people worldwide. Most epilepsy begins at the extremes of age (childhood and old age) but new cases can develop at any age (depending on the cause).

Is epilepsy inherited?

Some types of epilepsy have an inherited pattern. Most commonly these are forms of the generalized epilepsies that begin in childhood or adolescence. Some people have certain inherited diseases (rare in occurrence) that have epilepsy as one feature of the illness. When epilepsy is the sole manifestation of the illness, there is a low probability of inheritance.

How is Epilepsy Treated?

Antiepileptic drugs are the principal therapy for treating epilepsy. These drugs do not cure epilepsy but attempt to control it by suppressing seizures. The ultimate goal of antiepileptic drug therapy is to establish perfect seizure control and minimal or no side effects from medication. Sometimes long-term seizure control may not be possible because of the underlying cause.

Drug therapy must be individualized. It is important for the patient to be an active participant in the discussion and treatment of his or her epilepsy. Open communication between the physician and patient about what to expect, what is experienced, what is tolerable, and the impact of both adverse medication effects and seizures on the quality of life is the best way to manage drug therapy. The person’s lifestyle and cost of the drug are additional factors which the physician must take into consideration when recommending a particular medication for seizure control.

When drug treatment of epilepsy is started, it may take several months of adjusting dosages and trying different drugs before optimal effects can be achieved

What can I do to help improve my memory?

Many people with epilepsy complain of absentmindedness, forgetting names and things that went on in the past. This may be due to the underlying cause of the epilepsy, medication, or a combination of both. While there is no cure, there are ways to compensate for these difficulties.

1. Use simple memory aids.
2. Pay better attention.
3. Stay calm and take the time to recall things carefully.

What restrictions does epilepsy impose on daily activities?

Depending on the seizure type and frequency, certain restrictions may apply. Each case must be judged individually. Consult your physician to determine what restrictions may apply to you. It is your responsibility to be straight-forward, honest, and apply common sense in any discussion regarding restrictions on activities such as driving, working at heights, or bathing and swimming alone.

First Aid for Seizures

Generalized Tonic Clonic Seizure

In convulsive (tonic-clonic or grand mal) seizures, the individual loses consciousness and falls. The body is initially rigid (tonic phase). In the clonic phase, the arms and legs jerk or twitch rhythmically. Consciousness is regained slowly.

• Stay calm.
• Time the seizure – Usually there is no need for a trip to the hospital, unless the seizure lasts longer than five minutes (not including the postictal phase), the person has more than one seizure in a row, or if a person is injured, pregnant, or has diabetes.
• Remove objects that may cause harm – clear the area of sharp or dangerous objects.
• Do not hold the person down or restrain their movement.
• Do not put anything in the person’s mouth: it is not possible for someone to swallow their tongue.
• Turn the person on his or her side as the seizure ends to allow saliva or other fluids to drain away and keep airway clear.
• Do not offer food or drink until the person is fully alert.
• Stay with the person until they are fully alert and thinking clearly. Reassure the person when consciousness returns.

Complex Partial Seizure

For someone with disturbance of consciousness and undirected behaviour, such as mumbling or random movements including head turning or pulling at clothes:

• Speak calmly.
• Do not restrain, but gently guide the person away from danger.
• Stay with the person until he or she is fully alert.

Please note, the seizure and post seizure confusion may last as long as 20 minutes.

Absence Seizure (Petit Mal)

For momentary lapses of attention (absence or petit mal seizures) no first aid is needed; the seizures only last a few seconds. The individual may appear to be daydreaming. Because these seizures are so mild looking, they may go undiagnosed. If you suspect someone of having absence seizures, bring it to the attention of an appropriate person

For more resource on Epilepsy, visit http://www.purpleday.org/aboutepilepsy