Epilepsy Management

Epilepsy is a brain disease characterised by abnormal electrical activity that causes seizures or unusual behaviour and sensations, and sometimes loss of consciousness, with neurological, cognitive, psychological and social consequences.

Epileptic seizures occur when groups of nerve cells in the brain follow an abnormal signal, which briefly alters the person’s consciousness, movements or actions. They affect the cerebral cortex where the brain functions that require our will are located (e.g. speaking, understanding, memorising, moving, paying attention…) and it is also the one that receives information from our senses (sight, hearing, touch, smell and taste). An epileptic seizure can therefore alter one or more of these functions, which is why epileptic seizures can be very variable. They are often called “seizures”, but seizures do not always manifest themselves in this way. Let us try to describe the different types of seizures.

Epileptic seizures can be:

a) Partial: the bioelectrical activity is limited to a specific area of the brain. In its simple form, the muscles of the hands, feet or face, controlled by that part of the brain, move involuntarily during the seizure. In this case there is no loss of consciousness.

  • Depending on the area affected, we can also find different types: Motor (affecting the locomotor apparatus) Gelastic (laughing): a very atypical variety that appears in small children who laugh for no reason. Sensory: the patient may see or hear non-existent sounds or have visual and auditory hallucinations. Psychic: a feeling of unreality as if in a strange place (jamais vu) or an opposite effect of déjà vu or familiarity.
  • In its complex form, there is a loss of alertness; during these seizures, they do not respond or respond incoherently or with inappropriate behaviour. They may perform automatic movements, called “automatisms”, which help to identify the seizures: sucking, mouth movements with attempts to swallow, rubbing their hands together or other movements that, if you are not attentive, may go unnoticed. They may even walk without being aware of it.

b) Generalised: these affect both cerebral hemispheres (sides of the brain) from the onset of the seizure. The most common are:

  • Tonic-clonic seizures (formerly called grand mal seizures): the person falls to the ground It starts with rigidity of the limbs (tonic phase), followed by jerking of the whole body (clonic phase), may bite the tongue and lose sphincter control (urinate).
  • Tonic seizures: following a sudden loss of consciousness, muscles throughout the body contract and hyperextend abruptly.
  • Atonic seizures: there is a sudden loss of muscle tone. The person collapses, which can lead to traumatic head injuries.
  • Absence seizures (small mal seizure): the person may roll their eyes and blink; they have lapses where they stare and are not conscious and cannot respond. The episode lasts a few seconds and he recovers as if nothing has happened. Sometimes several seizures are repeated in short periods of time (“seizure salvos”). It is more common in children than in adults. They are often so brief that they go unnoticed and it may take months and years before the patient sees a doctor.
  • Myoclonic seizures: rapid, brief contractions of body muscles, usually occurring at the same time on both sides of the body. Occasionally they involve an arm or a foot. People often think of them as sudden jerks or clumsiness, and because they do not see a doctor, their diagnosis is often delayed.

The main treatment for epilepsy is based on the use of anti-epileptic drugs.

From the first epileptic seizure, the cause of the seizure should be sought, because treatment of the cause takes priority over treatment of the seizure symptoms. Depending on the type of epilepsy and any existing illnesses the patient may already have, the treatment will vary.

Medication often has important side effects that can range from depression and irritability to euphoria or difficulty in managing emotions.

For this reason, sometimes another medication (combined therapy) is used to counteract the excessive action of the first one in order to find the best physical and emotional state for the person. During this period, patience is required because the dosage regulation takes months and each body metabolises it in different ways.

There is no single formula, but it is necessary to find the best one for each person. There are other options for which each patient must assess whether he or she is a candidate because of his or her type of epilepsy.

Tonic-clonic seizures start when someone loses consciousness, suddenly stiffens, falls to the floor and jerks. The first golden rule is to KEEP CALM, because once the seizure starts, you cannot stop it.
  • Stay with the person. Keep observers away.
  • Protect the person from harm – remove dangerous objects from the area. Put something soft under the person’s head. Loosen tight clothing that may make breathing difficult and remove glasses or any objects that could hurt the person during the seizure.
  • Carefully turn the person on his or her side so that any fluid in the mouth can flow out safely.
  • Note the time/duration of the seizure.
  • When the seizure is over, check that he/she is recovered. Allow the person to rest if desired.
  • Do not move the person to another location.
  • Never hold the person during the seizure unless the movements cause a blow to the head. Leave the person alone; shaking or otherwise stimulating the person does not help to stop the episode.
  • Never try to force the person’s mouth open or insert any object. You could injure the person’s lips, tongue or teeth or bite your own hand.
  • Do not give water, medication or food.
  • It is not necessary to call a doctor or ambulance if the seizure does not last more than five minutes if you have had similar seizures before. In case of doubt, repeated seizures or if the person was not previously diagnosed with epilepsy, the doctor should be notified by calling the 112 emergency room.

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