Epilepsy Management

Epilepsy is a neurological condition that affects the brain and nervous system. Epilepsy is considered a ‘spectrum disorder’ because it has numerous causes and several different seizure types and its severity and impact can vary from person to person, with a range of co-existing conditions.

People with epilepsy have a tendency to experience frequent seizures, which cause a huge range of symptoms, from becoming stiff or staring blankly into space to uncontrollable shaking or jerking. Epileptic seizures start in the brain and are caused by a disturbance in the brain’s electrical activity. Other types of seizures, such as those caused by low blood sugar or heart problems, are not epileptic seizures

What are the main types of epilepsy?

a) Focal epilepsy when the seizures come from one half of the brain, such as focal aware seizures and focal impaired awareness seizures

  • Focal seizures without loss of consciousness also known as ‘focal aware’ seizures, where you remain aware of what’s going on around you and do not lose consciousness. Symptoms can include involuntary jerking of an arm or leg, and sensory symptoms such as feeling a tingling sensation, dizziness and seeing flashing lights.
  • Focal impaired awareness seizures during these seizures your awareness or consciousness is affected. Your body tends to make involuntary movements, such as lip smacking, arm waving and making random noises, or you may simply stare into space.

b) Generalised epilepsy when a range of generalised seizures, which begin in both halves of the brain, are experienced. These may include absence, myoclonic, atonic, tonic, and tonic-clonic seizures.

  • Tonic-clonic seizures these are the seizures that are typically associated with epilepsy. They have two phases, typically lasting for around one to three minutes in total. If seizures go on for five minutes, it’s important to get medical assistance. The first is the ‘tonic’ phase, when you lose consciousness, go stiff and fall to the floor. In the second (‘clonic’) stage, the limbs will jerk repeatedly, and breathing may be affected, which can cause a blue tinge around the mouth. Sometimes you may bite your tongue or lose control of your bladder and bowels.
  • Tonic seizures depending on where in the brain the seizure starts, the muscles in one area of your body or in your entire body will tighten, making your body go stiff. If it happens when you are standing up, you might fall to the floor. These are short and generally last for less than 20 seconds.
  • Atonic seizures these only last for a few seconds, but they have a strong effect as they cause all the muscles to go limp. This can cause you to fall to the floor, or your head to drop forwards and your knees to sag.
  • Absence seizures this type of seizure usually lasts for up to 10-15 seconds and mainly affects children. Symptoms include fluttering eyelids, slight jerks in the body and staring into space as if in a daydream.
  • Myoclonic seizures These seizures are very short, lasting only for a fraction of a second, so consciousness is not generally affected. They cause sudden jerks or twitches that can affect some or all of your body. Myoclonic seizures can be mild or more forceful, like an electric shock.

If you are diagnosed with epilepsy there are a range of treatments available including medication, surgery and stimulation treatments. While epilepsy cannot generally be cured, with the right treatment many people are able to keep seizures under control or even stop them altogether.

Medication.

Most people with epilepsy take anti-epileptic drugs (AEDs) to help control seizures by changing the chemical levels in the brain. AEDs are effective for around seven out of ten people with epilepsy. If the first AED is not effective, doctors may try alternatives or a combination of different types to find what works for you. Epilepsy medication comes in capsule, liquid, tablet and syrup forms and is usually taken on a daily basis. Any side effects experienced from these drugs should always be discussed with a doctor or pharmacist. The epilepsy drugs may also affect other medication so should always be taken under the supervision of your healthcare professional.

Medication can have significant side effects ranging from lethargy and irritability to euphoria or difficulty managing emotions.

Stay calm and try to reassure others around you

Check the surroundings: if the person is not in immediate danger, do not move them. Move nearby objects (e.g. furniture) away to prevent injury. Note the time when the seizure starts. Protect their head by placing something soft underneath if they have fallen to the ground

  • Do not restrain them or try to stop their movements
  • Do not put anything in their mouth
  • Ask bystanders to step back to give the person space and privacy
  • When the seizure stops, gently place them in the recovery position and check that their breathing returns to normal. Check the mouth carefully to ensure nothing is blocking the airway (e.g. food or dentures). If breathing remains difficult, call an ambulance
  • Preserve their dignity: if there has been loss of bladder control, manage this discreetly and as privately as possible
  • Stay with them until they are fully recovered and provide calm, gentle reassurance
  • Do not give food or drink until they are fully alert and recovered
  • Call an ambulance if:
    • This is the person’s first known seizure
    • They are seriously injured during the seizure
    • They have difficulty breathing after the seizure has stopped
    • One seizure follows another without recovery in between
    • The seizure lasts longer than usual for them (e.g. more than two minutes beyond their normal duration)
    • You do not know how long their seizures typically last

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