When someone hears the word “seizure,” they visualize a person with their eyes rolled back, lying on the ground, convulsing. But actually, there are many kinds of seizures, and such an image represents only one. Unfortunately, there remains a lack of recognition in our society, which can lead to a delayed diagnosis or misdiagnosis. By properly educating oneself on the seizure types, one can better recognize when friends or loved ones experience a seizure. One in every 10 people will experience a seizure in their lives, so there is a high probability that everyone will witness one at some point.
Seizures are a sudden surge of abnormal electrical activity in the brain that affect how a person feels or acts for a short period of time. In 2017, a new seizure classification system was devised by the Epilepsy Foundation to replace the previous version from 1981. Under both systems, there are dozens of classifications. Effective seizure recognition begins with understanding and identifying some significant ones, including infantile spasms, absence, myoclonic, atonic, simple partial (focal aware) and tonic-clonic.
Infantile spasms, or West syndrome, are a rare seizure disorder that occurs in children. Onset typically begins between 3 and 8 months of age and ends between 2 to 4 years. In the United States, only about 2,500 children are diagnosed each year with this syndrome. If the child is sitting up, the head will fall forward suddenly and the arms will flex forward. If lying down, the knees will be drawn up with the head and arms flexed forward. Children who develop infantile spasms are at high risk for developmental disability and autism. With early recognition, medications that control these spasms can be prescribed.
Generalized absence seizures are sudden lapses of consciousness. These seizures are recognized as a blank stare which begins and ends abruptly. The person lacks awareness of what is happening during the seizure but returns to complete awareness when the seizure ends. Often times, absence seizures go unrecognized or are interpreted as daydreaming, despite the person having no awareness or ability to interact with their surroundings. As such, some people will go their whole lives without being diagnosed.
Myoclonic seizures are sudden, brief, massive muscle jerks that may involve the whole body (generalized myoclonic) or only parts of the body (focal myoclonic). During these seizures, the person is aware and able to think clearly. This seizure type is frequently misinterpreted as clumsiness or poor coordination. Most people with myoclonic seizures will also experience tonic-clonic seizures.
Atonic seizures are a sudden loss of muscle tone. A generalized atonic seizure manifests as a sudden collapse or drop affecting the head, trunk or whole body. In contrast, a focal atonic seizure will only affect one part of the body, such as an arm or leg, resulting in selective limpness. Atonic seizures are most common in childhood but may last into adulthood. Atonic seizures are commonly misread as clumsiness, a normal childhood stage or a lack of walking skills. No first aid is needed with this type of seizure unless the person is injured during the fall.
Simple partial seizures, classified as “focal aware” under the revised classification system, are characterized by sudden jerking in one area of the body, such as the arm, leg or face. The person will remain awake and alert through the duration of the seizure. These seizures sometimes progress to a convulsive episode. Other times, the person may be frozen during the seizure and, despite awareness, unable to respond to others. These seizures have been thought to be hysteria, mental illness, psychosomatic illness or a mystical experience. No first aid is necessary but reassurance and emotional support is appreciated.
Generalized tonic-clonic seizures are the type most people associate with epilepsy. They can start with a sudden cry, fall or rigidity, followed by muscle jerks, shallow breathing, blush skin and possible loss of bladder or bowel control. These seizures last a couple of minutes. It is best to clear the area of possible hazards, turn the person on their side so they do not asphyxiate, remove any constricting items from the neck and cushion the person’s head. Despite common misconception, there is no danger of swallowing one’s tongue. As such, never place any objects in or near the mouth of the person seizing, as doing so may result in injury. Attempt to time the seizure. If it lasts longer than five minutes, call paramedics. Otherwise, medical intervention should not be necessary. With complex partial seizures, there is a postictal stage, or altered state of consciousness, once the seizure ends. It may take a few minutes for the person to become fully oriented.
Too often, those living with epilepsy face a lack of understanding from their community. Aside from the potential of misdiagnosis, this lack of awareness creates issues, including increased medical complications.
It can also strengthen of the stigma surrounding the disorder and increase social isolation among those living with it. With public understanding of these basic types of seizures, much can be done for those living with epilepsy.