Epilepsy & seizures: what they are & what you need to know
I’m sure you’ve seen seizures on TV before. If it was on Nigerian TV or home videos, I have a pretty good idea of what you might have seen: someone suddenly fell down, then started to shake and jerk uncontrollably, their eyes rolled back…and then it happens — it always happens on Nigerian TV and film seizures — the foam starts to spill out the sides of their mouth. All the seizures seem to play out the same way, and it's not a seizure if there’s no foam. (I'd be glad to hear of anyone that's different from this norm.) In real life, though, it’s a completely different scenario. There are far more kinds of seizures than you might imagine, and today I’m going to tell you all about it. (OK not all, obviously — we’re not getting technical here — but I’ll tell you the basics you need to get started.)
First, you need to understand the language here…
A seizure is the result of a sudden and abnormal surge of electrical activity in the brain, with whatever follows.
A convulsion is a seizure that involves movement abnormalities.
Epilepsy is basically recurring seizures. Aka seizure disorder. More precisely we say someone has epilepsy when they've had at least two unprovoked seizures — that is, without an identifiable cause.
[bctt tweet="A seizure = result of sudden abnormal surge of electrical activity in the brain. Learn more…" username="DocAyomide"]
That’s really all there is to it. Now before we get into how this works out…
50 million: number of people with epilepsy
1 in 10 people have had a seizure before
80% of people with epilepsy live in low and middle income countries (LAMIC)
70% of the time, people with epilepsy respond to treatment
But…get this: 75% of people with epilepsy in LAMIC don’t get treatment!
[bctt tweet="70% of the time, people with epilepsy respond to treatment. Read more…" username="DocAyomide"]
What happens during a seizure episode
So, normally, our brains send out these little electrical signals, which are how pretty much everything works: the brain is constantly sending out all these little signals to the rest of the body to make it do stuff. For instance, as you read these words, your brain is sending signals to your eyes and receiving signals right back. If you tapped anything on the screen, your brain fires signals to your hand, instructing it to move, and then instructing it to pull back after so you can keep reading. All in microseconds. (You could say it was like a brain box, but it’s already a brain.)
The thing about all this electrical activity is it's very highly coordinated. But during a seizure, this coordination is disrupted, signals fire wrong and anything can happen, depending on what part of the brain the signals are coming from…
- The parts that control movement, that’s what you get (not just jerking, but also stiffness.)
- The parts that interpret the senses, you get abnormalities in sensation including, sometimes, even hallucinations.
- The parts modulating behaviour, you get behavioural abnormalities, including unprovoked agitation and sometimes even violence. And it's still just a seizure o, not “madness.” (Not that I believe in “madness,” anyway — except, of course, you mean the madness of Lagos traffic.)
- There are even seizures in which the person only experiences a momentary loss of awareness — that is, they just “go blank” for a few seconds
- And there’s a kind of seizure where the person has a “feeling that it will happen,” minutes — and sometimes hours or days — before it does.
The point is, seizures come in far wider varieties than movies portray. (Note that often — but not necessarily always — A person who has had a seizure episode is not aware of what was happening, even in the behavioural types.)
In a way you can think of seizures like a sort of electrical surge. All kinds of stuff can happen. The TV goes blank, freezer goes kaput, a couple lightbulbs blow out — but the problem would be with none of those things. You’d know the real issue was the surge. In a seizure, the electricity is obviously far less (you can't even perceive it without special instruments), and the reality is far more complex, but you get the idea.
(I should also point out that, since epilepsy is unprovoked seizures, seizures due to, say, infections, brain growths, or other medical conditions are not epilepsy. And in these conditions, the specific cause needs to be treated.)
What about epilepsy treatment?
Treatment for epilepsy exists and it works amazingly well. Honestly, if you wanted to know just one thing about, this would be enough.
There are different kinds of drugs available, but they basically all do something similar: suppress the brain activity. You could say epilepsy drugs act like stabilisers. (No joke: they are actually called that in another sense: some of them are used in treating bipolar disorder — where they've been found effective — and called mood stabilisers.) More details on anticonvulsants below (1).
We all know what stabilisers do: they intervene between current from the mains to protect home appliances in case of surges and other electrical fluctuations. Similarly, anti-epileptic drugs intervene to "stabilise" the abnormally uncoordinated "current" in the brain before it's delivered to the body parts and brain.
Our wrong beliefs about seizures
- “Seizures are contagious.” This is so untrue. Seizures are not contagious. I repeat: seizures are not contagious! As you can see from the explanation about how seizures happen, you simply cannot catch seizures. I know of parents who had to pull their kids out of school because other parents were afraid of their own kids “catching” the seizures. So on top of seizures, the kids now couldn't be in school. Now that’s just sad.
[bctt tweet="Seizures are not contagious. I repeat: seizures are not contagious! — via @DocAyomide" via="no"]
- “People can swallow their tongues during a seizure.” They can’t o. Please. The things people do to “prevent” this — putting spoons and other objects in their mouths — are the real danger.
[bctt tweet="People in seizures DON'T swallow their tongue. Spoon in their mouth is the real danger.—via @DocAyomide" username="DocAyomide"]
- “Seizures are caused by evil spirits.” All I’m going to say to that is this: it’s rather hard to take seriously the kind of “evil spirits” that “fear” medication. Because, you know, the medication actually works.
- “It needs to be treated traditionally.” One such “treatment” is putting the feet of the person to a fire. Literally. If you think I’m being extreme, just know I’ve people actually do this — here in this Lagos — and I’ve seen at least one case of gangrene developing as a result. The person ended up requiring amputation. True story.
What do you do when someone has a seizure?
Well, first here’s what NOT to do.
- Don’t run away. Remember: seizures are not contagious. On the other hand, don’t crowd them, either.
- Don’t put a spoon or any other object in their mouth. (Remember what I said earlier.)
- Don’t forcefully hold their hands and legs: this won’t stop the seizure and may only harm them.
- Don’t take them to a traditional practitioner or try other traditional “treatments,” like putting their feet to fire.
- Don’t bother trying to fan them or pour water on them or anything like that. There’s just no need.
- Don’t give food or water until they are fully alert.
What to do then?
- Do keep them safe: remove any potentially harmful objects on or around them (including eyeglasses, or ties and other neckwear). Also cushion their head with something if they fell on the ground.
- Do check the time: it’s very useful information for the doctor. If it lasts longer than 5 minutes (and especially if they aren't already on treatment for seizures)…
- Do call an ambulance or otherwise get them to a doctor. (In Lagos, you can get an ambulance by calling 767.) In the
- Do stay with them until the seizure stops by itself and they are fully awake and aware.
- Do talk to the person about the seizure after. If it stops while you’re still there, calmly tell them what happened and let them know you’re there for them and the seizure doesn’t change how you see them.
On a final note…
If you have seizures, and especially if you're being treated for epilepsy, please keep a seizure diary. Basically that means a record of whenever a seizure happens, how long it lasts (as far as you can estimate from surrounding events or anyone present), and whatever you may have been doing or feeling before it happened, as far as you can remember. Take this with you whenever you go to see your doctor.
Have you ever experienced a seizure, or observed one? Do you have any further questions about seizures? Email me (email@example.com) and tell me all about it! Or you can post it in the comments or tweet @DocAyomide if it’s something you can share.