Epilepsy attack: symptoms and first aid

General information

So, epilepsy is a chronic disease, which in most cases manifests itself as a result of gene disorders or is inherited. The most well-known symptom of the disease is a convulsive seizure, which can be either local (in a certain area of ​​the body) or generalized (when the whole body is involved in the convulsive process).

There are several types of epilepsy, including:

• idiopathic (cryptogenic) - when the cause is unclear;
• myoclonic (juvenile) - occurs more often in adolescents and sometimes in young children;
• symptomatic (temporal, frontal, occipital, etc.) - if the cause of the disease is in one specific area of ​​the brain;
• rolandic (nocturnal) - occurs at night, sometimes called focal.

You can read more about classification in this article.

As for the inheritance of the disease, it does not matter in which generation the relative suffered from this disease, the fact itself is important, which will become one of the main signs indicating the formation of epilepsy, and not another disease. An acquired illness may remain dormant for a long time without manifesting itself, or, on the contrary, it may arise at the most inopportune moment.

In addition to hereditary and genetic causes, the development of epileptic (Jacksonian) seizures can be influenced by:

• tumor, cyst or other brain lesion;
• traumatic brain injury (TBI);
• toxic brain poisoning (alcohol, drugs, potent drugs);
• neuroinfections.

The severity of the disease may depend on many factors, including the state of the body’s immune system, the environmental situation in the region and the presence of provoking factors in the patient’s environment (loud sounds, bright lights, prolonged lack of sleep).

So how to treat epilepsy?

What do seizures look like in epilepsy?

Seizures due to changes in certain parts of the brain

Local, partial or focal seizures are the result of pathological processes in one part of the human brain. Partial seizures can be of two types - simple and complex.

Simple partial seizures

With simple partial seizures, patients do not lose consciousness, but the symptoms present will always depend on which part of the brain is affected and what exactly it controls in the body.

Simple seizures last about 2 minutes. Their symptoms are usually expressed in:

• a sudden causeless change in a person’s emotions;
• the occurrence of twitching in various parts of the body - limbs, for example;
• feeling of deja vu;
• difficulty understanding speech or pronouncing words;
• sensory, visual, auditory hallucinations (flashing lights before the eyes, tingling in the limbs, etc.);
• unpleasant sensations - nausea, goose bumps, changes in heart rate.

Complex partial seizures

With complex partial seizures, similar to simple ones, the symptoms will depend on the area of ​​the brain that is affected. Complex seizures affect a larger part of the brain than simple ones, causing changes in consciousness and sometimes loss of consciousness. The duration of a complex attack is 1-2 minutes.

Among the signs of complex partial seizures, doctors identify:

• the patient's gaze into emptiness;
• the presence of an aura or unusual sensations that occur immediately before a seizure;
• patient screams, repeating words, crying, laughing for no reason;
• senseless, frequently repeated behavior, automaticity in actions (walking in a circle, chewing movements without reference to food, etc.).

After the attack, the patient experiences disorientation. He does not remember the attack and does not understand what happened and when. A complex partial seizure can begin with a simple one, and then develop and sometimes turn into generalized convulsions.

Generalized seizures

Generalized seizures are a seizure that occurs when pathological changes occur in a patient in all parts of the brain. All generalized seizures are divided into 6 types - tonic, clonic, tonic-clonic, atonic, myoclonic and absence.

Tonic seizures

Tonic seizures got their name due to the special effect on human muscle tone. Such cramps provoke tension in muscle tissue. Most often this affects the muscles of the back and limbs. Typically, tonic spasms do not cause fainting. Such attacks occur during sleep and last no more than 20 seconds. However, if the patient is standing while they occur, he is more likely to fall.

Clonic seizures

Clonic seizures are quite rare compared to other types of generalized seizures, and they are characterized by rapid alternating relaxation and contraction of muscles. This process provokes rhythmic movement of the patient. Most often it occurs in the hands, neck, and face. It will not be possible to stop such a movement by holding the twitching part of the body.

Tonic-clonic seizures

Tonic-clonic seizures are known in medicine as grand mal - “big disease”. This is the most typical type of seizures that occur with epilepsy in the minds of many people. Their duration is usually 1-3 minutes. If a tonic-clonic attack lasts longer than 5 minutes, this should be a signal to urgently call an ambulance.

Tonic-clonic seizures have several phases. In the first, tonic phase, the patient loses consciousness and falls to the ground. This will be followed by a convulsive or clonic phase, since the attack will be accompanied by twitching, similar to the rhythm of clonic seizures. When tonic-clonic seizures occur, a number of actions or events may occur:

• the patient may experience increased salivation or foaming from the mouth;
• the patient may accidentally bite his tongue, which will lead to bleeding from the bite site;
• a person, without controlling himself during a period of convulsions, can get hurt or hit surrounding objects;
• patients may lose control over the excretory functions of the bladder and bowels;
• The patient may experience blue discoloration of the skin.

After the end of the tonic-clonic convulsion, the patient is weakened and does not remember what happened to him.

Atonic attacks

Atonic or astatic seizures, which involve brief loss of consciousness by the patient, get their name due to the loss of muscle tone and strength. Atonic attacks most often last up to 15 seconds.

When atonic seizures occur in patients in a sitting position, either falling or simply nodding the head may occur. If the body is tense in the event of a fall, it is worth talking about a tonic attack. At the end of the atonic seizure, the patient does not remember what happened. Patients prone to atonic attacks may be advised to wear a helmet, since such attacks contribute to head injury.

Myoclonic spasms

Myoclonic seizures are most often characterized by rapid jerking movements in some parts of the body, like small jumps inside the torso. Myoclonic seizures mainly affect the arms, legs, and upper body. Even those people who do not suffer from epilepsy may experience myoclonic spasms when falling asleep or waking up in the form of twitching or jerking. Hiccups are also classified as myoclonic spasms. Patients have myoclonic seizures affecting both sides of their body. The attacks last a few seconds and do not cause loss of consciousness.

The presence of myoclonic seizures may indicate several epileptic syndromes, for example, juvenile or progressive myoclonic epilepsy, Lennox-Gastaut syndrome.

The nature of absence seizures

Absence seizure or petit mal most often occurs in childhood and is a short-term loss of consciousness. The patient may stop, look into emptiness and not perceive the surrounding reality. In complex absence seizures, the child experiences some muscle movements, such as rapid blinking of the eyes, or chewing-like movements of the arms or jaw. Absences last up to 20 seconds in the presence of muscle cramps and up to 10 seconds in their absence.

With a short duration, absence seizures can occur repeatedly even within 1 day. They can be suspected if the child is sometimes able to switch off and does not respond to the treatment of people around him.

Ways to eliminate the disease

There are several ways to get rid of this disease, including:

• medication (conservative treatment);
• non-traditional methods of treatment;
• surgical intervention;
• folk remedies.

Initially, a person consults a neurologist, who, after making a diagnosis, can refer the patient to an epileptologist (if available), or can independently begin treatment.

It is difficult to completely get rid of a disease, and most likely, it is more correct to talk not about getting rid of it, but about controlling the disease, because there is no 100% guarantee of recovery. It (the disease) is insidious and can manifest itself repeatedly.

What does a person feel during an epileptic attack?

I had epilepsy from 11 to 12 years old. More than four years have passed, but I still remember the terrible sensations that I had to endure. It was a fairly mild form of epilepsy, it happened once a month, like clockwork, only at night, during sleep. About half a year after the attacks began, I began to roughly feel them approaching, and I was afraid to go to bed. But you couldn’t just stay awake overnight to avoid the cramps; they would have happened anyway, only later. Such delaying of the inevitable, aggravating the general state of health, would not lead to good. I took pills three times a day every day, when I forgot, my parents argued a lot, and because of this I only became more nervous, but epilepsy occurs due to nervousness.

Now I will describe everything that happened to me during the attacks. According to my parents: I got out of bed at night, walked with open but empty eyes, looked, but didn’t see anything, came into their room, shouted “mom” or something incomprehensible, then fell and began to jerk my left hand convulsively and foot. My mother, a doctor (a neurologist who treats epileptics, ironically), turned me over on my side and did everything necessary to make sure I suffered the attack as easily as possible. When the convulsions stopped, but I was still unconscious, my father carried me to the bed, and they both sat next to each other, waiting for me to wake up (not very long, two minutes was usually enough for me). I didn’t remember anything except, directly, the convulsions. But here are my feelings: it was as if I was trying to say something, but I couldn’t, so it came out as an indistinct moo, and I was never able to grasp the boundaries between sleep and an attack, so I can’t say where it all started. For some reason I tried to turn on the other side and raise myself on my elbows, but I couldn’t control my limbs and body in general, which caused terrible fear. Yes, I never felt such fear from anything else, I felt helpless, but the whole joke of attacks is that you don’t understand that it’s an attack, you just feel bad, it’s not clear when, where and why. Everything happens in a half-asleep, half-forgotten state, and after the convulsions there is a rather long recovery. My eyes were open, but I didn’t see any clear pictures: everything was dark and blurry. I only heard my own mooing and, occasionally, the words of my parents.

This is a very unpleasant disease, I felt bad because I had attacks once a month, I can’t imagine how bad it is for people who have it several times a day.

Indications for conservative therapy

Before deciding to prescribe drug therapy, the specialist must be sure that he is dealing with epilepsy. Drugs can be prescribed only after diagnostic procedures (MRI and, most importantly, EEG).

Conservative treatment is the main one and it should begin with monotherapy - treatment with one specific drug. No matter what type of disease, at the very beginning the patient will take one drug.

In cases where the drug is ineffective, it is possible to prescribe mixed therapy (using a mixture of several drugs).

Treatment is always selected strictly individually, and the criteria for choosing medication and dosage include:

• gender and age of the patient;
• what type of epilepsy is diagnosed;
• neurological or psychological changes and their severity;
• the presence of other diseases that may aggravate the underlying disease;
• working conditions of the patient.

The list of medications used to treat epilepsy includes:

• Preparations containing valproic acid.
• Carbamazepine group.

Valproic acid group

Treatment should begin with taking drugs of this particular group, since the principle of their action is to improve neural patency.

One of the drugs has a name - Depakine. This medicine cannot be called new, but it has proven itself quite well.

Available in the form of tablets or injections. It is always worth remembering that you cannot prescribe your own dosage, as this can worsen the condition.

The dose and duration of administration depends on the patient’s age, gender, weight and individual characteristics of the body, which the doctor takes into account.

This drug has a number of contraindications (cannot be taken for blood diseases, hepatitis of any severity and in combination with certain medications).

Is it possible to cure epilepsy completely in an adult using only this drug? It’s unlikely, since this medicine will only allow you to take control of the disease, but will not get rid of the unpleasant illness.

Carbamazepine group

This group of drugs is used for more severe forms of the disease, when a more stable and long-lasting effect is needed.

There are several tablets of this group:

• Finlepsin.
• Finlepsin retard.
• Trileptal.

The necessary remedy, as in the case of the valproic acid group, is prescribed by a neurologist.

The principle of action of drugs in this group is based on the inhibition of neural activity, which in most cases is the main condition for the formation of epileptic seizures.

Therapy begins with small dosages, which are gradually increased until the optimal dose for a particular person is reached.

With the carbamazepine group, too, not everything is as simple as it seems at first glance. Firstly, medications in this group have side effects (headache, nausea, drowsiness), secondly, sudden withdrawal of medications can provoke a severe epileptic seizure, and thirdly, there are a number of contraindications for taking these tablets, including :

• individual intolerance to components;
• blood diseases;
• AV block of heart rhythm;
• parallel treatment with lithium salts;
• impossibility of combining carbamazepine and antidepressants.

Signs of an epileptic seizure

The first symptom of an epileptic attack may be an aura. Sometimes it is easy for the patient to recognize it by characteristic feelings, thoughts, and behavior. An aura is characterized by the appearance of unusual smells, sounds or tastes, blurred vision, fear, panic, negative or very pleasant feelings, chaotic thoughts, headache and dizziness, nausea, numbness or tingling in different parts of the body.

Visible seizure symptoms last longer than the seizure activity on the EEG. These include fainting, memory loss, confusion, inability to distinguish or hear sounds, loss of vision or visual hallucinations, speech disturbances, drooling, frequent blinking, lack of movement or muscle tone, tremors, jerking of the limbs or the whole body, automatisms (repetitive movements) , convulsions, urinary or fecal incontinence, change in skin color (pallor, cyanosis), difficulty breathing, rapid pulse, etc.

After an epileptic seizure, some people recover immediately. Others require several minutes or even hours. At this time, they may experience drowsiness, memory impairment, weakness, slow reactions, speech impairment, dizziness, headache, nausea, thirst, and upset stomach.

Associated symptoms:

1. Convulsions
2. Tremor
3. Headache
4. Dizziness
5. Visual impairment
6. Nausea
7. Urinary incontinence
8. Drowsiness
9. Memory impairment
10. Hallucinations
11. Impaired self-awareness

Other antiepileptic drugs

For those patients who cannot be treated with drugs from the first two groups, there is an alternative. It may not be as effective in speed as previous drugs, but its effect is not much worse.

Lamitor (tablets based on the active substance - lamotrigine) - this medicine reduces the activity of neurons by suppressing the production of glutamic acid.

This drug is successfully used to treat epilepsy in children under three years of age and in pregnant women.

Tebantin (tablets based on the active substance - gabapentin) - suppresses the movement of calcium ions, thereby reducing the risk of developing a seizure. It is used, as a rule, in the treatment of children of older adolescence.

In addition to taking medications, there are several options for additional therapy that will help the patient heal.

For example, music. Music therapy for this disease can be used as an auxiliary element to relieve nervous tension. Naturally, the patient should not be offered hard rock or rhythmic tracks played in nightclubs to listen to. It should be a relaxing melody (perhaps a classic) that will help you relax and relieve the fatigue that has accumulated during the day. Is epilepsy curable with this method or not? More likely no than yes. Since music is designed to relieve only one provoking factor, but not all symptoms.

Treatment of epilepsy in children

Childhood imposes certain difficulties with therapy, since the baby’s fragile body does not always adequately respond to the use of certain medications.

For example, for infants the dosage may be two or even three times less than for a teenage child.

Child in a special protective helmet

Moreover, different types of medications are used for different ages, as some can be used for newborns, while others cannot.

Childhood epilepsy is also characterized by the fact that it may not be cured with drugs, but may go away on its own, after a certain age and a decrease in hormonal levels. However, this rule does not work with the symptomatic type, which cannot be eliminated using this method.

For children, medications containing lamotrigine, valproic acid, carbamazepine or topiramate as the active substance are used. You can purchase any medicine from this list at the pharmacy, but only on the recommendation of a doctor, this is important! Don't self-medicate!

Treatment is carried out according to the same scheme as with adults (first monotherapy and only in the absence of effect mixing).

The differences will be in the timing of deliverance (for children they are shorter).

Surgical treatment of epilepsy

Surgical intervention is resorted to in especially severe cases or when there are indications for brain surgery.

It is possible to recover quickly with surgery, but you should understand that any surgical intervention is associated with certain risks both for the nervous system and for the body as a whole, and when it comes to removing part of the brain, the patient’s relatives should understand that more serious ones may arise consequences than epileptic seizures that will begin after surgery.

We talk about intervention in the structure of the brain when there are problems with its functioning (presence of a tumor, cyst or hemorrhage) that need to be eliminated to stop seizures.

In addition, it is possible to perform an operation called magnetic therapy. The operating principle is as follows: I implant a special device under the patient’s skin in a place where he can react as quickly as possible to an approaching attack, and the person independently controls this device. For example, when a patient has an aura (precursors) of a seizure, he uses an implanted component that sends special impulses to the brain and prevents the attack. Moreover, this device can work independently, without human intervention, but where the boundary it uses in its work is unclear.

The device will be as effective as the battery allows (usually up to five years); after five years, the power supply will need to be replaced, that is, repeated surgery. Epilepsy will be cured using a magnetic field. Is epilepsy treated with the help of such innovative devices? Rather, it is taken under tighter control and remains there throughout the duration of the implanted device.

First aid for an epileptic attack

If you suspect a person is having an epileptic seizure, follow these steps regardless of the type of seizure:

1. Stay with the person until the attack is over. The attacks are unpredictable: some start with minor symptoms but lead to loss of consciousness or a fall. If a person is injured during an attack, he will need the help of other people or doctors.

2. Pay attention to the duration of the attack and tell the patient or healthcare worker the time of its beginning and end.

3. Stay calm. Most attacks last only a few minutes and do not require medical attention.

4. Remove sharp and hard objects that could injure a person during an attack.

5. Help the person position himself in a safe place with maximum comfort.

6. If a person falls to the floor, support their head to prevent impact.

7. Ask onlookers to move away. When a person wakes up, he may feel confused or afraid of the crowd.

8. Do not try to forcibly stop the attack or hold the person’s legs or arms. This may cause injury.

9. Don't put anything in a person's mouth! Don't worry, he won't be able to swallow his tongue during an attack.

10. Make sure that it is easy for the person to breathe. Turn it on its side to prevent saliva from entering the airways.

11. During a convulsive or tonic-clonic seizure, you may feel as if the person has stopped breathing. When the tonic part of the attack is over, the muscles will relax and breathing will resume. Artificial respiration and cardiac massage are usually not required.

12. Do not give the person water or pills until he has fully recovered.