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Health Centres - Epileptic attacks
Reviewed by Dr Anthony Marson, lecturer in neurology
What is epilepsy? Epilepsy is a condition in which people have seizures or 'epileptic attacks'.
There are many different types of attacks, ranging from minor symptoms noticed only by the affected person, to convulsions, the most easily recognised type of epileptic attack.
Important facts about the attacks are:
- where in the brain they start
- how they spread
- how much of the brain is affected.
Is it possible to divide the attacks into groups?
Epileptic attacks are divided into two main groups.
Partial Attacks
Partial (focal) attacks
These attacks start in a specific part of the white matter of the brain (cerebral cortex). The starting point of the abnormal electrical activity is called the 'focus'. During attacks, they can either stay there, spread to the surrounding areas or eventually spread to involve the whole brain.
It is most important to determine the very first symptoms of an attack, as this will indicate where the focus is.
- If the person has twitches in the right hand, the focus must be in the left half of the brain. In general, the left side of the brain controls the right side of the body.
- If the attack starts with a flash of light, the focus is in the area at the back of the brain (the occipital lobe) that deals with vision.
- If there are hallucinatory experiences, which can be the awareness of a strange taste or smell or a sensation of déja vu, the attack comes from a temporal lobe situated at the sides of the brain.
Simple partial attacks
Are characterised by the sufferer being alert, awake and knowing what is going on. These types of attacks are often called auras (from Greek = breath), especially when they progress to more severe attacks.
It is an advantage for the person to be able to communicate with those around them during the attack and, for instance, be able to tell people that the attack is not dangerous and that it will stop by itself.
Complex partial attacks
In this type of attack, the person loses awareness and is, therefore, unable to communicate or remember what happened. It is often preceded by a simple partial attack.
Because awareness is lost the person may stare into space or do automatic things like make chewing or lip-smacking movements, pick at clothing or nearby objects or get up and wander around in a confused manner. Attacks typically last a few minutes.
These attacks can be embarrassing and socially disabling.
Most complex partial attacks start in the temporal lobe. They can be difficult to control with medication and are sometimes cured by surgery.
Secondary generalised attacks
When the attack spreads to involve the whole brain, the victim will have what is called a secondary generalised tonic clonic seizure. This is also known as a convulsion or grand mal attack.
Doctors currently prefer to use the term tonic clonic seizure as it is descriptive of what happens during the attack: first the person goes stiff (tonic) and then shakes (clonic).
Breathing may stop during the attack and the person's skin may turn blue.
Shaking typically lasts one to two minutes, but can go on for longer. When the shaking stops, it may be impossible to rouse the person for a few minutes.
During attacks, people may be injured by falling to the floor. They may bite their tongue or become incontinent.
During a tonic clonic seizure, it is important to remove all sharp or heavy objects near the person, and to put them on his or her side in the recovery position. Nothing should ever be put in the mouth of someone having a tonic clonic seizure.
Generalised attacks
In this type of attack there is no focus. Generalised seizures occur due to abnormal electrical activity occurring spontaneously on both sides of the brain.
Many of the epilepsies that cause generalised seizures are thought to have a genetic basis. There are a number of types of generalised attacks
Generalised tonic-clonic seizure
. As well as occurring in people with a focal epilepsy, those with a generalised epilepsy can have tonic clonic seizures.
It is very important for doctors to be able to distinguish between tonic clonic seizures with a generalised onset and those with a partial onset, as the treatment and investigation differs.
Tonic clonic seizures with a generalised onset will occur without warning.
For tonic clonic seizures with a focal onset, patient will usually get a warning (aura) and may also be experiencing simple partial or complex partial attacks.
Absence seizures
In this type of attack, the person briefly loses awareness and stares into space (usually for less than 10 seconds) and makes an immediate recovery. During the attack the patient may blink their eyes.
Sometimes absences can occur with great frequency, up to 100 times a day, and therefore it may be a serious problem, for instance when the person is in school and their condition goes unrecognised.
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