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Types of Seizures

Seizures are sudden, uncontrolled electrical disturbances in the brain that can affect movement, behaviour and consciousness. While they are often associated with epilepsy, a neurological disorder where seizures occur frequently, they can also result from other medical conditions such as brain injuries, infections, strokes and metabolic imbalances.

Seizures can differ for each person and can vary in severity, from ‘minor’ to ‘major’. According to the Epilepsy Society, there are more than 60 different types of seizures. Understanding and recognising different types of seizures is crucial for ensuring a fast and appropriate response. Each type of seizure can present differently and knowing how to react can help protect the individual and reduce the risk of injury or even death.

Today, we will focus on identifying the various types of seizures and provide practical guidance on how to respond effectively to each type to help ensure the safety and well-being of those affected.

Responding to seizures

What are Seizures

A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behaviour, movements, feelings or levels of consciousness. Seizures occur when the brain’s electrical activity becomes abnormal, which leads to temporary disruptions in normal brain function. The electrical surges disrupt the normal communication between neurons and can lead to a variety of symptoms, depending on which area of the brain is affected.

While seizures are a hallmark of epilepsy, a chronic condition characterised by recurrent seizures, they can also occur due to other factors, including:

  • Brain injuries: Trauma to the brain can cause seizures, either immediately after the injury or as a long-term effect.
  • Infections: Conditions such as meningitis or encephalitis, which cause inflammation in the brain, can trigger seizures.
  • Metabolic disorders: Imbalances in blood sugar, electrolytes or kidney and liver function can lead to seizures.
  • Other causes: Stroke, high fever (febrile seizures) especially in children, drug or alcohol withdrawal and certain genetic conditions can also provoke seizures.

Seizures can manifest in many different ways, from brief lapses in awareness or muscle twitches to violent convulsions and loss of consciousness. They may last only a few seconds or several minutes. Given this wide range of possible symptoms, recognising the specific type of seizure is critical for appropriate and effective management. This understanding helps people know how best to respond to the seizure and informs treatment decisions.

Types of Seizures

Seizures are primarily classified into two main categories:

  • Focal (partial) seizures
  • Generalised seizures

This classification occurs depending on where in the brain the abnormal electrical activity begins and how it affects the body. Understanding the type of seizure is key to providing appropriate care and ensuring the safety of the individual experiencing the seizure.

Focal (Partial) Seizures

Focal seizures start in one specific area of the brain and typically affect a particular part of the body. They can cause a variety of symptoms, depending on the region of the brain involved and may or may not impair consciousness. There are two main types of focal seizures:

Focal Aware Seizures (Simple Partial Seizures)

In these seizures, the person remains fully conscious and aware, although, in some cases, they may be ‘frozen’ and unable to respond. Seizures usually last less than two minutes but the person may have feelings, movements or sensations that feel out of their control. The seizure begins on one side of the brain. Symptoms can include:

  • Sudden, unexplainable emotions like fear, joy or anger.
  • Sensory changes, such as tingling, dizziness or abnormal smells and tastes.
  • Uncontrolled movements in one part or one side of the body, such as twitching or jerking of a limb.
  • Changes in their senses, such as their smell, taste or feeling.
  • Sweating.
Recognising types of seizures

Focal Impaired Awareness Seizures (Complex Partial Seizures)

This type of seizure begins on one side of the brain, usually in one area or one group of brain cells. The seizure affects consciousness and can cause the person to appear confused or unaware of their surroundings. Common symptoms include:

  • Repetitive movements, such as lip-smacking, hand-gesturing, chewing or fidgeting.
  • Flailing their arms or bicycling their legs.
  • Wandering around.
  • Impaired consciousness: The person may not respond to their environment and may seem dazed.
  • The person often doesn’t remember the event once the seizure ends. These seizures may last 1-2 minutes and recovery can take several minutes.

Generalised Seizures

Generalised seizures involve both sides of the brain from the onset and typically result in loss of consciousness. There are several types of generalised seizures each with distinct characteristics:

Absence Seizures (Petit Mal)

These seizures involve brief lapses in awareness, often lasting only a few seconds. They are commonly mistaken for daydreaming or inattentiveness. Absence seizures usually occur in children and may happen multiple times a day. Symptoms include:

  • Staring spells.
  • Eyes may turn upwards, rapid blinking or eye fluttering.
  • Open and closing lips subtly or slight chewing motions.
  • A sudden stop in movement or speech without any warning.

Tonic-Clonic Seizures (Grand Mal)

Tonic-clonic seizures are the most recognised type of generalised seizure and have two stages:

  • Tonic phase: Muscles stiffen, causing the person to fall or lose balance. Air may be forced through the vocal cords which can cause a crying or groaning noise. The person typically loses consciousness. They may also bite their tongue.
  •  Clonic phase: Rhythmic jerking of the body, especially the arms and legs

The person may also lose control of their bladder. These seizures typically last a few minutes. Post-seizure confusion, fatigue or drowsiness often follows, sometimes lasting for several hours.

Atonic Seizures

Also known as ‘drop attacks’, atonic seizures cause a sudden loss of muscle tone. They are brief but can result in injury from the sudden collapse. Symptoms include:

  • Sudden loss of muscle tone causes the body to become limp, and the person to collapse, droop their head or limbs or drop things.
  • If the person is standing, they will fall to the ground which can result in injury.

Myoclonic Seizures

Myoclonic seizures cause sudden, brief jerks or twitches of muscles which often occur in both arms or both legs simultaneously. These jerks usually happen shortly after waking and last only for a few seconds. 

Tonic Seizures

Tonic seizures involve a sudden stiffening of the muscles, especially in the arms, legs and back. The person may fall if standing due to muscle rigidity and consciousness is usually affected. Tonic seizures often happen during sleep and involve all or the majority of the brain, meaning they affect both sides of the body.

Clonic Seizures

Clonic seizures are characterised by repetitive, rhythmic jerking movements typically in the arms, neck or face. 

Recognising Seizures

Recognising the signs and symptoms of a seizure can help ensure a quick and appropriate response. Different types of seizures present with various symptoms which makes it important to be aware of the characteristics of different seizures to help you identify the type of seizure. Seizures can present in a variety of ways, including brief lapses in awareness, unusual sensations or more noticeable physical symptoms like muscle stiffness or jerking. Common signs include sudden changes in consciousness, involuntary movements or staring spells. These symptoms can range from mild and brief to severe, involving loss of consciousness and convulsions.

If you witness a seizure in another person, it is important to carefully observe and note specific characteristics, as these details can help medical professionals determine the type and severity of the seizure. Key aspects to monitor include:

  • Duration: Knowing how long the seizure lasted can help medical professionals determine the type and severity.
  • Type of movements: Documenting whether the person has jerking, stiffening or twitching movements is crucial.
  • Level of consciousness: Whether the person remains aware or loses consciousness can help differentiate between focal and generalised seizures.
  • Post-seizure behaviour: How the person behaves after the seizure, such as confusion or exhaustion, can provide further insights.

It can also be helpful to note down other information, such as what the person was doing before the seizure, any mood or sensory changes that you noted, whether the seizure happened without warning, what first alerted you to the seizure, whether the person’s breathing changed and whether their colour changed. 

Responding to Seizures

Responding appropriately to a seizure can help protect the person from harm and ensure their safety during and after the event. Below are general guidelines for managing different types of seizures:

Focal Aware Seizures

  • Reassure the person: Stay calm and offer reassurance. The person is usually conscious and aware of their surroundings, which can make the seizure even more frightening for them.
  • Stay with them: Stay close until the seizure ends. These seizures are typically brief, but the person may feel confused or disoriented afterwards.
  • Ensure safety: If the person seems disoriented, gently guide them away from dangerous situations like traffic or heights.

Generalised Tonic-Clonic Seizures

  • Protect from injury: Cushion the person’s head with something soft and remove sharp or hard objects from the area to prevent injury during convulsions.
  • Turn them on their side: Once convulsions have stopped, turn the person onto their side to keep their airway clear and reduce the risk of choking.
  • Do not restrain movements: Allow the seizure to run its course without holding the person down or restricting their movements.
  • Do not put anything in their mouth: Contrary to common myths, placing objects in the mouth can cause injury or block the airway.
  • Loosen clothing around the neck: If the person is wearing tight clothing around their neck, such as a collar or a tie, it is recommended to loosen it to help their breathing.

Absence Seizures

  • Monitor seizure duration: Note how long the absence seizure lasts and how often they occur, as this information can help doctors assess the condition.
  • Guide them back to activity: After the seizure ends, gently remind the person of what they were doing, as they may not be aware that the seizure happened.

Although seizures can be scary to see, it is important not to panic. It is generally recommended not to move a person who is having a seizure unless they are in danger. For example, if someone is having a Focal Aware Seizure and is standing next to a fire or a steep drop, you should move them for their own safety.  

In many cases, the person will require no medical attention after receiving a seizure, particularly if they have had seizures before. However, in some cases, emergency medical help will be required. It is recommended to call 999 if:

  • The seizure lasts longer than five minutes.
  • The seizure lasts longer than is usual for them.
  • The person does not regain consciousness.
  • The person has multiple seizures without regaining consciousness in between.
  • The person is seriously injured during the seizure.
  • The person has difficulty breathing following the seizure.

If it is the person’s first seizure or the cause is unknown, it is recommended to seek medical help and advice, either by calling 999 or visiting A&E. Alternatively, if the seizure was very mild, making an appointment with their GP or visiting the local walk-in centre may be the best course of action.  

Different types of seizures

Aftercare and Support

Providing proper care after a seizure is essential for the person’s recovery and to ensure their safety. Every person manages their recovery period differently and people who have experienced seizures before may already have a recovery plan they follow. However, it can still be beneficial to offer care and support. 

Some common tips that can help once the seizure has ended are:

  • Check for injuries: After the seizure, examine the person for any injuries they may have sustained during the episode, such as cuts, bruises or head injuries from falls.
  • Provide reassurance: The person may be disoriented, confused or embarrassed following a seizure. Offer calm and supportive reassurance and let them know they are safe.
  • Allow them to rest: After a seizure, it’s common for the person to feel tired or want to sleep. Let them rest in a safe, comfortable position while monitoring their recovery.
  • Aid with forgetfulness: Some people experience forgetfulness following a seizure. It can be helpful to remind them of any important tasks, such as taking medication. If necessary, it may be beneficial to help the person cancel any plans or commitments they don’t feel able to fulfil.
  • Treat any injuries: If the person bit the lips or tongue during the seizure, fell and hurt themselves or acquired a different type of minor injury, helping to treat the injuries is a great way to provide care. This could include cleaning cuts, helping them to put ointment on their lips or providing an icepack. For more serious injuries, medical help may be required, for example by calling 111 or 999 or visiting A&E.

Following the seizure, it may also be recommended to follow up with a healthcare provider, particularly in the following situations:

  • First-time seizures: If the person is experiencing a seizure for the first time, it’s crucial to seek medical attention to determine the cause and assess the need for further evaluation.
  • Concerns: Encourage follow-up with a healthcare provider if the seizure was prolonged, unusual or resulted in injury or if there is uncertainty about the person’s condition.
  • Seizure management: For individuals with a known seizure condition, healthcare providers may adjust treatment plans based on the documented information to better manage future seizures.

Conclusion

Recognising and responding appropriately to different types of seizures is crucial for ensuring the safety and well-being of individuals experiencing them. Quick intervention can significantly reduce the risk of injury and provide comfort during a distressing episode. Understanding the various types of seizures – focal, generalised – and their specific characteristics, empowers caregivers and bystanders to offer effective support.

Education and preparedness play a significant role in managing seizures effectively. By familiarising ourselves with the signs and symptoms of seizures, we can respond confidently and compassionately. This preparedness not only aids in the immediate care of individuals during seizures but also creates a supportive environment that reduces stigma and promotes understanding.

For those affected by seizures or epilepsy, seeking further information and training is highly encouraged. Resources are available through the NHS, support groups and educational organisations. By improving our knowledge, we can improve the lives of those affected and ensure that they receive the best possible care and support.

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About the author

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Nicole Murphy

Nicole graduated with a First-Class Honours degree in Psychology in 2013. She works as a writer and editor and tries to combine all her passions - writing, education, and psychology. Outside of work, Nicole loves to travel, go to the beach, and drink a lot of coffee! She is currently training to climb Machu Picchu in Peru.