Overview
Brain cells work by passing small electrical signals. In a seizure, a burst of excessive electrical activity spreads through part or all of the brain. Epilepsy is diagnosed when seizures happen again and again without an obvious one-off cause.
A single seizure is not epilepsy. Epilepsy can begin at any age, and it is not contagious.
Symptoms
What a seizure looks like depends on which part of the brain is involved. Seizures usually last seconds to a few minutes and stop by themselves.
- Stiffening, then jerking of the arms and legs, with loss of awareness and sometimes passing urine
- A sudden fall, from stiffening or from going limp
- Blank staring for a few seconds with no memory of it, most often in children
- Brief jerks of an arm, a leg or the whole body
- Strange smells, tastes, fear or tingling while still partly aware
- Confusion, headache and tiredness afterwards
When to see a doctor
See a doctor within a few days if seizures change in pattern or number, continue despite regular medicines, or if medicines are running out or causing side effects, or if a pregnancy is being planned.
Causes
In about half of all people no cause is found. When there is one, it may be brain damage around birth, a genetic condition, a head injury, a stroke, an infection of the brain such as meningitis, a parasite infection or a tumour.
Triggers in someone who already has epilepsy include missed medicines, lack of sleep, fever, alcohol, stress, and for a few people flashing lights.
Risk factors
- Lack of oxygen or injury around the time of birth
- A head injury, particularly a severe one
- Stroke or other brain blood vessel disease
- Past infection of the brain, including meningitis and parasite infections
- A brain tumour or scar, or a family history of epilepsy
Complications
Injuries from falls, burns and drowning are the most common harm, so a person with uncontrolled seizures should not swim or bathe alone. A seizure that will not stop can damage the brain and needs emergency treatment.
Anxiety, low mood and memory difficulty are more common in people with epilepsy, and sudden unexpected death is a rare risk that good seizure control reduces.
Prevention
- Taking anti-seizure medicines exactly as prescribed, without gaps
- Sleeping regular hours and avoiding heavy alcohol
- Wearing a helmet while riding, and using seat belts
- Good care during pregnancy and childbirth, and treating high fever in children promptly
- Treating brain infections early, and preventing parasite infections through clean food and water
Diagnosis
The description of the event matters most, so an eyewitness account, or a video recorded safely on a phone, is very useful.
Tests usually include an EEG, which records the brain's electrical activity, and an MRI or to look for a cause. Blood tests and heart tracing help rule out fainting and other conditions that can look like a seizure.
Treatment
Anti-seizure medicines are the main treatment, and up to seven in ten people become free of seizures when the right medicine is taken regularly. They control seizures rather than cure epilepsy, so they should never be stopped suddenly.
When seizures continue despite two suitable medicines, a specialist may consider surgery, a nerve stimulation device or a special diet used under supervision.
Everyone with epilepsy should know basic seizure first aid: stay with the person, move hard objects away, cushion the head, time the seizure, turn them on their side once the jerking stops, and stay until they are fully awake.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Put a spoon, key, shoe or onion in the mouth or hand to stop a fit.”What is true?
Fact
Nothing should be put in the mouth of someone having a seizure. It can break teeth, injure the jaw and block breathing. A seizure stops on its own within a few minutes, and none of these objects shortens it.
Myth“Hold the person down tightly until the shaking stops.”What is true?
Fact
Holding someone down or trying to stop the movements can injure them and the person helping. The safe steps are to clear hard objects away, cushion the head, time the seizure, and turn the person on their side once the jerking stops.
Myth“Epilepsy is catching, so a person having fits should be kept apart from others.”What is true?
Fact
Epilepsy is not contagious. It cannot pass through touch, saliva, sharing food or sharing a room. Keeping someone apart adds loneliness to an illness that is already isolating.
Myth“Fits are a curse, possession or punishment, so healers and rituals are the answer.”What is true?
Fact
Seizures come from bursts of excessive electrical activity in the brain, and they respond to anti-seizure medicines. Delaying medical treatment means more seizures and more risk of injury. Stigma and beliefs like this are a common reason people do not get the treatment that works.
Myth“People with epilepsy are mentally ill and cannot study, work or marry.”What is true?
Fact
Epilepsy is a condition of the brain's electrical activity, not a mental illness. With treatment, most people have their seizures controlled and lead ordinary lives, including school, jobs and marriage. A doctor advises on the few activities, such as driving, that depend on being free of seizures.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
What exactly should I do if someone near me has a fit?
Stay calm and stay with them. Move away anything hard or sharp, put something soft under the head, loosen tight clothing at the neck and remove spectacles, and note the time the seizure started. Once the jerking stops, turn them gently onto one side with the mouth pointing towards the ground, and do not give food or water until they are fully awake.
Can a child with epilepsy go to school and play with other children?
Yes. Children with epilepsy learn and play like others, and most have their seizures controlled with medicine. Teachers should be told what a seizure looks like and what to do, and swimming and bathing need an adult nearby while seizures are not fully controlled. Keeping a child out of school because of stigma does far more harm than the condition.
Will medicines have to be taken for life?
Not always. If someone has been free of seizures for a long period, a specialist may consider reducing and stopping the medicine slowly, weighing the chance of seizures returning. This decision belongs to the doctor, and stopping on one's own often brings seizures back.
Can a woman with epilepsy have a healthy baby?
Most women with epilepsy have healthy pregnancies and babies, but some anti-seizure medicines can harm the developing baby, so the treatment is reviewed before pregnancy rather than after. Anyone planning a pregnancy should tell their doctor early and keep taking their medicine until advised otherwise.
