Epileptical attack

and Martina Feichter, medical editor and biologist

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

Brief overview

What is an epileptic fit? A short-term disorder of the brain, with or without loss of consciousness. Occasionally, accompanying motor disorders such as stiffening, twitching, tongue biting, perception disorders occur. Most often an epileptic seizure occurs in epilepsy. But there are also other possible triggers for a seizure (e.g. alcohol withdrawal, poisoning, fever, hypoglycaemia).
Forms of epileptic seizure: e.g. focal seizure (epileptic seizure that affects only parts of the brain), generalized seizure (epileptic seizure that affects the whole brain)
First aid: keep calm! Protect the patient from injuries, e.g. by padding the head. But never hold the patient!

What is an epileptic fit?

During an epileptic seizure, the function of the brain is temporarily disturbed: nerve cells in the brain are excessively activated. The effects can be very different - depending on which areas of the brain are affected.

In most cases, an epileptic fit occurs in the context of epilepsy. Doctors differentiate between different types of seizures and different forms of epilepsy. The main types of seizures include focal seizures and generalized seizures: They differ in whether the seizure affects only a limited area (focal) or the whole brain (generalized).

What most people have in mind when they think about an epileptic seizure are so-called grand mal seizures. This is a special form of generalized seizure. It is characterized by the fact that the person concerned falls, cramps and sometimes bites his tongue. However, an epileptic seizure can also be very inconspicuous - the person concerned then only seems to have stepped away for a short time (absenteeism).

Epileptic attack: first aid

In most cases, an epileptic fit is not dangerous and will end on its own within a few minutes. If you experience such a seizure, here are some rules you should follow to help the patient:

Keep Calm!
Don't leave the patient alone, calm him down!
Protect the patient from injuries!
Do not hold the patient!

Remove dangerous objects: For example, remove glasses, cutlery, tables, chairs or vases from the immediate vicinity. If the patient is holding something potentially dangerous, you should not forcibly tear it away from them. Instead, there are other ways to defuse the danger. For example, wrap a knife in a cloth or break off a lit cigarette.

Protecting the head: If someone has a major seizure and / or loses consciousness during the seizure, the most important thing is to protect the patient's head. You can put a jacket or pillow under it, for example. You should also loosen tight clothing if necessary.

Don't push anything between your teeth! Some people bite their tongue during an epileptic fit. Nevertheless, you should never push anything between the teeth of the patient, especially not by force! The patient and you could be injured.

Don't hold on! It is also very important that you should not hold the patient in the event of muscle spasms and twitching. Otherwise bones may break.

Conveying security: Both during and after a seizure, patients can be very anxious and feel bad. Help them and make them feel safe.

Consider shame: Prevent epileptic seizures from gathering in public. If the patient loses urine or feces during the seizure, cover the mishap with a jacket or blanket.

Measuring the duration of the seizure: You should keep an eye on the clock during the seizure. In this way you can tell whether the epileptic seizure is lasting unusually long and whether you need to call an emergency doctor.

After the attack

Check airways: After the attack, you should check that the patient's airways are clear.

Stable lateral position: Some patients are very exhausted after an epileptic seizure and want to rest. Then the best thing to do is to lay her on her side in a stable position.

When do you need to call a doctor?

Many people with epilepsy are fine a few minutes after the seizure. You don't need any medical help. In the following situations, however, you should notify the emergency doctor in the event of an epileptic seizure (Tel. 112):

The seizure lasts more than five minutes. Then there is a potentially life-threatening status epilepticus. He urgently needs medication!
Shortly after the first seizure, a second seizure follows without the patient regaining consciousness in between. Such a series of seizures must also be treated by a doctor!
The patient was injured or you suspect an injury during the seizure.
If you don't know if it's an epileptic fit.
When someone has an epileptic fit for the first time.
If the patient is a known epileptic but the current seizure is unusual.

Epileptic seizure: harbingers

An epileptic seizure is sometimes preceded by depression, irritability and headache. Sometimes a so-called aura also occurs. These are perceptual disorders that only the patient himself / herself notices. He sees, hears or smells something that is not there. In some cases, a vague, often uncomfortable feeling becomes noticeable in the upper abdomen, which sometimes rises upwards (epigastric aura).

Psychological aura symptoms are also possible: The patient perceives the inner and outer world as changed or distorted. Sometimes an object appears further away or smaller than it is. Feelings like fear can also be part of the aura.

The aura is not always followed by a seizure. It can also appear in isolation!

Epileptic seizure: Focal seizure

A focal epilepsy attack occurs in a localized part of the brain. The symptoms depend on the function of this area of the brain.

Motor symptoms

In the case of a partial seizure, for example, motor symptoms can occur, i.e. symptoms that affect movement (motor skills). For example, an arm may suddenly twitch (clonic seizure) or cramp / stiffen (tonic seizure).

In some patients, the muscle tension in one region of the body suddenly decreases (atonic attack), for example in the neck muscles. Then the chin suddenly drops to the chest, or the head falls to one side.

Sensory symptoms

A partial seizure can also begin with sensory symptoms. These are symptoms that affect sensory impressions. Many patients experience abnormal sensations such as tingling, burning, or feeling cold or warm in one part of the body.

Hallucinations are also possible: the patient perceives supposed noises, voices, smells or tastes. Optical hallucinations also occur. The patients then “see” flashes of light or even entire scenes.

Dizziness and anxiety

Sometimes the partial seizure is also accompanied by dizziness or feelings of anxiety.

Simple or complex partial seizure

If the patient remains fully conscious during the focal epilepsy, it is a simple focal seizure.

In contrast, a complex focal seizure is accompanied by a more or less pronounced disturbance of consciousness. For example, people are drowsy, absent, or confused. They often react unwillingly or even aggressively to external disturbances. Otherwise, in principle, the same symptoms can occur as with a simple partial seizure (see above).

Automatisms

In the case of a complex focal seizure, patients typically show so-called automatisms. These are unconscious (automatically running) and often rhythmic sequences of movements such as

Chewing movements
Smacking
rhythmic opening and closing of the fists
Scratching your feet
Nibbling or plucking clothes

Such automatisms can also occur with simple partial seizures. However, they are particularly typical for complex focal seizures.

Duration of the seizures

Complex partial seizures usually last from a few minutes to a quarter of an hour. The patient can then no longer remember the attack (memory loss).

Transition from focal to generalized

A focal beginning can be generalized in the further course, that is: The "thunderstorm in the head", which initially only affects a limited area of the brain, spreads to the entire brain. This is referred to by medical professionals as a secondary generalized seizure.

Generalized seizure

In generalized epilepsy attacks, practically all nerve cells in the brain briefly fire synchronously: They discharge themselves excessively. However, this does not mean that a generalized seizure is necessarily more severe than a focal one. However, generalized seizures are more often accompanied by loss of consciousness.

Motor seizure forms

A generalized seizure can manifest itself in different ways. Motor attacks of various types often occur. These include, for example, tonic, clonic and atonic seizures, as they are also possible in focal epilepsy. In the generalized form of the disease, however, they are more extensive.

Cramping and stiffening: For example, in a generalized tonic seizure, all limbs can cramp and stiffen.

Clouded consciousness: The patient's consciousness can be clouded, but does not have to be.

Decrease in muscle tension: In the event of an atonic attack, the general muscle tension suddenly decreases, for example in the legs. If this happens while walking, the legs can suddenly buckle - the patient falls.

Slowly twitching limbs: During an extended clonic seizure, large muscle groups (such as in the arms or legs) suddenly begin to twitch slowly. Most people are unconscious during the seizure.

Rapid twitching: In contrast, a myoclonic seizure leads to sudden, rapid twitching of individual muscle groups. The patient usually remains conscious.

Grand times

The best known form of seizure is the so-called generalized tonic-clonic seizure ("grand mal" = "major seizure"). It takes place in two typical phases:

Tonic phase: In the tonic phase, the whole body is stiff, the arms and legs are mostly straight. The patient is deeply unconscious. Breathing stops for a short time. Together with the increased muscle tension, this can lead to a lack of oxygen. This can be recognized by a slightly bluish discoloration of the skin and mucous membranes (e.g. lips). Doctors call this cyanosis.
Clonic phase: after ten to 30 seconds, the clonic phase follows with uncontrolled twitching in arms and legs. Patients can also bite their tongues. Sometimes urine and (less often) stool also pass involuntarily. The clonic phase generally lasts only a few minutes.

After the grand mal seizure, patients regain consciousness, but only briefly: they soon fall into a deep sleep from which it is difficult to wake them up. After waking up, they cannot remember the epileptic seizure themselves, but they usually suffer from sore muscles.

Absence (petit mal)

Epilepsy patients can experience a generalized seizure in its mildest form - as a so-called absence. This is understood to be an abrupt, seconds-long disturbance of consciousness; the consciousness pauses briefly, so to speak, so that the person concerned does not pay any attention to his surroundings. However, they do not lose consciousness in the process! An absence is also referred to as a "petit mal" ("small attack").

Typical absences

Doctors differentiate between different types of absences. On the one hand, there are the typical absences: The patient suddenly stops involuntarily in his activity (eating, walking, playing, washing the car, etc.). His gaze becomes rigid and empty, his face appears expressionless.After a few seconds he resumes his activity as if nothing had happened. Many patients do not even know that they have just had an absence attack.

Such a simple typical absence can also be accompanied by side effects. These include, for example, slight muscle twitching on both sides, for example in the face or in the arms. Sometimes, due to sudden muscle tension, the head is pulled back and the gaze is directed upwards (stargazing sign). In such cases one speaks of a complex typical absence.

Atypical absences

Epilepsy patients can also show what is known as an atypical absence. The side effects are much clearer here than with a complex typical absence. The seizure does not begin and end so abruptly. In addition, atypical absences can occur more and more frequently in a row. This can go so far that one absenteeism spills over into the next. Then doctors speak of the absence status. It is dangerous and must be treated.

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