followed by a postictal period of disorientation or confusion. or disorientation of period postictal a by followed

weakness, fatigue, or headache. or fatigue, weakness,

The seizure usually lasts between one and two minutes and is often often is and minutes two and one between lasts usually seizure The

postictal period that involves temporary confusion, temporary involves that period postictal

a experience often people seizures, of types other After • inappropriate times. inappropriate

After some types of seizures, people return to normal quickly. normal to return people seizures, of types some After • behavioural changes such as screaming, undressing, or laughing at at laughing or undressing, screaming, as such changes behavioural

arm or leg.The person may fall over. The seizure is very brief. very is seizure The over. fall may person leg.The or arm the brain. the at clothing, or random walking. Occasionally there are more dramatic dramatic more are there Occasionally walking. random or clothing, at

results in a sudden jerk of part of the body such as the the as such body the of part of jerk sudden a in results include movements such as chewing motions, lip smacking, pulling pulling smacking, lip motions, chewing as such movements include Generally only prolonged seizures may cause damage to damage cause may seizures prolonged only Generally •

seizure seizure myoclonic A seconds. few a for last seizures often characterize the seizure. These may may These seizure. the characterize often automatisms called control person or a risk of harm to others. to harm of risk a or person

or nodding the head involuntarily. Typically, these these Typically, involuntarily. head the nodding or Random purposeless movements over which the individual has no no has individual the which over movements purposeless Random the to harm no cause and naturally end seizures Most •

falling down or almost falling down, dropping objects, objects, dropping down, falling almost or down falling

Most seizures last for seconds to several minutes. several to seconds for last seizures Most •

awareness is altered and can warn of an impending seizure. impending an of warn can and altered is awareness

sudden loss of muscle tone often resulting in a person person a in resulting often tone muscle of loss sudden

. The aura often occurs just before before just occurs often aura The . aura an as to referred movement

seizure involves a a involves seizure atonic An seizures. myoclonic and

Facts About Seizures About Facts

The seizure often begins with an unusual sensation, feeling, or or feeling, sensation, unusual an with begins often seizure The

atonic include seizures generalized of types Other

occur.

period of fatigue, confusion, or a severe headache after the seizure. the after headache severe a or confusion, fatigue, of period awareness and may appear dazed and confused. A dreamlike state may may state dreamlike A confused. and dazed appear may and awareness

Awareness is regained slowly and the person often experiences a postictal postictal a experiences often person the and slowly regained is Awareness seizure, a person experiences altered altered experiences person a seizure, aware impaired focal a During

seizure.

skin color, and drooling. drooling. and color, skin

purposeful manner. purposeful

or may progress to a focal impaired aware or even a bilateral tonic-clonic tonic-clonic bilateral a even or aware impaired focal a to progress may or

control may be lost and there may be shallow breathing, a bluish or gray gray or bluish a breathing, shallow be may there and lost be may control

Afer a seizure a person can be uncooperative, pushing people away, but not in a a in not but away, people pushing uncooperative, be can person a seizure a Afer dizziness, or a sudden overwhelming emotion. An aura may occur alone alone occur may aura An emotion. overwhelming sudden a or dizziness,

limbs. Usually the movements involve the whole body. Urinary or bowel bowel or Urinary body. whole the involve movements the Usually limbs.

are they mentally disabled. disabled. mentally they are nor violence to prone neither are epilepsy with sound, or smell, sudden jerky movements of one area of the body, body, the of area one of movements jerky sudden smell, or sound,

seizure is convulsive with jerking and twitching of the muscles in all four four all in muscles the of twitching and jerking with convulsive is seizure

deliberate acts and people people and acts deliberate not are Seizures seizures. non-epileptic psychogenic be different forms. For example, an aura might be a distortion in sight, sight, in distortion a be might aura an example, For forms. different

of the the of phase clonic or phase second The lungs. the of out forced being air of

. An aura can take many many take can aura An . aura an called movement or feeling, sensation,

Sometimes seizures can be mistaken by others to be deliberate acts. They could could They acts. deliberate be to others by mistaken be can seizures Sometimes

or groan at the start of a convulsive seizure is not from pain. It is the sound sound the is It pain. from not is seizure convulsive a of start the at groan or

It may involve symptoms that result in a person experiencing an unusual unusual an experiencing person a in result that symptoms involve may It

of awareness, and a fall as consciousness is lost and muscles stiffen. The cry cry The stiffen. muscles and lost is consciousness as fall a and awareness, of

activity occurs. activity

of this seizure type typically involves a crying out or a groan, a loss loss a groan, a or out crying a involves typically type seizure this of phase much longer. much

The form the seizure takes depends on where in the brain the excessive electrical electrical excessive the brain the in where on depends takes seizure the form The

seizure usually lasts seconds to minutes, and sometimes sometimes and minutes, to seconds lasts usually seizure aware focal A tonic tonic The minutes. three to one from lasts usually seizure tonic-clonic A

uncontrolled movements, altered awareness, odd sensations, or a convulsion. convulsion. a or sensations, odd awareness, altered movements, uncontrolled

A seizure may take many different forms including a blank stare, muscle spasms, spasms, muscle stare, blank a including forms different many take may seizure A

In a focal impaired seizure, awareness is impaired. is awareness seizure, impaired focal a In alertness is regained quickly. regained is alertness

During a focal aware seizure, awareness remains intact. intact. remains awareness seizure, aware focal a During aware. impaired

of seizure. The onset and the recovery are sudden. Following the seizure, seizure, the Following sudden. are recovery the and onset The seizure. of

contagious. not is it and disease a or disorder psychological focal focal and aware focal are seizures focal of kinds common most two The

or inattentiveness. There is often fluttering of the eyelids during this type type this during eyelids the of fluttering often is There inattentiveness. or

a a not is It disorder. seizure a is Epilepsy seizures. non-provoked recurrent or

the seizure. These seizures are sometimes misinterpreted as daydreaming daydreaming as misinterpreted sometimes are seizures These seizure. the

tonic-clonic. bilateral

however, is not epilepsy. Epilepsy is a condition that is defined by multiple multiple by defined is that condition a is Epilepsy epilepsy. not is however,

The seizure starts and ends abruptly, and awareness is impaired during during impaired is awareness and abruptly, ends and starts seizure The

focal to to focal as to referred are These generalized. become and spread then

will experience at least one seizure during their lifetime. A single seizure, seizure, single A lifetime. their during seizure one least at experience will

seizures result in a blank stare usually lasting less than 10 seconds. 10 than less lasting usually stare blank a in result seizures Absence

limited to one part of the brain. Sometimes seizures begin as focal and and focal as begin seizures Sometimes brain. the of part one to limited Anyone can have a seizure. In fact, approximately one in ten people in Canada Canada in people ten in one approximately fact, In seizure. a have can Anyone

A focal seizure occurs when the excessive electrical discharge is is discharge electrical excessive the when occurs seizure focal A

(with convulsions). (with clonic

that results in a change in the person’s behavior or function is a seizure. a is function or behavior person’s the in change a in results that

Focal Onset Seizures Onset Focal tonic- or convulsions) (without absence forms: two of one takes commonly

the person’s behaviour or function may result. This abnormal activity in the brain brain the in activity abnormal This result. may function or behaviour person’s the

motor involvement (may or may not be convulsive). A generalized seizure seizure generalized A convulsive). be not may or (may involvement motor

electrical discharge that disrupts the normal activity of the nerve cells, a change in in change a cells, nerve the of activity normal the disrupts that discharge electrical . generalized

throughout the entire brain. A generalized seizure may have motor or non- or motor have may seizure generalized A brain. entire the throughout

and and focal categories: two into grouped are they and brain the of areas

through electrical and chemical signals. When there is a sudden excessive excessive sudden a is there When signals. chemical and electrical through

A generalized seizure is characterized by excessive electrical discharge discharge electrical excessive by characterized is seizure generalized A

There are many types of seizures. The different types begin in different different in begin types different The seizures. of types many are There The brain is made up of billions of nerve cells or neurons that communicate communicate that neurons or cells nerve of billions of up made is brain The

Common Seizures Types Seizures Common Seizures Generalized Seizures Generalized

This publication was produced by the Partners in Improving the Quality of Life SEIZURES & FIRST AID for Those Who Live With Epilepsy:

Canadian League Phone: 780-488-9600 Toll Free: 1-866-374-5377 Fax: 780-447-5486

Email: [email protected] Website: www.edmontonepilepsy.org Against Epilepsy EpilepsyEpilepsy

This booklet is designed to provide general information about Epilepsy to the public. It does not include specific medical advice, and people with La Ligue Epilepsy should not make changes based on this information to previously Canadienne prescribed treatment or activities without first consulting their physician. Contre l’Épilepsie 1-866-EPILEPSY 905-415-3917 [email protected] [email protected] www.canadianepilepsyalliance.org www.claegroup.org Special thanks to our consulting team, which included epilepsy specialist neurologists & neuroscience nurses, hospital epilepsy clinic staff, educators, individuals with epilepsy, and their family members. This Epilepsy Booklet Series is a project by the Edmonton Epilepsy Association www.edmontonepilepsy.org 11215 Groat Road Edmonton, Alberta T5M 3K2 Phone: 780-488-9600 Toll Free: 1-866-374-5377 Fax: 780-447-5486 [email protected]

Free Canada-wide distribution of this publication was made possible by a © Edmonton Epilepsy Association, 2020 sponsorship from UCB Canada Inc. EPILEPSY EDUCATION SERIES Seizures and First Aid Seizure Type Characteristics First Aid Generalized • Typically 1 to 3 minutes in length • Stay calm. Let the seizure take its course. Tonic-Clonic • a crying out or a groan • Time the seizure. (formerly called • a loss of consciousness • Protect from injury. If necessary, ease the person to the floor. Move hard or sharp grand mal) • a fall objects out of the way. Place something soft under the head. • a convulsion (stiffening, jerking) • Loosen anything tight around the neck. Check for medical identification. • may involve: • DO NO restrain the person. - loss of urinary or bowel control • DO NOT put anything in the mouth. The person will not swallow his or her tongue. - shallow breathing • Gently roll the person onto his or her side as the convulsive seizure subsides to - bluish or gray skin color allow saliva or other fluids to drain and keep the airway clear. - drooling • After the seizure, talk to the person reassuringly. Do not leave until the person is • may be followed by confusion, fatigue or headache reoriented. The person may need to rest or sleep.

Absence • Typically less than 10 seconds in length First Aid generally not required. (formerly called • a sudden blank stare If absence seizures occur in a cluster, remove the person from any activities that could petit mal) • impaired awareness pose a risk (e.g., swimming). • may involve rapid blinking, eyes rolling upwards • alertness regained quickly following seizure Focal Aware • Typically seconds to minutes in length First Aid generally not required as person remains aware. (formerly called • awareness retained but person cannot control symptoms Stay calm. Stay with the person. Offer emotional support and reassurance. simple partial) • may involve: - jerking in one area of the body that may spread to If the seizure progresses to a focal impaired awareness or tonic-clonic seizure, see another area of the body First Aid as outlined for focal impaired awareness or tonic-clonic seizures. - an unusual sensation such as seeing, smelling, or hearing things that aren’t there - a sudden overwhelming feeling such as joy or fear - symptoms such as stomach upset or flushing • may be referred to as an aura (a sudden unusual sensation, feeling or movement) • may progress to a focal impaired or generalized seizure

Focal Impaired • Typically 1 to 2 minutes in length • Stay with the person. Let the seizure take its course. Speak calmly and explain to Awareness • altered awareness others what is happening. (formerly called • dreamlike state • Move dangerous objects out of the way. complex partial) • appears dazed, confused • DO NOT restrain the person. • often begins with an aura (a sudden unusual sensation, • Gently guide the person away from danger or block access • feeling or movement) to hazards. • typically involves random purposeless movements such • After the seizure, talk reassuringly to the person. as chewing motions, picking motions in the air, or pulling Stay with the person until complete awareness returns. at clothing If the seizure progresses to a tonic-clonic seizure, see First Aid as outlined for a tonic- • often followed by confusion and disorientation clonic seizure. • may progress to a generalized seizure Generalized Atonic • Typically a few seconds in length As seizures occur suddenly, it is often difficult to intervene in time. (also called drop • sudden loss of muscle tone Check for injury following a fall. attacks) • a fall, dropping objects, head nodding • typically a loss of awareness Myoclonic • Typically a few seconds in length As seizures occur suddenly, it is often difficult to intervene in time. • sudden jerk of part of the body such as arm(s) and leg(s) Check for injury following a fall. • sometimes a fall • awareness retained Infantile Spasms • A spasm typically lasts a few seconds but often occurs Protect from potential risk of injury. Doctor should be consulted promptly. (West Syndrome in a cluster of 5 to 50 or more. Epilepsy) • sudden flexing forward of head and arms • sudden drawing up of knees, raising both arms • sudden body flexing at waist

Status Epilepticus Calling An Ambulance In assessing the need to call an ambulance, a combination of factors has to be considered. For example, if A continuous seizure state, or status epilepticus, is a cyanosis (blue or gray color) or laboured breathing accompanies the seizure, then an ambulance may be called life-threatening condition. Seizures are prolonged or earlier. If a person is known to have epilepsy and the seizure pattern is uncomplicated and predictable, then occur one after another without full recovery between ambulance help may not be necessary. seizures. The seizures may be convulsive or non- convulsive. Immediate medical care is necessary. CALL AN AMBULANCE: • If a seizure occurs in water and there is any chance that the person • If a convulsive seizure lasts longer than 5 minutes. has inhaled water. Inhaling water can cause heart or lung damage. Sudden Unexplained Death in Epilepsy • If consciousness or regular breathing does not return after the • If it is a first-time seizure, or the person is injured, pregnant, or has (SUDEP) seizure has ended. diabetes. A person with diabetes may experience a seizure as a The cause of SUDEP, where death occurs suddenly for • If seizure repeats without full recovery between seizures. result of extremely high or low blood sugar levels. no discernible reason, is unknown. This is rare. • If confusion after a seizure persists for more than one hour.