Child Neurology Society, Philippines, Inc.
Epilepsy and Neurophysiology
Seizures and Epilepsy
by: Dorothy Ann Calma-Camus, MD
Last edited March 28, 2025
"SEIZURE" is an abnormal excessive neuronal discharge arising from the brain that is capable of causing transient or temporary alteration in a person’s function and/or behavior.
"SEIZURE" is not a diagnosis but a symptom.
The signs and characteristics manifested during a seizure depends on the area of the brain that is involved. It may include a change in behavior, alteration in motor activity, autonomic function, consciousness, or sensation.
If a seizure occurs in association with or as a result of a trigger - such as fever, infections, trauma, metabolic disorders, hypoxia, and other conditions, it may be considered as provoked seizure and is non-epileptic. In these cases, correction of the underlying problem prevents these seizures from recurring.
If seizures occur unprovoked, it is considered "epileptic seizures" such as those that occur in a condition called "EPILEPSY"
"EPILEPSY" is a neurological disorder characterized by recurrent, unprovoked, seizures.
Not all seizures are obvious to other people. There are many different kinds of seizures. The two main types of seizures based on the area of the brain that is involved -- focal seizures and generalized seizures.
FOCAL SEIZURE
GENERALIZED SEIZURE
Focal seizures originate in a specific area of the brain, usually coming from one hemisphere.
· Clinical features: Symptoms depend on the brain region involved. For example, seizures originating in the temporal lobe may involve unusual sensations (like déjà vu) or complex behaviors.
· Electroencephalogram (EEG): Focal seizures are associated with abnormal electrical activity in a specific brain region, visible on EEG.
· Causes: Focal epilepsy can be caused by brain lesions, head trauma, infections, tumors, or genetic factors. In some cases, the cause is unknown (idiopathic).
Generalized seizures involve and quickly spread throughout the entire brain.
· Clinical features: Generalized seizures affect the entire body, causing loss of consciousness, muscle rigidity, or convulsions. They often involve sudden, uncontrolled movements.
· Electroencephalogram (EEG): EEG show abnormal electrical discharges across both hemispheres, often in the form of spike-and-wave patterns.
· Causes: Generalized epilepsy is often genetic, with some forms being inherited. It can also result from metabolic disturbances, brain damage, or be idiopathic.
The International League Against Epilepsy (ILAE) classifies seizures in terms of their onset or the description of how they begin. This information may be gathered as how the seizure was witnessed, or through the description of the patient. When the information is not available, the seizure may be classified as "unknown onset".
Generalized-onset seizures may be described as:
o Tonic-clonic seizures (previously known as grand mal): Involve a sudden loss of consciousness, followed by stiffening of the body (tonic phase), then rhythmic jerking (clonic phase).
o Absence seizures (previously known as petit mal): Brief periods of impaired consciousness, often without noticeable motor activity, and may be mistaken for daydreaming.
o Myoclonic seizures: Sudden, brief jerks or twitches of muscles, often in both sides of the body.
o Atonic seizures: Sudden loss of muscle tone, causing the person to collapse or drop his or her head.
· Focal-onset seizures can occur as follows:
o Focal seizures without loss of consciousness (also known as simple partial seizures): The person remains conscious and aware, but may experience abnormal sensations or movements (such as jerking of a hand or strange sensations).
o Focal seizures with impaired awareness (previously known as complex partial seizures): These involve a loss of consciousness or awareness, and the person may exhibit automatic movements (such as lip-smacking, hand-wringing).
Diagnosing Epilepsies
A detailed description of seizure events is taken from interviews with the patient’s primary caregivers and witnesses of the seizure. If possible, the patient can provide information on the seizure, especially when it is not easily observable by other people. Information on previous illnesses or medical conditions, family history and other incidents surrounding the seizure will also help in diagnosis.
A systemic and neurologic physical examination is also important. Ultimately, data coming from the patient’s history and physical examination will be correlated with EEG to establish the seizure or epilpesy type. In a lot of cases, brain imaging through Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan of the brain will be requested in order to identify the possible lesion or etiology causing the seizures.
Emergency First Aid for Seizures
If someone has a seizure, stay calm. Protect them from injury, don’t put anything in their mouth, and let the seizure run its course (usually lasts 1-2 minutes). If it lasts longer, the patient must be in the emergency room by the 5th minute of seizure.
If a person is unaware or not awake during a seizure, place them on their side to keep the airway clear. loosen any tight clothing and place something soft under their head.
DO NOT restrain a person during a seizure.
DO NOT place anything in their mouth.
DO NOT attempt to stop the seizure by pinching, or hitting them.
Immediately bring a patient to the nearest emergency room in the following scenarios
1. Seizure lasts longer than 5 minutes.
2.Person does not return to their usual self.
3. Person is injured, pregnant or sick.
4. Repeated seizures.
5. First time seizure.
6. Difficulty breathing.
7. Seizure occurs in the water.
While some forms of epilepsy are manageable and even cure-able, epilepsy is a condition that can lead to long-term and possible life-long effects, including multiple psycho-social impacts. To lessen the stigma towards a person with epilepsy, it is important to help those around them understand the condition.
References:
1 Pebenito, R. Easy and Practical Neurology
2 Bolanos, Calotes-Castillo, Lubaton-Sacro, Lukban, Salonga-Quimpo, Sanchez-Gan and Tan. Seizures in Children, A Guide to Management 2018
3 Fisher, R. S., van Emde Boas, W., Blume, W., et al. (2005). Epileptic Seizures and Epilepsy: Definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia, 46(4), 470-472. DOI: 10.1111/j.0013-9580.2005.66104.x
4 Engel, J., & Pedley, T. A. (2008). Epilepsy: A Comprehensive Textbook. Lippincott Williams & Wilkins.
5 Epilepsy Foundation. (n.d.). Types of seizures. Epilepsy Foundation. Retrieved March 8, 2025, from https://www.epilepsy.com/learn/types-seizures
6 Epilepsy Foundation. (n.d.). Seizure first aid lockscreen. Epilepsy.com. Retrieved March 8, 2025, from https://www.epilepsy.com/sites/default/files/upload/image
Managing Epilepsies
Being diagnosed with epilepsy may become scary for both the child and their parents. Oftentimes, the first question that comes to mind is, "Will this be a lifetime condition?" or "Will my child become normal?"
In many cases, epilepsies can be managed successfully through an appropriate treatment plan. Some epilepsies can be expected to resolve with time. Some will require more permanent treatment strategies. A few will need more extensive interdisciplinary management.
Generally, the management of epilepsies require medication, healthy lifestyle strategies, regular monitoring and knowledge on emergency measures.
Medication
Antiepileptic drugs (AEDs) or Anti Seizure Medications (ASM) are the primary treatment to control seizures. Your physician will prescribe the right one based on the type of seizures, thus, it is very important to be able to classify the seizure type through the physician interview(history), physical and neurological examination and EEG findings.
Lifestyle Changes
Getting enough sleep, avoiding triggers (if there are any, such as, flashing lights or stress), and maintaining a healthy diet can help reduce seizures.
Surgery or Devices
There are some patients who are on multiple anti epileptic drugs or anti seizure medications but still with poor control of seizures, also known as multi-drug resistant epilepsy, brain surgery or device implants may be an option for theses patients whose medications don’t work. However, there are certain risks involved and costs and access to specialized care at the Philippine setting are the major limiting factors.
Regular Monitoring
Keep track of seizures. Close follow ups with your doctor is necessary to discuss any changes or adjustments in treatment if needed.
Always consult a doctor to develop the right treatment plan for managing epilepsy or seizures.
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