Epileptical attack

Quick Overview

• What is an epileptic seizure? A short-term dysfunction of the brain with or without loss of consciousness. Sometimes accompanying motor disorders such as stiffening, twitching, biting the tongue, cognitive disorders occur. Most epileptic seizures occur in epilepsy. However, there are other potential causes of seizure (such as alcohol withdrawal, poisoning, fever, hypoglycaemia).
• Forms of epileptic seizure: e.g. partial seizure (epileptic seizure involving only parts of the brain), generalized seizure (epileptic seizure affecting the whole brain)
• First aid: Keep Calm! Protect patients from injury, e.g. Pad off by the head. But do not hold on to the patient!

What is an epileptic seizure?

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

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

What most people have in mind when it comes to epileptic seizures are so called Grand mal seizures, This is a special form of generalized seizure. It is characterized by the fact that the person falls, cramps and sometimes bites his tongue. An epileptic seizure can also be very inconspicuous – the person affected is then only for a short time as stepped away (Absencen).

Epileptic seizure: first aid

In most cases, an epileptic seizure is not dangerous and ends on its own within a few minutes. If you are experiencing such a fit, follow these rules to help the patient:

• Keep Calm!
• Do not leave the patient alone, calm him down!
• Protect the patient from injury!
• Do not hold the patient!

Remove dangerous objects: For example, remove glasses, cutlery, table, chairs or vases from the immediate area. If the patient holds something potentially dangerous in his hand, you should not forcefully snatch it from him. Instead, you can mitigate the danger in other ways. For example, wrap a knife with a cloth or break off a burning cigarette.

Protect head: If someone suffers a major seizure and / or loses consciousness while seizure, it is important to protect the patient’s head. You can do this with a jacket or a pillow, for example. You should also relax tight clothing if necessary.

Do not push anything between your teeth! Some people bite into the tongue during an epileptic seizure. Nevertheless, you should never push the patient between the teeth, certainly not violent! The patient and yourself could be injured.

Do not hold on! Most importantly, you should not hold the patient in the case of muscle cramps and twitching. Maybe break bones otherwise.

Provide security: Both during a seizure and afterward, patients can be very anxious and feel bad. Stand by and convey security.

Consider shame: Prevent episodes from seeping into the public eye. If the patient loses urine or feces during the seizure, cover the mishap with a jacket or blanket.

Measure seizure duration: During the seizure, keep an eye on the clock. This will tell you if the epileptic seizure may take an unusually long time and you need to call an ambulance.

After the attack

Check respiratory system: After the seizure, you should check if the respiratory tract of the patient is free.

Stable side position: Some patients are very exhausted after an epileptic seizure and want to rest. Then you bring them best in the stable side position.

When do you have to call a doctor?

Many people with epilepsy are fine within minutes of seizure. You do not need medical help. In the following situations you should in an epileptic seizure but the Notify the emergency doctor (Tel. 112):

• The seizure stops more than five minutes at. Then there is a potentially lethal status epilepticus. He urgently needs medical treatment!
• Shortly after the first attack follows second attackwithout the patient regaining consciousness in between. Even such an episode series must be treated by a doctor!
• The patient has been during the seizure injured, or you suspect an injury.
• If you do not knowwhether it is an epileptic seizure.
• If someone for the first time has an epileptic seizure.
• If the patient is a known epileptic, however, the current epileptic seizureruns unusually.

Epileptic seizure: Harbingers

An epileptic seizure sometimes announces moodiness, irritability and headache. Occasionally, a so-called aura occurs. These are perceptual disorders that only the patient himself notices. He sees, hears or smells something that is not there. In some cases, a vague, often uncomfortable sensation in the upper abdomen becomes noticeable, which sometimes rises (epigastric aura).

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

Not always does the aura have a seizure. It can also occur in isolation!

Epileptic seizure: Focal seizure

A focal epileptic seizure occurs in a circumscribed part of the brain. The symptoms depend on the function of this brain area.

Motor symptoms

In a focal attack, for example, motor symptoms can occur, so symptoms that affect the movement (motor skills). For example, an arm may twitch suddenly (clonic seizure) or cramp / stiffen (tonic seizure).

In some patients, the muscle tension in a body region suddenly diminishes (atonic seizure), for example in the area of ​​the neck muscles. Then the chin sinks abruptly to the chest, or the head falls to one side.

Sensory symptoms

A focal attack can also begin with sensory symptoms. These are symptoms that affect sensations. Many patients feel about paresthesia such as a tingling, burning sensation, feeling cold or warm in a body part.

Also hallucinations are possible: The patient perceives, for example, supposed sounds, voice, smells or tastes. Also optical hallucinations occur. Patients then “see” flashes of light or entire scenes.

Dizziness and anxiety

Sometimes the focal attack is accompanied by dizziness or anxiety.

Simple or complex focal seizure

If the patient remains fully conscious during the focal epilepsy attack, 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, those affected are dizzy, appearing 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 focal seizure (see above).

automation

In a complex partial onset, patients typically present so-called automatisms. These are unconscious (automatic) and often rhythmic movements such as

• chewing movements
• smack
• rhythmic opening and closing of the fists
• Scrabble with your feet
• Picking or plucking the clothes

Such automatisms can also occur in simple focal seizures. However, they are especially typical for complex focal seizures.

Duration of seizures

The duration of complex partial seizures usually ranges from a few minutes to a quarter of an hour. The patient then can not remember the seizure (memory gap).

Transition from focal to generalized

A focal beginning can generalize in the further course, that is to say: The “thunderstorm in the head”, which first affects only a limited area of ​​the brain, affects the entire brain. This is called by physicians as secondary generalized seizure.

Generalized fit

In generalized epilepsy attacks, virtually all nerve cells in the brain fire synchronously for a short time: they discharge excessively. This does not mean that a generalized seizure is necessarily more severe than a focal one. However, generalized seizures are more often accompanied by unconsciousness.

Motor seizure forms

A generalized seizure may vary in appearance. Often, motor attacks of various kinds occur. These include, for example, tonic, clonic and atonic seizures, which are also possible in focal epilepsy. In generalized disease, however, they are more extensive.

Cramping and stiffening: For example, in a generalized tonic attack, all the limbs may cramp and stiffen.

Clouded consciousness: The patient’s awareness may be clouded, but not necessarily.

Declining muscle tension: In an atonic attack suddenly relieves the muscle tension, for example in the legs. If this happens while walking, the legs may collapse abruptly – the patient falls.

Slowly twitching limbs: In a prolonged clonic attack, large muscle groups (such as in arms or legs) suddenly start to twitch slowly. During the attack, those affected are usually unconscious.

Fast convulsions: In contrast, a myoclonic seizure causes sudden, rapid convulsions of individual muscle groups. The patient usually remains conscious.

Grand mal

The most common form of seizure is the so-called generalized tonic-clonic seizure (“Grand-Mal” = “big attack”). It runs in two typical phases:

• Tonic phase: In the tonic phase, the whole body is stiff, the arms and legs are usually stretched. The patient is in deep unconsciousness. Breathing stops for a short time. Together with the increased muscle tension, this can lead to oxygen deficiency. This can be recognized by a slight bluish discoloration of the skin and mucous membranes (for example, lips). Doctors call this cyanosis.
• Clonic phase: After ten to thirty seconds, the clonic phase follows with uncontrolled twitching in the arms and legs. Patients can also bite their tongue. Sometimes urine and (less often) stool are also involuntary. The clonic phase generally lasts only a few minutes.

After the grand mal seizure, the patients regain consciousness, but only briefly: they soon fall into one deep sleepfrom which you can hardly wake her up. After waking up, they can not remember the epileptic seizure itself, but usually suffer from muscle soreness.

Absences (Petit-times)

Epilepsy patients can experience a generalized attack even in its mildest manifestation – as a so-called absence. This refers to an abrupt, second-long disturbance of consciousness; the consciousness, so to speak, takes a short break so that the person concerned does not pay any attention to his surroundings. But they do not lose consciousness! Absence is also known as “petit mal” (“small seizure”).

Typical Absence

Physicians distinguish different types of absence. There are on the one hand the typical Absencen: The patient stops suddenly involuntarily in its activity (eating, walking, playing, car wash, etc.). His eyes become rigid and empty, his face looks expressionless. After a few seconds, he resumes his activity as if nothing had happened. Many patients themselves do not know that they have just had an absence seizure.

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

Atypical Absences

Epilepsy patients may also show a so-called atypical absence. The side effects are even clearer here than in a complex typical absence. The seizure begins and ends not so abruptly. In addition, atypical absence can occur more frequently in a row. This can go so far that finally an absence seizure passes into the next one. Then doctors speak of the absence status. He is dangerous and must be treated.