Charles Ribak, Ph.D. (Professor of Anatomy and Neurobiology, UC Irvine School of Medicine) gives expert video advice on: What happens to the brain and body during a generalized seizure?; What do I do if I think I'm going to have a generalized seizure?; What do I do if I see someone having a generalized seizure? and more...
What is a "generalized seizure"?
With regards to generalized seizures, according to the new nomenclature that has been used in the last 1-15 years, a generalized seizure is a seizure that starts in one particular part of the body and then generalizes throughout the entire body. So for example, you might have an arm that starts shaking uncontrollably, and then this would then progress to a generalized seizure where all of the body would be involved in a generalized convulsion. So this is the so-called "grand mal seizure." It used to be called the "grand mal seizure." That type of terminology is not used by the doctors these days. Instead, the term that is most often used is "generalized seizure."
What triggers a generalized seizure?
With regards to generalized seizures, what triggers a generalized seizure is something we really don't know. There are many different causes for seizures, many underlying causes. What essentially is the exact trigger for the brain at that moment that produces a generalized seizure is still a mystery and we are still trying to work on that in research laboratories and clinical laboratories throughout the world. In certain types of epilepsy there can be a trigger, for example, in a small percentage under 5%, photosensitivity will trigger a seizure. This would be a strobe light, once used on the disco floors in the 1970s. The strobe light flashes a light into the eyes of the individual and this can oftentimes trigger a seizure. Now it is possible whether this does trigger a generalized seizure or any another type of epileptic seizure.
What happens to the brain and body during a generalized seizure?
We can measure the brain activity during a generalized seizure and one of the things that we can do when we capture this in an EEG recording is that we see a great deal of spike and wave activity. Spike and wave activity indicates that there are cluster of large numbers of neurons in different parts of the brain that are synchronized in their activity. They'll have a burst of activity and then they'll get quiet again, and then they'll have another burst maybe for a period of time and get quiet again. This is brain activity, electrical activity that we can see during a seizure. In terms of the body, the motor cortex is activating all of the muscles of the body and so we can see various types of movements that we discussed in some of the earlier questions. We might see the tonic activity, where the arms and legs are extended outward, for example the arm would go out and would probably start trembling a little, or we might see clonic activity, where there is some flexion going on of the arms and also of the legs.
What happens to the brain and body after a generalized seizure?
With regards to generalized seizures, the postictal phase is the stage after a generalized seizure has occurred. You can imagine all of this excessive movement during the seizure will make a person extremely tired and fatigued. Therefore the postictal phase is what you can expect from a person who has had one of these generalized seizures. In addition, they probably will not have any memory of the actual seizure itself. They'll maybe remember a few things that occurred just prior to the generalized seizure, but the actual seizure will not be something they will have remembered. There is a period of time where they will lose consciousness during the seizure, and they will not be alert or responsive. Sometimes this period may extend into the postictal period for under a minute; 3 seconds perhaps.
What are the complications of generalized seizures?
With regards to generalized seizures, one of the major complications of a generalized seizure in the back of everybody's mind and every doctor's mind is that it could become status epilepticus, and status epilepticus can lead to death. There are certain medicines that can be placed either rectally or sub-lingually while the person is having the generalized seizure to prevent it from becoming status epilepticus.
What treatments are available to a person who has generalized seizures?
Dilantin, this is really used a lot for people with generalised seizures. Dilantin and Tegretol. Both of these medicines have a tendency to suppress neuronal activity. How do they do it? It's still unclear. They may embellish the inhibitory neurons in the brain which use GABA as a neural transmitter, or they may interact with glutamate or excitatory neurons in the brain. The basic bottom line is it suppresses activity in the brain. It has a tendency to dumb you down a little, and make you a little more tired throughout your day; maybe you'll find you don't have as much energy. However, at the same time, it is helping you to stop having seizures. Maybe it's not a complete block of seizures; maybe just the frequency of the seizures is decreasing. In either event, it is helpful and once you go on these medicines, do not stop taking them unless you're under a doctor's supervision.
What do I do if I think I'm going to have a generalized seizure?
With regards to generalized seizures, I think it is very important that if you have any type of clue preceding a seizure, it is very important to communicate this clue to your doctor. Certain seizures that arise from the temporal lobe or from an olfactory region of the temporal lobe, the aura or the so-called pre-ictal would then indicate a localization in the brain and it would be very helpful for doctors trying to understand the underlying basis or cause of your seizures. So, this is something I would definitely write down and relate this information to your doctor.
What do I do if I see someone having a generalized seizure?
With regards to generalized seizures, the most important thing to do if you see someone having a generalized seizure is to clear the area of all objects that could be kicked and maybe land onto the person. Maybe wrap the person with a blanket, put a pillow under their head and try to make them as comfortable as possible. At this point in time, it's not considered to be helpful to try to put a belt or a wallet into their mouth. This has a tendency to break their teeth more often than not, and they really do not recommend this anymore.