Epilepsy is a disorder that takes the form of recurring seizures caused by sudden excessive discharge of electrical energy in the brain. Under certain circumstances, anyone can have a seizure. A diagnosis of epilepsy occurs after recurrent seizures. It can affect any person at any age, and many factors can contribute to the development of epilepsy including: brain infections; head injuries; cerebral tumours; and strokes.

The effects of epilepsy are characterised by a seizure. Though you cannot stop a seizure you can assist a person to make a quick and safe recovery.

There are many different types of seizures. Seizures can be divided into three major groups: focal (previously called partial), generalised and unknown. Focal seizures start in one part of the brain, and may move to other parts. Generalised seizures are due to abnormal activity in both sides of the brain. Because of this, consciousness is lost at the onset of the seizure. Unknown seizures are a grouping of seizures that cannot be diagnosed as focal or generalised.

Most people with epilepsy will only experience one or two types of seizures, although a person with severe epilepsy or significant brain damage may experience multiple types

The effect that a seizure has on a person depends on which part of the brain is involved. The effects may involve:

  • A change in a person’s conscious state;
  • Uncontrolled body movements;
  • Alterations in sensation, perception, emotion;
  • Changes in autonomic functions such as pulse rate; or
  • All of the above in various combinations.

Focal seizures

Focal seizures were previously called simple partial seizures. Lasting less than a minute, they are often described as ‘auras’ or warnings of the focal dyscognitive or tonic-clonic seizure that may follow. There is no loss of awareness or consciousness. The seizure may involve: movements like stiffness or shaking; an abnormal feeling in one part of the body such as numbness or an unpleasant smell or taste; feelings of deja-vu; or increased heart rate, nausea, or blushing.

Usually a person with a focal seizure does not require any particular help, although you should make sure that they do not hurt themselves.

Focal dyscognitive seizures

These seizures were previously called complex partial seizures. These seizures result in an altered state of awareness or responsiveness. People often appear confused and dazed and may do strange things like fiddle with their clothes, make chewing movements with their lipsor make unusual sounds. The seizure only lasts for one to two minutes but the person may be confused and drowsy for some minutes to several hours afterwards.

Following this seizure a person should be guided gently to a place of safety. They should not be restrained, as this is not necessary. Stay with them until they have fully recovered.

Generalised seizures

Tonic-clonic are the most recognised seizures. They usually begin with

  • a sudden cry, and some people may experience an ‘aura’ as a warning to the onset of the seizure.
  • the body becomes stiff and the person suddenly falls to the ground.
  • this is shortly followed by a jerking of muscles.
  • saliva may be bubbling from the mouth, and teeth may tighten on tongue or lips, causing bleeding.
  • there may be aloss of bladder control.

The seizure usually lasts for 2 minutes, followed by a state of confusion, anxiety and extreme tiredness. The person usually sleeps following this type of seizure.

For a seizure such as a tonic-clonicseizure adopt the following procedures:

  • Keep calm;
  • Roll person on front side with head turned to one side;
  • Only move the participant if they are in physical danger, it is better to move the objects around them;
  • Let the seizure run its course, you can’t stop it;
  • Watch the participant for signs ofbreathing;
  • Offer support when the participant regains consciousness, often they areconfused or embarrassed;
  • A change of clothing may be needed; and
  • Assist the participant to a place where they can rest or sleep.

If the seizure lasts longer than ten minutes or another seizure begins, get medical help immediately.

Absence seizures

These seizures almost always begin in childhood, and are often mistaken for daydreaming or inattentiveness. They are characterised by unresponsiveness, loss of facial expression, staring, eyes rolling back and eyelids fluttering. The seizure starts suddenly, lasts for 2 -10 seconds and then stops suddenly. There is usually no memory of the event. They may occur many times each day.

The participant who experiences an absence seizure usually does not require any help, though it will be useful to repeat any information the person may have missed during the seizure.

Myoclonic seizures

These are brief but significant muscle jerks, which generally involve the upper body, but can also involve the lower body. There is no loss of consciousness, but the person may fall off a chair or drop their cup. If multiple seizures occur over a short period, the person may feel confused. They often occur just after waking.

Tonic seizures

These are brief sudden stiffening of the muscles, whereby, if standing, the person will fall to the ground. Recovery is swift, although Injuries may be sustained from the fall. They often occur in sleep.

Atonic seizures

These are brief losses of muscles tone, which causes the person to fall to the ground. The fall is often head first, which results in facial and head injuries. No loss of consciousness takes place and recovery from the seizure is quick, although injuries from the fall may be quite serious.

Unknown seizures

These seizures comprise of sudden forward movement of the upper body, followed by stiffening. Often the arms are flung out and the knees bend up as the body bends. Less often, the head will be thrown back as the body and legs stiffen out. Each seizure only lasts 1-2 seconds, although they can occur in clusters.

A participant with epilepsy will have medication prescribed, and it is important to know the dosage and frequency of dosage. Most people with epilepsy achieve good control through their medication and can become seizure free, and live full and active lives

Programming Considerations

  • A participant with epilepsy should be supervised during all activities and should not participate in activities where a sudden seizure will jeopardise their safety;
  • Never let them swim alone or undertake any high risk activity unsupervised;
  • Ensure all safety precautions and equipment is provided such as helmets, appropriate harness, etc. to minimise the risk but not limit the challenge; and
  • In hot weather keep people hydrated.

Strategies for Inclusion

  • Although additional supervision may sometimes be required, it is important for leaders to be as unobtrusive as possible, so that the person with epilepsy does not appear singled out.

Behaviour Management Issues

  • It is important to know what may trigger a seizure and if possible avoid these situations.
  • Be sure leaders have basic information on the kind of seizures, how long they last, what first aid is required, what triggers seizures, medication requirements and when their last seizure occurred.
  • Encourage fluid replacement with water and not sweet fluids and juices.

(Source – Epilepsy Action Australia Fact Sheet)

Further information

Epilepsy Action Australia – www.epilepsy.org.au