Epilepsy and its Many Faces
This article explains all the different types of seizures that are not common and people miss them because they are not familiar with them.
Our brain controls our muscle movements, behavior, sensation, and states of awareness. The brain is made up of cells called neurons which communicate with each other via electrical signals. A sudden burst of abnormal electrical activity between neurons results in a seizure. We diagnose epilepsy when a person has 2 or more unprovoked seizures.
Epilepsy can present in many different ways. The classic picture of shaking all over the body is only seen in about a quarter of the time.
Different areas of your brain perform different functions. Depending on the area where the abnormal electrical activity is your seizures will have different symptoms. For example, if the burst of uncontrolled electrical activity is in the memory area you will have a feeling like déjà vu.
Different Types of Seizures
The International League Against Epilepsy has made a clear and concise classification of all the seizures for easy understanding and study. Given below is a flow chart of the different types of epilepsy.
Generalized Seizures
Tonic-clonic Seizures
The most famous type of generalized seizure is a tonic-clonic seizure. These were previously called grand-mal seizures. In this type of seizure neurons all over the brain start discharging abnormal electrical impulses. It’s like your entire brain is on fire. At this point, your muscles will stiffen and you will experience the tonic phase.
In an attempt to put out this fire the brain tries to stop these electrical impulses using an inhibiting chemical called Gamma Amino Butyric Acid (GABA). Due to the inhibition, your muscles can have jerking movements called the clonic phase.
Tonic Seizures
Sometimes a person will only experience the tonic phase where the whole body or a part becomes rigid.
Clonic Seizures
A clonic seizure is where there is only brief muscle twitching and muscle jerks called myoclonic jerks. This unfortunate condition is often seen in children. The children are mostly labeled as clumsy due to the nature of symptoms and can often go undiagnosed.
Atonic Seizures
In atonic seizures, the muscles become weak or limp and they cannot support the body. As a result, the patient can fall and sustain injuries. This is dangerous and the patient can be confined to a wheelchair or have to wear head protection.
Epileptic Spasms
These are commonly seen in babies. The body flexes and extends rapidly in this type of seizure. It can affect a baby’s development and needs quick treatment.
Absence Seizures
An absence seizure is a type of non-motor generalized seizure. This is also seen in children. They get spells where they stare off into space and are unresponsive. Absence seizures can also have brief twitches of the eyelids or a specific part of the body.
Focal Seizures
In focal seizures, the abnormal electrical activity is confined to a part of the brain. Therefore, the actions controlled by that part of the brain are affected.
If the motor region of the brain is affected there will be spasms of one part of the body (e.g.: face, arm, leg). The abnormal electrical activity can spread to the whole brain. This was first explained by Dr. Hughlings Jackson after seeing these symptoms in his wife. It is called the Jacksonian March in honor of him.
There can be focal clonic or atonic seizures affecting a single part of the body like the arm.
The amygdala is the part of the brain that controls our emotions. If this part of the brain is affected you will have feelings of fright and anxiety. Then you develop a seizure with movements. Some patients start crying (dacrystic seizures) or laughing (gelastic seizures) suddenly. These are often misdiagnosed as panic attacks.
Some focal seizures can present in the following ways-
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Automatisms- Here your arm moves on its own and you start picking at your clothes. You cannot control your movement.
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Behavioral arrest- here you suddenly stop moving and pause. You are unresponsive.
The frontal lobe coordinates many functions. If the frontal lobe is affected you can have grimacing of the face, agitation, anger, anxiety, fear, crying or laughing, paranoia, and maybe even pleasure! You can also have jerky motor movements. Patients often wake up from sleep screaming and thrashing around. Patients can also have odd urges like to pee or to drink water.
Seizures of the insula can cause excessive salivation, goosebumps, hot flushes, increased heartbeat and you can look pale. This is because the insula controls the autonomic functions of the body.
Seizures of the occipital lobe where vision is processed can have the patient seeing flashes of light, shapes, or colors.
So, now you know that epilepsy is not just a shaking body and can come in many forms and sizes.