Ten percent of Americans will have at least one seizure at some point in their lives and 3.4 million live with epilepsy. That means there’s a good chance you’ll encounter someone having a seizure, or you may experience one yourself.

A seizure happens when there’s an uncontrolled electrical disturbance in the brain, and can show up in a variety of ways:

• Uncontrolled body movement

• Loss of consciousness

• Rigidity of the arm and legs

• Confusion or staring off into space

Causes of seizures

There can be a wide range of causes for seizures. Some triggers are easy to identify, like alcohol withdrawal, a virus or fever, heart or blood pressure changes or low blood sugar levels. Sometimes seizures can be traced to genetics, trauma or brain injury — but many times the cause remains unknown.

Seizures can take many different forms. They can happen in just one part of the brain (focal) or be generalized across both hemispheres of the brain. Seizures can impact:

• Awareness

• Muscle activity and tension

• Heart rate

• Breathing

• Skin appearance

• Cognitive abilities

• Emotional and sensory perception

Types of seizures

Consulting a physician after an initial seizure for a thorough evaluation is a must. If a person has had more than one seizure, their primary care physician will often refer them to a neurologist for a comprehensive neurological testing. Once all the known, identifiable causes are ruled out, then seizures fall into two general diagnoses: epilepsy or functional (non-epileptic) neurologic disorder, or FND.
 
The two types share many characteristics and the same first aid is appropriate. The difference lies in the mechanism causing the seizure. You can think about it like this: if your brain is a super computer then epileptic events are like having an electrical issue in your computer’s “hardware.”  

A functional seizure is more like having “software” that’s not running right. In either case, the computer isn’t working properly, and it may seize or need to re-boot — which is what a seizure looks like.
 
FND is a recognized medical condition characterized by problems with the functioning of the nervous system and how the brain and body send and receive signals. For much of medical history this condition has been downplayed and misunderstood with many identifying it as “hysteria” or “pseudo seizures”.

Generalized seizures

• Tonic-clonic – convulsive seizures. These are probably what you typically think of as a seizure.

• Clonic – seen as repeated jerking. Movement cannot be restrained, so don’t try.

• Tonic – the body, arms or legs become suddenly stiff or tense. The person remains aware throughout the seizure.

• Myoclonic – shock-like jerks, twitching and shaking characterize these events.

• Atonic – a person experiencing this will become completely limp. There’s a high incidence of injury, because the person will drop to the ground without warning. These are sometimes called “drop-attacks.”

• Absence – characterized by staring motionless. The person is typically unaware during these events. 

Since the mid-2000s neuroscientific studies have shown that functional neurologic seizures have specific clinical features that differentiate them from epileptic seizures or seizures with known causes. To continue to learn and develop treatments for this condition, a partnership between modern psychiatry and neurology has emerged. Current research in neuroimaging and mapping neural networks is driving new understanding and treatments of FND.
 

Do’s and don’ts of seizure first aid

When you see someone is having a seizure, there are a number of things you should do — and not do — to make sure they are safe and comfortable. 

DO:

• Stay calm. Speak calmly.

• Make the person as physically safe as possible:
  – Remove hazards in the immediate area that are likely to cause harm
  – Protect the person’s head if possible
  – Turn the person on their side if they’re choking
  – Offer a pillow or blanket if the person is responsive

• Look for medic alert jewelry. If they have frequent seizures, this may give you additional information about the type, duration and how to treat their unique seizures.

• Time the seizure and stay with the person until it has passed. Most epileptic seizures only last a few minutes, but functional seizures can last 20-30 minutes or longer.

• Help them get someplace safe after the seizure is over.

DON’T:

• Let a crowd gather. One or two support people are plenty. No one appreciates an audience for their seizure.

• Try to “stop” the seizure or restrain the person’s movements.

• Call 9-1-1 unless:
  – They are having trouble breathing
  – They were injured during the seizure or fall
  – They have never had a seizure before
  – You don’t know the person’s seizure history and the seizure has lasted more than 5 minutes

 
While epilepsy can’t be cured, 70% of people with epilepsy can manage their seizure disorders with medication, reducing stress, getting plenty of sleep, avoiding alcohol and drugs, and avoiding their triggers — like bright flashing lights or loud sudden noises. Many seizures that start in childhood decrease into adulthood.

While there is no recognized medical intervention for FND seizures today, the more that’s learned about brain functions the closer science comes to finding answers.