As doctors, we talk about seizures, but the general public use the terms seizures and fits interchangeably. Most people think of a seizure as when someone falls to the ground and their body starts shaking and jerking uncontrollably. But seizures can be more subtle, affecting just one side of the body or one limb, or even repetitive finger or eye movement, or there may be no visible signs, and in an absence seizure a person zones out for a few seconds or minutes without movements. Seizures all have in common a disruption to normal brain activity, and the person affected is unable to control a seizure, put it off, bring it on, or pull themselves out of one. Some occur in sleep, others while awake, some people may become unconscious during a seizure, which can cause a dangerous drop in oxygen levels. Some last momentarily, whilst others last for longer. If you have two or more seizures more than 24 hours apart, this is considered to be epilepsy until proven otherwise. Any seizure which lasts longer than five minutes is a medical emergency and needs immediate medical attention. Medications are used to help control the symptoms as best as possible.
Epilepsy is the underlying condition causing most seizures that repeat and persist. Other causes include a head injury, stroke, brain tumour or a brain infection such as meningitis. They can also occur as a result of low oxygen, low sodium or low blood sugar levels, alcohol or drug poisoning, or as a side effect of certain medications. These are more likely to be seizures related to a particular episode, and they stop once the cause is treated, such as normalising the level of sodium in your blood.
Seizures appear suddenly and may be very obvious to those around, or they may be subtle. The first time requires medical attention, but for those with repeated seizures, those that know them best may grow attuned to more subtle signs that they are having a seizure. The only indication some may feel after having a seizure is feeling very tired, spaced out, head-achy or confused. People may experience a sudden loss of consciousness or responsiveness. They may collapse on the floor, their bodies rigid, and a limb or the head may be jerking and shaking. They may salivate or bite their tongue, or have loss of bladder and bowel control. It can be distressing to see, and frightening if this is the first seizure. Most people will not remember the seizure and may have no memory for a good while afterwards, perhaps 30 to 60 minutes.
If you have a fit, the doctors will refer you urgently to a first fit clinic, to identify the cause of your seizure. They will arrange blood tests looking for any medical conditions that might be causing seizures, such as diabetes or low sodium. At the hospital they may arrange several tests such as an EEG (a recording of brain activity called an electroencephalogram). An MRI, a scan of the brain, may also be ordered to determine the brain’s structure and identify any areas of damage. These tests do not rule in or out epilepsy but can help provide a possible cause or type of epilepsy, and – importantly – they exclude certain causes too. An EEG is a painless procedure whereby small sensors are placed on your scalp to record the brain's electrical activity on a computer. It only gives an indication of what's happening at the time of testing so may miss past or future epileptic activity – it's best done during a seizure to capture a particular pattern.
If you have a seizure of any kind, you need to stop driving and inform the Driving and Vehicles Licensing Agency (DVLA). This is because there is a risk you could have a seizure while driving, putting both yourself and others in serious danger. The DVLA has certain rules about taking up driving again once you’ve been investigated and diagnosed, and have been seizure-free for a certain period of time. Similarly, you may need to discuss any seizure investigations with your employer if your job requires sustained concentration, with a risk to your or others if you have a lapse in concentration. Operating heavy machinery is one example. You also shouldn't swim or have a bath unattended until you have been assessed by a specialist, as a seizure during this time could cause drowning. Once you are under a specialist team with a diagnosis, they can advise further about potential risks and keeping yourself safe.