The movies and media have shaped what most people know about seizures. Unfortunately, there’s a lot of misinformation. For instance, not every seizure results in big, violent convulsions. With the right treatment and education, it’s very possible to prevent and respond to seizures safely.
Shelly Maniar, DO, a neurologist and epileptologist with Atlantic Health, helps us answer some of the most common questions about seizures.
If I have a seizure, does it mean I have epilepsy?
Having a seizure doesn’t necessarily mean you have epilepsy. A seizure is a symptom, not a diagnosis. About 1 in 10 people will experience a single seizure in their lifetime. Epilepsy is a chronic condition that means a person is more likely to have repeat, unprovoked seizures.
Similarly, a person can cough because of a cold or allergies, without having asthma — a long-term condition in which coughing or wheezing happens repeatedly.
“People can have seizures for many different reasons,” says Dr. Maniar. “With epilepsy, there is an inherent brain abnormality that increases a person’s likelihood of future seizures. That means they need to be on a daily anti-seizure medication to reduce seizure recurrence.”
Does every seizure cause convulsions?
Not all seizures result in sudden, irregular movements (convulsions) or thrashing on the ground. Seizure symptoms often depend on the type of seizure:
- Focal seizures start in a small part of the brain and continue to build, sometimes spreading seizure activity to the entire brain.
- Generalized seizures happen when the entire brain is involved all at once at the start of the seizure.
With a focal seizure, you may have more subtle symptoms, depending on the area of the brain that’s involved. Many people experience numbness, shaking or tingling on one side of the body. Symptoms can be as subtle as a twitch, mouth movements or even staring off into space with brief periods of unresponsiveness.
If I’m about to have a seizure, will there be warning signs?
Generalized seizures almost never give you a warning. But focal seizures can have warning signs as they build and spread in the brain. These warning signs, also called epileptic auras, vary depending on the part of the brain that’s affected. They usually precede a larger seizure by seconds to a minute and can include:
- A sudden wave of fear, anxiety or sense of doom
- A sense of familiarity like déjà vu
- A rising feeling in the stomach
- Out of place smells
- Visual changes
Do flashing lights always cause seizures?
Only specific types of epilepsy, called photosensitive epilepsies, make seizures more likely when you’re exposed to frequent, flashing lights. Most often, the lights must be really fast to induce a seizure, and can happen in certain patients whose seizures begin in their childhood or teenage years, not usually in patients with adult-onset epilepsy.
Other factors can increase your chance of seizures (lower your seizure threshold), such as:
- Electrolyte abnormalities, especially low sodium levels
- Fever or infection
- Very high or very low sugar levels
- Substance use, including alcohol withdrawal
Can you swallow your tongue during a seizure?
You cannot swallow your tongue during a seizure. If someone is having a seizure, don’t put anything in their mouth because it can cause a jaw fracture, break teeth or even hurt you.
Should I try to restrain someone during a seizure?
Never try to restrict movement during a seizure because it can increase the likelihood of an injury, such as a fracture. Instead:
- Make sure the person is in a safe location. They should be on a flat, soft surface, like a carpeted floor if possible.
- Remove large furniture or other potentially harmful items nearby.
- Turn the person on their side to reduce chances of choking on saliva.
- Record a video of the event if you can, which is helpful for the neurologist later.
- Note the time the seizure started and stopped.
- Call 911 when appropriate.
When should someone go to the ER if they have a seizure?
You should go to the emergency room if you have a seizure for the first time.
If you’ve been diagnosed with epilepsy, you should go to the emergency room if:
- Your seizure lasts longer than five minutes.
- You have multiple seizures back-to-back, without recovery in between.
- You have significant pain after the seizure or sustained an injury that requires medical attention.
- You have difficulty breathing or vomit after the seizure.
- You’re pregnant, have diabetes or have a fever, along with a seizure.
- You’re not returning to normal (baseline) within 30 minutes of the seizure.
- You have new neurologic deficits after the seizure, such as weakness on one side, trouble speaking or agitation.
Do seizures cause brain damage?
Having one seizure isn’t necessarily dangerous for the brain, but the concern with seizures is status epilepticus — rare, back-to-back seizures that are hard to control.
Studies have shown that more than 30 minutes of continuous seizure activity starts to damage brain cells. It’s important to control seizures, so they don’t become status epilepticus, which is a neurological emergency.
Additional studies have shown that patients who have more than three convulsive seizures a year are more likely to pass away from Sudden Unexpected Death in Epilepsy Patients (SUDEP). Controlling seizures can reduce risk of SUDEP. About 1 in 1,000 people with epilepsy die from SUDEP every year.
If I have a seizure, does it mean I can’t drive?
According to the New Jersey Department of Motor Vehicles (DMV), by law, if you have a seizure (or pass out and aren’t aware of passing out), you must restrict driving for six months. After six months, if you haven’t had another seizure, you can drive again.
Dr. Maniar says for six months post-seizure, you should also avoid situations in which impaired awareness or loss of voluntary control could harm yourself or others. Common seizure precautions include:
- Avoid biking or driving other vehicles on the road.
- Avoid working on ladders or at unprotected heights.
- Avoid operating heavy machinery, such as a forklift.
- Avoid swimming on your own, especially in deeper bodies of water.
- Avoid standing near platform edges, or walking near train tracks.
- Avoid standing over an open flame or stove.
- Use certain household appliances with caution (for example, irons and sharp objects like knives).
Is it hard to find epilepsy treatments that work?
There are many effective epilepsy treatment options. In fact, about two out of three people become seizure-free with medication. Many do well on the first or second medication they try.
However, about one in three people have drug-refractory epilepsy, meaning seizures continue despite trying appropriate medications. These patients may require different combinations of medications, though side effects must balance with seizure control. A subset of patients may need to consider epilepsy surgery — either removing the part of the brain involved in starting seizures or implanting devices that control seizure frequency over time.
“As an epilepsy doctor, my job is to partner with patients to understand their goals and come up with a treatment plan that optimizes their quality of life,” says Dr. Maniar.
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