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Generalised seizures

In generalised seizures the epileptic activity is in both halves of your brain. The main types of generalised seizure are tonic-clonic, absence, myoclonic, tonic and atonic.

In tonic-clonic seizures, you will fall to the floor. In some other types of generalised seizure the epileptic activity misses a small part of your brain and makes your symptoms more limited. For example, in absence seizures, you don’t fall to the floor. In a myoclonic seizure, the symptoms are jerking in just a part of your body, and you rarely fall to the floor.

Tonic-clonic seizures

This is the most common and widely recognised generalised seizure. There are two phases to this type of seizure: the ‘tonic’ phase, followed by the ‘clonic’ phase.

The tonic phase

You lose consciousness and, if standing, will fall to the floor. Your body goes stiff because all your muscles contract. You may cry out because your muscles contract, forcing air out of your lungs. Your breathing patterns change, so there is less oxygen than normal in your lungs. Because of this, the blood circulating in your body is less red than usual. This causes your skin (particularly around your mouth and under your finger nails) to appear blue in colour. This is called ‘cyanosis’. You may bite your tongue and the inside of your cheeks.

The clonic phase

After the tonic phase has passed, the clonic phase of the seizure begins. Your limbs jerk now because your muscles tighten and relax in turn. You may occasionally lose control of your bladder and/or bowels. It is not possible to stop the seizure, and no attempts should be made to control your movements, as this could cause injury to your limbs.

After a tonic-clonic seizure

After a short time, your muscles relax and your body goes limp. Slowly you will regain consciousness, but may well be groggy or confused. You will gradually return to normal but may not be able to remember anything for a while. It’s usual to feel sleepy and have a headache and aching limbs. Recovery times can be different for different people. Some people will quickly want to get back to what they were doing. Some people will need a short sleep and others will need plenty of rest.

Post-ictal state

‘Post’ means after and ‘ictal’ refers to a seizure. After a tonic-clonic seizure, some people may be very confused, tired or have memory loss. This is known as a post-ictal state. A post-ictal state can last from minutes to days.

Absence seizures

During an absence seizure, you are unconscious for a few seconds. You appear to be daydreaming or switching off. You don’t know what is happening around you, and you can’t be brought out of it.

Because anybody can daydream at any time, absences can be very hard to spot. It’s possible to have hundreds of absence seizures a day, preventing you from fully taking part in daily activities. You could also miss out on tiny pieces of information or events. This may be mistaken for lack of attention or concentration.

Myoclonic seizures

The word myoclonic comes from ‘myo’ meaning muscle, and ‘clonus’ meaning jerk. So in a myoclonic seizure your muscles jerk.

Myoclonic seizures can sometimes cause your whole body to jerk. More usually, they only cause jerking in one or both arms and sometimes your head. Although it may not be obvious, during the seizure, you are unconscious for a very brief time.

Even though the seizures are brief, they can be extremely frustrating. For example, they often result in spilt drinks or similar accidents.

The most common time for myoclonic seizures to happen is first thing in the morning.

Myoclonic seizures are similar to the jerks that some people have when falling asleep. These jerks when falling asleep are not epilepsy.

Tonic seizures

In a tonic seizure all your muscles tighten. Your body stiffens and you fall over unless you are supported. Tonic seizures usually last less than 20 seconds and most often happen during sleep.

Atonic seizures (drop attacks or akinetic seizures)

In an atonic seizure you lose all muscle tone and drop heavily to the floor. The seizure is very brief and you are usually able to get up again straight away. You are not confused afterwards.

Because your body usually falls forward in an atonic seizure, you are at risk of banging your head on furniture or other hard objects. If you have frequent atonic seizures, extra safety precautions – like protective headgear – make sense. Epilepsy Action can provide further information on this.

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  • Updated August 2013
    To be reviewed August 2015

Comments: read the 9 comments or add yours

Comments

I was removed from an18 year employment due to abscences relating to epilepsy and fatigue, and depression. I have spent over 12 months job hunting, yet I cannot get any jobs. I have tried to live a normal over the past 17 years that I have been diagnosed with grand mal epilepsy. My husband and daughter are good to me, I am still scared and very confused when it happens and my memory issue is also getting worse but the job seekers department will not except the reasons for non employment. Yet employers see it as a safety issue, so employment doesn't happen. Now I am annoyed and despite meds still having fits, due to fustration, and depression.

Submitted by Sonja on

I seem to have lots of different seizure types. I had my first fit when I was 8 years old, focal temporal lobe as I found out when I was 19 when I was finally diagnosed after having 3 tonic-clonics. I also have absences, atonic head drops, and very rarely myoclonic jerks. I have focal temporals almost daily, sometimes more than once a day, and yet my EEG came back normal. Docs are totally baffled by my condition because all my scans are normal except a tiny pineal cyst, deemed harmless.

Submitted by Laura on

Laura my EEGs also come back normal every time, also one to baffle the docs, your symptoms sound very similar to mine, but have yet to have my diagnosis confirmed, best advise I can offer is to keep fighting you will get there in the end only taken me nearly 30 years to get to this point of knowing what's wrong.

Submitted by Richard on

I have finally been given an initial diagnosis after nearly 29 years of random passing out every few years. I also have absence seizures several times a day (so my wife tells me). I have only been able to get to this point after my last major episode (ended up in hospital again but this time my wife was eight months pregnant) if it wasn't for my wife been with me at the doctors in tears trying to get them to take me seriously I would not have got to this stage. Still in the early days of diagnosis but already a massive relief to finally know I am not mad. The last major episode has been the worst I have ever had and still feeling the effects nearly nine months on (short and long term memory loss and increased amount of absence seizures), every time in the past I have been tested they have only looked at photo sensitive epilepsy and never anything else so was always ruled out. Thankfully this time my doctor listened and has done further tests (Never underestimate the power of a hormonal heavily pregnant women). Still have more appointments for it all to be finalised and treatment sorted. So would say to anyone who is still trying to get answers to fight on and not give in you will get there in the end.

Submitted by Richard on

Update on condition, had yet another appointment yesterday and still going down the epilepsy route, am now due to have a 48 hr portable monitor so can record whet is happening over a normal couple of days, as much fun this will be for colleges it seems the best option as seems it my be the only way to pinpoint what is wrong.

Submitted by Richard on

Recetly, I've been going to the doc's about a strange bout of 'episodes' where I go vacant, my limbs tingle, i feel sick (sometimes with actual vomitig) and my heart races. Often, I get visualizations of activities or places that I know is not real, such as my home being a hospital. Put on citalopram for anxiety but because mum fought, with a family history of epileptics and a great uncle who died from it, I'm now having a deep chat with the doc and hopefully finding out what is wrong.

If anyone has experienced something like this, it would be great to know I'm not alone, thank you.

Submitted by Charlotte on

Hi Charlotte

Epilepsy is very individual and can make itself felt in various ways. It all depends where in the brain the activity is coming from.

To hear from other people about their epilepsy, you may wish to post your question on facebook, twitter or our online forum.

If we can be of any more help, please feel free to contact us again, either by email helpline@epilepsy.org.uk or if you are in the UK, phone the Epilepsy Helpline freephone 0808 800 5050.

Yours sincerely

Diane

Submitted by Diane on

Im going through a hard time. Epilespy is diagnosed but the cause unknowb. MRI is clear awaiting EEG results. Not allowed to work. I work for NHS any future employment will be untenable if they terminate my employment. At the mo im generalised seisures. What ever that means

Submitted by sue ward on

Hi Sue

This must be a very worrying time for you, especially as your employer is not allowing you to work. Your employer shouldn’t be keeping you off work unless it is absolutely essential.

Epilepsy is a condition that can develop at any age. For most people there isn’t an explanation or known cause for their epilepsy to develop.

Most jobs, even healthcare work, are possible for people with epilepsy. It all depends on your seizure type, seizure frequency and maybe some reasonable adjustments at work.

Because of your diagnosis of epilepsy, you are covered by the Equality Law. This means your employer must not discriminate against you and if necessary make any ‘reasonable adjustment’. This is to make sure that you are not put at a disadvantage to a non-disabled person, just because you have epilepsy. A risk assessment is generally carried out to look at possible problems within your job. From this assessment there may be some reasonable adjustments suggested. Your employer should do their best to make sure that you are not put at a disadvantage because of your epilepsy.

You should speak to your union or ACAS if you think your employer is keeping you off work needlessly.

The most common way epilepsy is treated is with epilepsy medicine. Epilepsy medicine doesn’t cure epilepsy, but for 70/80 per cent of people it can stop their seizures. This fact should be taken into account when talking to your employer.

If you or your employer would like more information, please feel free to contact us again, either by email helpline@epilepsy.org.uk or phone the Epilepsy Helpline freephone 0808 800 5050.

Yours sincerely

Diane

Regards

Diane Wallace

Advice and Information Team

Submitted by Cherry on

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