This is a spell in which the individual loses contact or focus on events happening around her, appears blank, not answering your repeated queries or attempts to rouse her, may make some repeated facial or body movements or expressions, and then return back to normal in a matter of seconds to minutes, being unable to recall what had happened in those few moments.
Absence Spells may be “simple” as described here, or more “complex”, in which the person may perform complicated tasks requiring skill – such as driving her car – and yet not remember having done so!
The fits described above are generalized, involving all parts of the body simultaneously. The opposite of this is the focal fit which involves only one part of the body. The victim does not lose consciousness as long as the fit remains focal, though it may spread to other contiguous body parts and even the whole body, becoming secondarily generalized, which is then associated with a loss of consciousness.
Some people with focal fits have some attacks which remain focal, and other spells when they are generalized. During the focal fit the person remains conscious and aware of everything, and can recall how it started and what happened during the event.
Take a look at the video below; the gentleman is on the bed with a table, and initially has a few right hand movements which may think are voluntary, but are not. During this stage, he is quite conscious, aware of his surroundings, and nods his head when asked, “Are you having a seizure.” In the next few seconds, his head and body turns to the left, gradually at first, and then forcefully. He is not responsive any more and is clearly in the midst of a seizure: the lady in the room has already given a signal to the nurse. In the next few seconds, the body arches, the left hand becomes stiff and the victim falls back on the bed, and then the fit spreads to the rest of the body and becomes fully generalized.
This is the typical spread of a seizure from a focal onset to a generalized seizure.
If the fit becomes generalized the person loses his senses, may fall to the ground, sustain injury or pass urine or stool in his clothes, and may then not recollect the event after regaining his senses. Such events sometimes result in what is called retrograde amnesia – forgetting the events that happened in the immediate preceding moments before the fall and generalized seizure.
Because of this, victims of fits cannot always be expected to give a perfectly reliable account of events, and details from anyone who has witnessed the event then becomes crucially important to understand the event.
This is yet another type of epileptic fit in which the individual experiences jerks in an entire limb or part of a limb – sometimes randomly and frequently. Myoclonic jerks can involve several parts of the body simultaneously or sequentially, and sometimes the whole body, causing the person to fall down suffering an injury, even though there is NO LOSS OF CONSCIOUSNESS.
There are a few other kinds of fits like ATONIC fits, fits peculiar to children and neonates , and so on.
These EPILEPTIC FITS must be differentiated from non-epileptic fits. The hallmark of an epileptic fit is that it results from an abnormal electrical discharge in the brain.
The difference between normal and abnormal electrical activity in the brain can only be appreciated in a record of the electrical activity called the EEG (Electroencephalogram).
A focal fit happens when such an abnormal discharge starts at a focus and then spreads to the neighboring brain tissue. A generalized fit represents an event in which the abnormal discharge spreads and “seizes” the whole brain.
Absence spells are generalized by definition; they represent slightly different kind of abnormal discharge. Some generalized fits are generalized to start with, while in others, the spread through the brain is so rapid that the initial focal onset is not observable.
The point is that all kinds of fits result from one or other kind of abnormal electrical discharge in the brain.
The Epileptic Focus:
The epileptic patient has a tendency to have one or the other kind of electrical discharge, based on some changes which occur in some small area in the brain. These changes lead to the development of an epileptic focus. Many different “pathological processes” culminate in the development of an epileptic focus, and these processes are initiated by some or other insult to the brain, such as head injury, brain infection (viral encephalitis), or an Ischemic damage.
The characteristics of an Epileptic Focus:
Once the process is initiated, the epileptic focus develops over a period of time, undergoing progressive changes. It becomes hyperactive, discharging spontaneously, with a tendency to allow the discharge to spread rather than suppress the discharge.
The changes leading to the formation of an epileptic focus happen over a period of time, resulting in the formation of an abnormal circuit. The nerve cells or neurones that participate in this circuit become abnormal in structure and function, and develop a tendency to discharge together – something called HYPERSYNCHRONY. This tendency for hypersynchronous discharge is critical in the development of an epileptic focus.
Activity in an Epileptic Focus:
Once a focus has formed, it can become progressively more active. Each individual has a unique kind of focus; in some people, the focus discharges spontaneously, while in others it discharges only when provoked or severely stressed. In still others it may discharge frequently and spontaneously, leading to frequent, intractable fits.
Most people are somewhere in between.
Can we cure Epilepsy?
Understanding the mechanism described above will help you to understand why the following facts about epilepsy are true:
- Drugs for epilepsy – Anti-Epileptic Drugs, AEDs – help only to suppress the abnormal electrical discharge, or it’s spread; they have no effect on the underlying mechanism or the circuit that is causing these fits.
- An AED – like any other drug – has a limited duration of effect – hence regular intake to maintain drug levels in the blood is important.
- Frequent fits may increase the tendency to have more fits – AEDs should be used to control them not only to prevent a dangerous accident which can happen during the fit – but also to prevent increasing frequency and severity of epileptic fits.
- The only way an Epilepsy can be “cured” is by removing the focus from which the fits arise. Hence, this depends on there being such a focus, being able to identify that focus, the location of the focus being such that it can be removed surgically without causing damage to any important structures, and then performing such a surgery successfully.
The majority of epileptic fits can be controlled effectively with the standard AEDs; a few patients may require multiple drugs, or higher doses, and may face side-effects.
The importance of QUALITY OF LIFE for an epileptic patient:
The target and goal for an epileptic patient – for her as well as her doctor – is to achieve a GOOD QUALITY of LIFE. This means they should focus not only on controlling the fits, but also on minimizing side-effects.
A very general guideline for a person who gets focal fits – sometimes remaining focal, and sometimes becoming generalized, and who is studying, operates heavy machinery at work, drives, or does other regular activity of critical importance, would be like this:
- Ensure there are no generalized fits
- Keep the focal fits to the minimum
- Maintain alertness at all times
- Minimize memory problems.
If these guidelines are applied, then the chances that each and every epileptic patient can have good quality of life is very high.