An epileptic seizure can be terrifying – for both those witnessing it and for the person who is experiencing it. To bring more awareness to seizures and the additional complications related to epilepsy, we observe Epilepsy Awareness Month every November.

Home to a Level 4 Epilepsy Center, a designation indicating the highest level of care in the nation, VCU Health is joining the conversation about this important health topic. “What we are trying to do is educate and raise awareness within the community of people who suffer from epilepsy,” says Victor Gonzalez-Montoya, M.D, interim chief of epilepsy at VCU Health. “Education is going to remove the taboo status, and it’s going to encourage patients to seek out care.”

Defining the Varying Classifications of Seizures

Seizures result from abnormal phenomena that occur in the brain. They are typically triggered by excessive electrical activity that manifests in different ways, such as confusion, involuntary movements, loss of awareness or convulsions. While the spectrum of seizure severity is somewhat fluid, it is typically divided into varying classifications.

For example, a focal event occurs when a part of the brain is stimulating excessive activity, affecting consciousness or awareness. Another classification involves when individuals undergo convulsions, which is what most people associate with a seizure.

Additional types include sensory seizures, which are focal seizures with no alteration of awareness, and seizures with hallucinations – both visual and auditory.

Treatment Options for Patients Living with Epilepsy

Gonzalez-Montoya clarifies that just because a person experiences a seizure, it does not they have epilepsy. “Epilepsy implies the risk of having seizures or recurrence of seizures with no trigger factors. Having that propensity is what makes someone epileptic. They are the ones who need antiepileptic medications,” he explains.

Treatment options are tailored to the individual patient, based on additional medical conditions the patient may have or how much a medication’s side effects impact daily living.

“Typically, side effects are drowsiness and dizziness. For some people, it depends on the dosing. But that doesn’t mean it’s a failure of the medication,” assures Gonzalez-Montoya. “In some cases, we need to use trial and error, test other medications, change the doses, or change the way the medication is delivered so the patients experience the least amount of side effects and still experience the positive effects of the medication.”

First Aid 101: What You Can Do to Help

Not all seizures need emergent treatment, but there are also misconceptions surrounding what bystanders should do if someone is convulsing. One such myth is to put an object in the seizing person’s mouth to protect them from biting their tongue. According to Gonzalez-Montoya, this poses more harm than help. “Sticking objects in the person’s mouth could be very dangerous because they can break a tooth. They can choke on it, and that could be very, very harmful.”

The danger may also extend to someone trying to help by putting fingers in the mouth. “A seizure is like this excessive activity that is shooting out and making the muscles contract,” he adds. “All of them are contracted, and one can break fingers if they are put in the mouth. So, in any scenario, it is not a good idea to stick anything in their mouth.”

What people should do is create a safe space, making sure the person seizing is not in close proximity to hot surfaces or sharp objects. Also, stay with the person, stay calm and time the event. Approximately 95 percent of seizures end by themselves in less than five minutes, but anything longer needs medical attention to break the seizure and prevent epilepticus, which is essentially a nonstop seizure state.

Some patients experience warning sensations that a seizure is about to occur, allowing them to get into a safe position and reduce risk of bodily harm. Some even have enough time to call for help. Unfortunately, not everyone has this “luxury,” as Gonzalez-Montoya puts it. “Some seizures spread too fast within the brain that there is no time for the patient or anyone else to do anything about it, other than just deal with the consequences of falling,” he cautions.

Educate and Advocate

Gonzalez-Montoya encourages any patient whose medications are failing to stop seizures to contact their doctor so the level of care can be raised to an epileptologist – a neurologist with a sub-specialty in epilepsy. He also advises that friends and family members become more educated about what is happening with their loved one. “Family members, friends, co-workers of someone who has epilepsy – they need their help. They need to be educated.”

Listen to a full interview with Gonzalez-Montoya on this topic by clicking here. For more episodes, find the Healthy with VCU Health podcast on any major streaming platform or by visiting the VCU Health Podcast library at vcuhealth.org/podcasts.