Fits are a brief electrical storm in the brain, and most can be controlled.
Brain cells talk to each other with tiny electrical signals. In a fit (seizure) a group of cells suddenly fires all at once, out of order. Epilepsy means a tendency to have fits again and again. With the right medicine taken every day, most people with epilepsy have few or no fits.
In plain words.
Not every fit is epilepsy. A single fit can come from a high fever in a young child, very low or very high sugar, low sodium or calcium, a head injury, an infection of the brain, stopping alcohol suddenly, or some medicines. These causes are looked for first.
In India a common cause of fits is a tapeworm cyst in the brain (neurocysticercosis), caught by swallowing the worm’s eggs from unclean water, unwashed vegetables or unwashed hands. Other causes include a past stroke, head injury, brain infection, or a problem present from birth; often no cause is found.
Fits look different depending on where the storm is. When it stays in one part of the brain, a person may stare blankly, not respond, chew or fumble, or have twitching or a strange feeling in one part of the body. When it spreads to the whole brain, the person falls, goes stiff, then jerks, may bite the tongue or wet themselves, and is confused and sleepy afterwards.
Most fits stop by themselves within two or three minutes. A fit lasting more than five minutes, or fits coming one after another without waking in between, is an emergency: it may not stop without treatment.
Epilepsy medicines work only if taken every day. Missed doses, too little sleep, alcohol and fever are the most common reasons fits come back. Many people who stay free of fits for some years can, with their doctor, slowly come off medicine.
Calm, one patch, or the whole brain
Brain cells pass signals to each other a few at a time, in order. The brain’s wave pattern (EEG) shows small, steady waves.
A group of cells in one patch fires together, again and again. Depending on the patch, the person may stare and not respond, chew or fumble, or twitch on one side.
The storm spreads to the whole brain. The person falls, stiffens and jerks. Most fits stop within two or three minutes. Time it: over five minutes, call 112.
Go to hospital now if
- A fit lasting more than five minutes, or a second fit before the person wakes up from the first: call 112. If a rescue medicine has been prescribed, give it as you were shown.
- A first-ever fit, or a fit in pregnancy, after a head injury, with high fever, stiff neck or severe headache, or in someone with diabetes: call 112 or go to hospital now.
- The person is not breathing normally, stays blue, or does not start to wake within about ten minutes after the jerking stops: call 112.
- A fit in water, or a serious injury during the fit: call 112.
- A rash with fever, mouth or eye sores, blisters or peeling skin after starting a new medicine: go to hospital now.
- During a fit: note the time, move sharp or hot things away, cushion the head, and loosen tight clothing. Do not hold the person down and do not put anything in the mouth: no spoon, finger, water or medicine. Do not make them smell a shoe or onion. When the jerking stops, roll them onto their side and stay until they are fully awake.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a day or two if
- Fits are coming more often than usual, even short ones
- You have missed doses of your medicine for more than a day
- A new rash after starting an epilepsy medicine: see a doctor the same day
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Blood sugar, sodium and calcium | Checked straight away after a first fit, to find a cause that can be corrected. |
| EEG (brain wave test) | Records the brain’s electrical activity through small pads on the scalp. Can show the pattern of epilepsy, though it may be normal between fits. |
| MRI or CT brain scan | Looks for a cause: a tapeworm cyst, scar, past stroke, growth or problem from birth. |
| ECG | A faint from the heart can look like a fit; this checks the heartbeat. |
| Blood count, liver and kidney tests | Before and during some epilepsy medicines. |
| A video of the attack | A phone video by a family member often helps the doctor more than any test. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Never stop epilepsy medicine suddenly, even if you have been free of fits for a long time: it can bring on severe, long fits. Some epilepsy medicines make birth control pills less reliable, and some other medicines change epilepsy medicine levels; tell every doctor you see that you have epilepsy.
A video call can
- Go through a first fit with you and the family, and arrange the right tests
- Review EEG and scan reports, and explain what they mean
- Adjust medicines, alongside your neurologist, and deal with side effects
- Plan pregnancy, contraception and daily safety with you
Needs a visit in person
- A fit happening now: that is for hospital, not a video call
- EEG and brain scans
- Specialist assessment by a neurologist, especially for fits that are hard to control
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759