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WHAT HAPPENS DURING AN EPILEPTIC SEIZURE?
Most people’s view of a typical epileptic fit is the major grand mal seizure in which the sufferer falls to the ground unconscious and jerking. But this is only one of the very many different types of seizure. A few people suffer from more than one kind of seizure, and the form their epilepsy takes may change, so that they may have different kinds of seizures at different stages of their life. To understand exactly what happens during the different kinds of seizure, and why they occur, we need to look a little more closely at the way the brain works.
Information is transferred within the brain in the form of electrical impulses, passed from cell to cell by chemical messengers, which can make the cells which transfer information either more or less excitable. As each brain cell ‘fires’, it stimulates a neighbouring cell and this in turn fires and excites the next cell along the pathway. Some of the cells which fire are inhibitory cells and these tend to damp down the activity, so that it does not run rampant through the brain, out of control.
How excitable the brain is depends on the balance of those chemical messengers which excite and those which inhibit cell firing. In some people the brain cells are more excitable than normal. They will fire more easily and, instead of the normal damping down by inhibitory cells, there is a sudden paroxysmal burst of electrical activity within a group or groups of cells. This is known as the ‘epileptic spike discharge’ and its presence can usually be picked up through the scalp by use of the EEG. However, even if you have these spike discharges they needn’t cause any disturbance and you will normally be quite unaware of them. It is only when the damping down activity fails more extensively that the abnormal activity spreads. Whole areas of cells become involved and start to fire in these paroxysmal bursts: a seizure (convulsion or fit) then occurs.
Sometimes, if there is an area of localized brain damage, the cells at the centre of this damaged area are so altered that they can no longer fire normally. These cells are called pacemaker cells, and they fire abnormally and continuously. Nothing stops them. However, they do not, of course, cause fits continuously. Something else must happen to make a seizure occur.
We know that before a seizure occurs the pacemaker cells all clump together and discharge in unison. As they clump together, the pacemaker cells recruit the cells surrounding the damaged area into the discharge and it is this spreading of the discharge which causes a localized or focal seizure. Yet why should this happen in the first place? What makes the pacemaker cells which are firing all the time suddenly interest the cells surrounding them in their faulty messages? The answer seems to be that some change in behaviour or thinking, or even something as simple as drowsiness, makes these neighbouring cells temporarily more excitable so that they can be drawn into the seizure discharge more easily.
These focal seizures can sometimes spread to include the whole brain ? a process called secondary generalization, which often results in a major seizure.
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