About Epilepsy

What Is Epilepsy?

Epilepsy is a neurological condition that affects the brain and nervous system. Epilepsy is considered a ‘spectrum disorder’ because it has numerous causes and several different seizure types and its severity and impact can vary from person to person, with a range of co-existing conditions.1
People with epilepsy have a tendency to experience frequent seizures, which start in the brain and are caused by a disturbance in the brain’s electrical activity.2
During a seizure, patients can temporarily lose control of their movement, vision or awareness and there’s a chance they could lose consciousness. Usually, seizures stop within a few minutes, though sometimes they may last longer.3
Epilepsy usually starts in childhood or in people over 60 years old. Despite epilepsy being such a widespread condition, the cause is known in just a minority of cases. It is normal for your doctor to be unable to explain the cause of seizures.4

Types Of Seizures

The main symptom of epilepsy is repeated seizures. Seizures can have very different appearances in different people, depending on which part of their brain is involved. Seizures can be classified into 3 major groups: 3,6,5,7

Focal on set seizures:

Focal onset seizures start in, and affect, just one part of the brain. These include: focal aware seizures (the person is conscious) and focal impaired awareness seizures (the person’s consciousness is affected, and they may be confused).

Generalised onset seizures

Generalised onset seizures:

Generalised onset seizures affect both sides of the brain at once and happen without warning. These include: convulsive (tonic, clonic, myoclonic) and non-convulsive (atonic, absence) seizure types. The person will be unconscious (except in myoclonic seizures), even if just for a few seconds and afterwards will not remember what happened during the seizure.

Unknown onset seizures

Unknown onset seizures:

This term is sometimes used to describe a seizure if doctors are not sure where in the brain the seizure started. This may happen if the person was asleep, alone or the seizure was not witnessed.

Prolonged, Acute, Convulsive Seizures (PACS)

Prolonged, Acute, Convulsive Seizures (PACS):

Convulsive seizures which last for longer than 5 minutes are known as prolonged, acute, convulsive seizures (PACS).

seizures usually do not last more than

60 - 90 seconds

Status Epilepticus

Seizures usually stop by themselves (without any treatment). However, sometimes they do not stop, or one seizure follows another without a return of consciousness between them. Either 5 or more minutes of continuous seizure activity or repetitive seizures without regaining consciousness is known as status epilepticus (SE).8,9
Status epilepticus in a convulsive seizure is a medical emergency which requires swift treatment (within 5-10 minutes of the start of the seizure) to prevent associated complications such as brain damage.7

Seizure Risk Factors

For many people with epilepsy, seizures happen on their own. However, for some people seizures can happen because of a specific trigger.10

Triggers can differ from person to person, but common triggers include:10

  • Tiredness and lack of sleep
  • Stress
  • Alcohol
  • Drugs
  • Photosensitivity
  • Use of certain medications

What Does It Feel Like To Have A Seizure?

There are some early signs to look out for in a patient which indicate that they may be about to have a seizure. These are called auras, and can include symptoms such as distorted sounds, tastes and smells, as well as physical sensations such as headaches, light-headedness and nausea.11
During a seizure, patients may experience motor symptoms (e.g. jerking, twitching) and non-motor symptoms (e.g. loss of awareness, visual hallucinations, feelings of panic or fear).11

After a seizure, it is normal for the patient not to feel their usual selves, experiencing symptoms such as nausea, drowsiness and headaches. It usually takes a few minutes for the patient to recover, although it may take up to a few hours in some cases.11

Treatment Options

Patients usually take medication every day for their epilepsy. This is known as daily medication. A wide range of daily medications are available. The patient’s doctor will have chosen the one best suited to their needs.12
There are other treatment options for people whose seizures are not controlled by anti-epileptic drugs. These include:13
  • Diet Control
  • Epilepsy Devices
  • Epilepsy Surgery

Emergency Medication

Daily medication works hard to keep epilepsy under control. However, prolonged, acute, convulsive seizures (PACS) may sometimes occur in spite of daily medication.14
If a patient has experienced PACS in the past, their doctor will recommend a second medicine that should be taken only if seizures don’t stop after 5 minutes. This is known as rescue medication. As the name suggests, this medication gets to work quickly and may help stop your child from needing to go to the hospital. Rescue medication can be given in 1 of 3 main ways: the mouth (oromucosal), the bottom (rectal) or by injection.14

First Aid During A Seizure

If your child has a seizure, the first thing to do is to time it to establish whether it is a prolonged acute convulsive seizure or not. Rescue medicine should be given if the convulsive seizure lasts 5 minutes or more. Remember to follow your doctor’s advice at all times. Always make sure to check the individual care plan.15
There are also several other steps you can take to ensure your child is as safe as possible when they experience a seizure:15

Cushion head, remove glasses

Loosen tight
clothing

Don’t move the child unless they are in danger

Time the seizure

Don’t put anything
in their mouth

Remove any
dangerous objects

Don’t hold them down

If the seizure subsides, roll the child onto one side into the recovery position

Speak gently and reassure

Call An Ambulance Immediately If:16

  • The seizure does not stop within 10 minutes of administering BUCCOLAM

  • You cannot administer BUCCOLAM, or cannot give the full dose

  • The patient’s breathing slows down or stops

  • The patient vomits and the seizure does not stop within 10 minutes of administering BUCCOLAM

  • You observe signs of a heart attack such as chest pain or pain that spreads to the neck or left shoulder and down the left arm

  • You give too much BUCCOLAM and there are signs of overdose (see patient information leaflet)

NEVER Give Another Dose Of Buccolam:16
  • Even if the seizure does not stop within 10 minutes
  • If the patient vomits or salivates

Please read the patient information leaflet inside the box for additional signs indicating need for medical support.

References:

  1. NIH: The Epilepsies and Seizures: Hope Through Research. Accessed from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through  

  2. The Epilepsies and Seizures: Hope Through Research. Available from: https://www.nhs.uk/conditions/epilepsy/symptoms (accessed 03 June 2021) 

  3. NHS. Epilepsy Symptoms. Available from: https://www.nhs.uk/conditions/epilepsy/symptoms/  (accessed 03 Apr 2020) 

  4. NHS. Epilepsy Overview. Available from: https://www.nhs.uk/conditions/epilepsy/ (accessed 03 Apr 2020) 

  5. World Health Organization. Epilepsy. Available from:  https://www.who.int/news-room/fact-sheets/detail/epilepsy
    (accessed 03 Apr 2020) 

  6. Epilepsy Society. Seizure Types. Available from:  https://www.epilepsysociety.org.uk/seizure-types#.XZXqspNKhTb
    (accessed 03 Apr 2020) 

  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018870/ 

  8. Epilepsy Society. Status Epilepticus. Available from:  https://www.epilepsysociety.org.uk/status-epilepticus#.XZXq-JNKhTZ (accessed 03 Apr 2020) 

  9. Pellock JM. Overview: definitions and classifications of seizure
    emergencies. Journal of Child Neurology. 2007 May;22(5_suppl):9S-13S 

  10. Epilepsy Foundation. Triggers of Seizures. Available from:  https://www.epilepsy.com/learn/triggers-seizures
    (accessed 03 Apr 2020) 

  11. Epilepsy Foundation. What Happens During a Seizure. Available from:  https://www.epilepsy.com/learn/about-epilepsy-basics/what-happens-during-seizure (accessed 03 Apr 2020) 

  12. Epilepsy Society. Anti-epileptic Drugs. Available from:  https://epilepsysociety.org.uk/about-epilepsy/anti-epileptic-drugs#.XZXripNKhTZ (accessed 03 Apr 2020) 

  13. Epilepsy Society. Epilepsy treatment. Available from: https://epilepsysociety.org.uk/about-epilepsy/treatment#.XZXrxZNKhTY  (accessed  03 Apr 2020) 

  14. Epilepsy Action. Status epilepticus and emergency treatment. Available 
    from:  https://www.epilepsy.org.uk/info/firstaid/emergency-treatment-seizures-last-long-time (accessed 03 Apr 2020) 

  15. NHS. What to do if someone has a seizure (fit). Available from:  https://www.nhs.uk/conditions/what-to-do-if-someone-has-a-seizure-fit/ (accessed 03 Apr 2020) 

  16. Buccolam PIL. Available from:  https://www.medicines.org.uk/emc/files/pil.2768.pdf
    (accessed 03 Apr 2020) 

This information is provided as a resource for patients who have been prescribed Buccolam by their doctor or other healthcare professional.

Reporting of adverse events (Healthcare Professionals in the UK)

Adverse events should be reported. Reporting forms and information can be found at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Neuraxpharm. at: pv-uk@neuraxpharm.com