Brain storm

The kind of seizure an older person may have depends on where the electrical disturbance takes place and how much of the brain is affected. It's possible to have just one type of seizure, or more than one type.

Generalized seizures happen when waves of electrical activity swamp the whole brain at once. These may produce convulsions (tonic clonic or grand mal seizures); sudden falls (atonic seizures); massive muscle jerks (myoclonic seizures); or momentary blackouts (absence seizures).

Tonic clonic seizures, which many people call convulsions, are the ones most people think of when they hear the word "epilepsy."

Tonic clonic seizures often start with a cry, caused by air being suddenly forced out of the lungs. The person slumps in his seat or falls to the ground, unconscious. The body stiffens briefly and then begins to jerk.

The tongue may be bitten. A frothy saliva may appear around the mouth. Breathing may be very shallow and even stop for a few moments.

Sometimes the skin turns a bluish color because breathing may be briefly interrupted and the blood doesn't get as much oxygen as usual.

After a minute or two the jerking movements slow down and the seizure ends naturally. Bladder or bowel control may be lost as the body relaxes after the seizure. Consciousness will then slowly return.

Partial seizures happen when a smaller area of the brain is affected. Partial seizures in the elderly may produce uncontrolled shaking, alter emotions, or change the way things look, smell, feel, taste or sound to the person having the seizure. When people have these experiences, yet stay fully conscious, the episodes are called simple partial seizures.

Man Thinking

But there's nothing simple about them to an older person going through this experience. When familiar surroundings suddenly look different, when people hear voices and nobody's there, when they see images -- perhaps of a loved one who's passed on, or an object that suddenly appears where it's not supposed to be -- it can be terrifying.

Episodes of this kind are caused by electrical disturbances in the part of the brain that controls senses such as sight (causing visual disturbances), or hearing (producing the illusion of voices or sounds) or even memory (creating perhaps an image of the past or blocking recognition of familiar places).

However, elderly people may not talk about these episodes, even to their doctors, because they're afraid they're losing their minds. They're not, of course. These are seizures, not symptoms of mental illness.

And the doctor should be told about them because these seizures may require a medicine that's different from what he or she might otherwise prescribe.

Complex partial seizures are experienced in a different way. They affect consciousness while they're happening and people can't remember them afterwards.

Complex partial seizures typically produce a kind of confused, dreamlike state. A senior citizen with complex partial seizures may stare, make chewing movements with the mouth, pick at clothing, mumble, do the same actions over and over again.

He or she won't be able to talk to other people while the seizure is going on, but may respond to simple requests made in a calm, friendly voice.

Complex partial seizures are particularly common in older people with epilepsy, but they occur at any age.

Sometimes people wander during these episodes. In rare cases they may become very agitated, make flailing movements with their arms, try to undress, try to run, scream, or cower in fear.

Although it's always possible for seizures to change, people usually develop a pattern of things they do and these are likely to occur in the same order each time.

Sometimes partial seizures spread to involve the whole brain, causing a convulsion or a fall. When this happens as a regular part of a person's seizure pattern, the special feeling produced by the partial seizure acts as a warning. Sometimes it gives people enough time to get to a safe place before they lose consciousness. The warning feeling is often called an aura.

Symptoms of Seizures

Simple Partial Seizures

  • Jamais vu (familiar things suddenly seem unfamiliar)
  • Trembling that moves up one side of the body
  • Déjà vu (unfamiliar things seem familiar)
  • Out of body experiences
  • Sudden shifts in mood
  • Unexplained anger or fear
  • Disturbed speech

Complex Partial Seizures

  • Lip smacking
  • Swallowing
  • Picking at clothes
  • Wandering
  • Lack of response to others
  • Repeated phrases
  • Senseless, clumsy movements
  • Lost time
  • Disrobing
  • Being briefly unaware of danger or pain

Generalized Seizures

  • Brief staring
  • Sudden muscle contractions
  • Sudden falls
  • Convulsions
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
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