Seizure Overview

A seizure is a sudden burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings and levels of consciousness. Epilepsy is defined as having two or more seizures at least 24 hours apart that don’t have a known cause. But epilepsy doesn’t cause all seizures.

There are many types of seizures. They have a range of symptoms and vary in how much they affect your daily life. Seizure types also vary by where they begin in the brain and how far they spread. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency.

Seizures can happen after a stroke or a head injury. An infection such as meningitis or another illness also may be the cause. But often the cause is not known.

Seizure Symptoms

Symptoms vary based on the type of seizure. They also can range from mild to serious. Seizure symptoms may include:

• Short-lived confusion.
• A staring spell.
• Jerking movements of the arms and legs that can’t be stopped.
• Loss of consciousness or awareness.
• Changes in thinking or emotions. These may include fear, anxiety or a feeling of already having lived the moment, called deja vu.

Most seizures fall into one of two classes called focal or generalized. The classes are based on how and where the brain activity causing the seizure began. If health professionals don’t know how the seizures began, they may say the seizures are of unknown onset.

Types of Seizures

Focal seizures

Focal seizures result from electrical activity in one area of the brain. This type of seizure can happen with or without passing out, called losing consciousness.

• Focal seizures with impaired awareness. These seizures involve a change or loss of consciousness or awareness that feels like being in a dream. During these types of seizures, people may seem awake. But they stare into space and don’t respond to anything around them. They may repeat movements such as hand rubbing and mouth movements, repeat certain words, or walk in circles. They may not remember the seizure or even know that it happened.
• Focal seizures without impaired awareness. These seizures may change emotions. They also may change how things look, smell, feel, taste or sound. But people having a focal seizure don’t pass out. During these types of seizures, people may feel angry, joyful or sad. Some people have nausea or odd feelings that are hard to describe. These seizures may cause trouble speaking and jerking of a body part such as an arm or a leg. They also may cause sudden symptoms such as tingling, dizziness and seeing flashing lights.

Symptoms of focal seizures may seem like those of other conditions of the brain or nervous system. These other conditions include migraine, mental illness or a condition that affects how the brain manages sleep-wake cycles, called narcolepsy.

Generalized seizures

Seizures that appear to involve all areas of the brain from the time they start are called generalized seizures. Types of generalized seizures include:

• Absence seizures. Absence seizures often happen in children. These seizures once were called petit mal seizures. People who have absence seizures most often stare into space or make slight body movements such as eye blinking or lip smacking. The seizures most often last for 5 to 10 seconds. Absence seizures can happen up to hundreds of times a day. They can come in clusters. And they can cause a brief loss of awareness.
• Tonic seizures. Tonic seizures cause muscles to get stiff. These seizures most often affect muscles in the back, arms and legs. People who have these seizures may pass out and fall to the ground.
• Atonic seizures. Atonic seizures cause a sudden loss of muscle use, most often in the legs. They’re also called drop seizures. People having this type of seizure may collapse.
• Clonic seizures. Clonic seizures are linked with jerking muscle movements. These seizures usually affect the neck, face and arms on both sides of the body.
• Myoclonic seizures. Myoclonic seizures most often cause sudden brief jerks or twitches of the arms and legs. People who have these seizures don’t often pass out.
• Tonic-clonic seizures. Tonic-clonic seizures are the most common type of generalized seizure. They once were called grand mal seizures. They can cause passing out, body stiffness and shaking. They sometimes cause people to urinate or to bite their tongues. Tonic-clonic seizures last for several minutes. Tonic-clonic seizures may start as focal seizures that spread to involve most or all of the brain.

Seizure stages

Seizures can have a beginning phase, a middle phase and an end phase. These phases also are called prodrome, ictal and postictal.

• Prodrome. This is the earliest warning that a seizure may happen. During the prodrome, people may have a hard-to-describe sense that a seizure may happen. They also may have changes in behavior. This can happen in the hours or even days before a seizure. The prodrome stage may include an aura. The aura is the first symptom of a seizure. Symptoms during the aura may include the feeling that a person or place is familiar, called deja vu, or a feeling that a person or place is not familiar. Or people may simply feel strange, feel fear or panic, or even have good feelings. Symptoms also may include smells, sounds, tastes, blurred vision or racing thoughts. Most often, auras are feelings that are hard to describe. The prodrome may include headache, numbness, tingling, nausea or dizziness. Many people with seizures have a prodrome or aura. But some people do not.
• Ictal phase. The ictal phase lasts from the first symptom, including the aura, to the end of the seizure. Symptoms of the ictal phase depend on the type of seizure.
• Postictal phase. This is the period after a seizure during recovery. The postictal stage can last minutes or hours. Some people recover quickly, while others take hours. The length of the postictal phase depends on the type of seizure and what part of the brain was affected. During this phase, people may be slow to respond, have trouble with memory, and have trouble talking or writing. They may feel sleepy, confused, dizzy, sad, scared, anxious or frustrated. They also may have nausea, a headache or weakness. They may feel thirsty or urinate.

Meadows Seizure and Medication Policy

Seizure Protocols

It is recommended that all individuals who have had a seizure in the last two years from the date of the lesson (e.g., epilepsy, seizures as a secondary condition) wear a safety harness for the duration of the lesson if the individual plans to ride a chairlift. An exception is when using a sit-ski, in which case the sit-ski restraints and evacuation strap fill this role. The safety harness should include an easily accessible carabiner that can be attached to a chairlift while the individual is seated on the chairlift. It is recommended that the instructor teaching this lesson be trained and signed off by the Adaptive Supervisor or Training Coordinator. This e-learning course is part of your training.

It is recommended that all instructors teaching an individual with a seizure disorder alert the Adaptive Supervisor or Training Coordinator and carry a MHM radio throughout the day for emergencies. If a seizure were to occur, instructors may radio Ski Patrol on Channel 3 immediately. Please make sure that the guest is laying in a safe space with his or her airway open. Remove ski or snowboard equipment and allow a seizure to occur versus attempting to stop convulsions. Stay calm and safe until ski patrol is able to assist. Once ski patrol is present, radio the Adaptive Supervisor and MLC Managers on Channel 7. 

Administration of Medication

To the extent possible, Mt. Hood Meadows instructors should not administer medication to an individual participating in a lesson. If an individual requires the administration of medication, please call Ski Patrol immediately. The individual or designated caregiver is responsible for administering their own medications, and instructors may be allowed to assist with a hand-over-hand technique for lifesaving medications (e.g., epi-pen). 

If a student is required to carry a life-saving medication with them at all times, the Adaptive Supervisor and MLC Manager will create a medication management plan. If your student has a medication management plan, you will be notified before the lesson and educated about the plan and the medication.