It is very essential for everybody to be aware of a detailed account of the attack of major (or grand mal or generalized), focal or Jacksonian and petit mal epilepsies. At times, tests like electroencephalogram (EEG) and / or computed tomographic (CT) scanning may be normal in a case of epilepsy, and, therefore, it is only the evidence of the eyewitness, who is in a position to report the details to the attending physician, when the patient is brol1ght to the hospital. As an emergency case, a clinical diagnosis of epilepsy can be made on the spot. Moreover, such cases/emergencies need immediate treatment, and the tests, even if they are conducted, take their own time.
In major (or grand mal or generalized) epilepsy, after momentarily experiencing a peculiar sensation or feeling, i.e. one of the types of auras, described earlier (the aura may even be absent), the patient loses consciousness instantaneously, and he collapses all at once. And if unluckily, the place is odd, e.g., a patient is coming down the stairs or standing near a fire or on a hill top, he may injure himself badly.
Following the fall, all the muscles of the body, i.e. all the muscles of the limbs, abdomen, chest and even face become rigid/ stiff. Due to the spasm of the trunk/respiratory muscles, breathing almost stops, and as the muscles of the face are also involved, the mouth gets firmly closed, and the teeth get clenched. The patient then experiences acute agony, and is close to death. But within a few seconds, all the muscles relax, breathing is regained, and the patient starts getting convulsions of the whole body, which usually continue for about 1-2 minutes, and thereafter, the whole body gets relaxed or becomes absolutely limp.
During such convulsions, the tongue moves repeatedly inside the mouth, and together with the repeated movements of the jaws, the saliva in the mouth gets stirred, and frothing occurs. The tongue may also be bitten when it comes in-between the teeth, and sometimes bleeding may also occur, causing a blood-stained froth. The patient may pass urine (and rarely faces) during this phase of convulsions. It should be remembered that tongue-bite, frothing, passing of urine are important clinical features of an attack of epilepsy, which must be noticed carefully by the eyewitness, for the information of doctor.
The patient may sleep for hours following an attack. However, he may be awakened after a reasonable time when he may complain of a marked headache and pain in all the muscles. When awake, he may have no recollection of his severe fall or convulsions. At the most, he may remember the aura, i.e. transitory symptoms that he may have experienced before the onset of the attack of epilepsy. However, this information about the aura has a great significance in clinical diagnosis, and, therefore, the patient must be coaxed again and again to elicit the required information.
The patient may even get the attack during sleep, and in such cases, tongue-bite or passing of urine in bed should help in the diagnosis. The patient may even die due to suffocation if he happens to turn over during this nocturnal attack of epilepsy, with his face buried in the pillow.
Attacks of grand mal epilepsy may occur many times a day. However, the occurrence of attacks of epilepsy are quite variable to the extent that the patient may not have any further attack during his/her whole life. And hence the value of mass awareness about the clinical diagnosis of epilepsy increases because the treatment cannot be started when a single/first attack of epilepsy occurs, which remains doubtful due to the lack of evidence. On the other hand, the patient may get one attack after the other without regaining consciousness in between the attacks, called status epilepticus, which could be even fatal, if immediate medical aid is not provided.
At times, there is a transitory jerky movement of the limb / s, so that in case both the lower limbs are involved and the patient is standing, he may fall down all at once. This state is called myoclonic epilepsy. Sometimes the small muscles of face, eyes etc. may also be involved.
In petit mal epilepsy, which occurs often in children, there is an extremely transitory attack of unconsciousness. The child, if standing, does not even fall down, and if he/she is doing his/her home work, the child continues with the work as if he/she has had no interruption. The attack of epilepsy may occur repeatedly even 15, 20, 30 times a day. When the attacks are limited to 1 to 2 per day, or on alternate days or even less, the child may remain unaware of such an attack. And even if he/she brings it to the notice of the parents, it may be ignored altogether.
However, whenever a child brings the attack to the notice of his parents, they. must take it very seriously, and tests like EEG, CT scan etc. should not be delayed. Therefore, the knowledge of symptoms of petit mal epilepsy is most important for parents, and even for teachers in schools, so that the disease may not remain undetected especially in early and occasional cases. However, in rare cases, the child may even collapse during unconsciousness. This is called an akinetic attack/ epilepsy, and thus, in such cases, there is usually no difficulty in diagnosis.
The attacks of petit mal epilepsy may disappear altogether on attaining maturity, although the treatment will have to be commenced as soon as the diagnosis is confirmed.
It is urgent that all persons, particularly all members/ friends/colleagues concerned with the case must keep in mind all the relevant signs and symptoms whenever the patient is to report to the physician for diagnosis.
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