cryiling

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what’s the lightest infraction you’ve blocked somone for

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Writing Seizures

 Latest installment in Disability Writing Guides! As always, feel free to add something, or come into my ask box with a question, comment, or request. 

This post is intended as a writing resource, not medical advice or a comprehensive exploration of seizures or seizure disorders.

Vocab

A seizure is a brief change in normal brain activity. Sometimes this is visible and sometimes not. They can last variable lengths of time and occur with varying frequency depending on the cause. They can be caused by epilepsy, trauma, illness, drug use, or any number of other factors.

Epilepsy is a general term for brain disorder characterized by frequent seizures. A person can have seizures without having epilepsy. Epilepsy is not a distinct diagnosis; there are many different types.

Epilepsy is diagnosed after a patient either has two seizures, or one seizure and an EEG that shows the potential for future seizures.

Again: If a person seizes more than once, they are medically defined as epileptic. A person can be diagnosed as epileptic after only having one seizure if their EEG shows potential for more.

Rescue meds are medications given to stop a seizure currently in progress.

Antiseizure drugs or ASDs, also known as anticonvulsants or antiepileptics, are drugs taken daily to prevent seizures from occurring. These are different from rescue meds.

Status epilepticus is a seizure that lasts longer than five minutes or having a seizure and then seizing again within five minutes without regaining full consciousness. Status epilepticus is extremely dangerous and can cause brain injury or death. Someone experiencing status epilepticus needs immediate medical attention. 

Generally speaking, serious intervention would begin before the seizure reached its fifth minute. If someone is seizing past four minutes with no sign of stopping, the people timing the seizure should not wait until five minutes to call 911, administer rescue meds, etc.

A seizure cluster is when a person experiences two or more seizures within a 24 hour period.

A nonepileptic event is an event that may look like a seizure but is produced by a different condition. Examples include ticcing due to Tourette’s or a heart arrhythmia causing a person to pass out suddenly.

Tonic refers to the muscles in the body becoming stiff.

Atonic means the muscles in the body relaxing.

Clonic refers to periods of shaking or jerking in parts of the body.

Myoclonic also refers to short jerking in parts of the body, but is generally more localized/occurring in a smaller area of the body.

Types of Seizures

I’m not going to go through every type of seizure, but I will go over some basics. This is massively simplified, and intended as a general writing resource, not technical or medical knowledge. Feel free to correct if I’m saying something wrong, or add detail.

Seizures are first divided into two overarching groups. Generalized seizures mean that excessive or unusual electric signals are being discharged across the entire brain. Focal or partial seizures mean that excessive or unusual electric signals are being discharged in one specific part of the brain.

Tonic-clonic seizures are the kind most commonly portrayed in media. They involve a total loss of consciousness and involuntary muscle contractions and shaking or jerking in parts of the body. This type of seizure may begin as a focal seizure or a myoclonic seizure (more on this later), but a tonic-clonic seizure is always generalized. Also - this type of seizure was formerly known as grand mal, but this is an outdated term and no longer used.

Myoclonic seizures are partial seizures, characterized by the sudden, involuntary twitching of a muscle or group of muscles. People retain consciousness during these seizures, but do not have control over their body or movements.

Atonic seizures, also called drop seizures or akinetic seizures, cause the sudden loss of muscle strength. They’re called drop seizures as they often (but not always!) cause a person to drop to the ground. A person experiencing an atonic seizure generally remains conscious.

Focal, partial, or absence seizures are seizures that do not involve the whole brain. They can involve repetitive movement like muscle jerking, but more often are characterized by being “frozen,” feeling “out of it,” or “staring into space.” It may be difficult for observers to tell that someone is seizing. This type of seizure was formerly known as petit mal, but this an outdated term and is no longer used.

Focal onset aware seizures, formerly known as “simple partial seizures,” occur when someone has a partial seizure and retains consciousness and awareness. Someone can look unaware and still be aware when experiencing this type of seizure. This type of seizure may involve feeling “frozen” or repeated small muscle movements.

Focal onset impaired awareness seizures, formerly known as “complex partial seizures,” occur when someone has a partial seizure and loses consciousness or awareness. This is type of seizure may involve feeling “out of it,” “staring into space,” or a loss of memory.

In describing a seizure (in modern-day America), the convention followed is seizure type, awareness level, and sometimes, where a seizure begins if it is a partial seizure. Thus, you get diagnoses like “Focal onset impaired awareness seizures arising from the temporal lobe,” “Focal onset atonic aware seizures arising in the frontal lobe,” or “General onset tonic-clonic seizures.”

These diagnoses are very wordy, and are sometimes shortened. Drop seizures or absence seizures are typically used as more casual terms. Also, as seizures generally begin in one of the four lobes of the brain, epilepsy is sometimes described by which lobe the seizures arise in (temporal lobe epilepsy, occipital lobe epilepsy, etc.)

Process of a Seizure

An aura is a feeling, sensation, or “warning” experienced by a person who is about to seize. Auras tend to present the same way over and over. Someone may not have auras, or recognize an aura as being a prelude to a seizure. Sometimes, an aura occurs and a seizure does not follow. Basically, there are no real rules with auras, but they are pretty common, and are generally not observable except to the person experiencing them.

Fun fact: people who have migraines also tend to have auras! It is believed that Lewis Carrol wrote Alice in Wonderland while experiencing a pre-migraine aura.

The ictal period refers to the experience of an actual seizure, when electrical activity in the brain is at its most intense. What a seizure itself looks or feels like depends on the type of seizures a person experiences, and y’all should conduct research into that for your characters.

Some people need rescue meds administered every time they seize. Others are only supposed to be given if they seize for a certain amount of time (longer than two minutes, for instance). Meds can be administered as nasal sprays, rectally, or tucked under the tongue or into the cheek. Rescue medications are only injected in hospital settings.

Remember that regardless of how often a character seizes or how long they’ve had epilepsy, seizing for more than five minutes, or multiple times within five minutes without regaining consciousness, is a medical emergency. Rescue meds should be administered and whatever medical intervention is appropriate for your setting should be immediately undertaken.

The post-ictal stage occurs after a seizure ends and lasts anywhere from five to thirty minutes. This is the period when a person is still experiencing after affects from their seizure, like confusion, drowsiness, hypertension, headaches, or nausea. Not everyone experiences post-ictal symptoms, and a person may continue to feel exhausted, irritated, or “out of it” more than thirty minutes after they seize.

Seizure Etiquette

Seizures can be surprising and very noticeable. A person that is seizing still deserves privacy. In your story, they should be given privacy, and good friends/teammates/co-characters could steer other people away or block them from being a public spectacle while they seize.

Do not have anyone put anything in a seizing character’s mouth. Ever. This is not necessary and can be dangerous, as a person can choke, or the person attempting to put something in their mouth could get accidentally bitten.

Do not restrain a person that is seizing. The character seizing or the character attempting to restrain them could get hurt, and the restraints are not going to be helpful whatsoever. Characters can move chairs or place cushions to keep a seizing character from hitting them; do not attempt to stop the seizing character’s body from moving how it will.

If necessary, the person seizing can be placed on their side, otherwise, do not attempt to move them.

If a non-epileptic character seizes, it is an emergency. Epilepsy can arise spontaneously at any age, but seizing with no prior history of seizures is a big deal, and the causes for a seizure need to be checked out to understand what caused it.

If your characters have access to medical knowledge and medical treatment, it would be realistic to have them time the seizure so that they know if a character needs rescue meds or has entered status epilepticus.

Rescue meds can be very, very expensive. A character will likely not receive rescue medication every time they seize, especially if their condition is largely stable.

It can be scary and emotional to watch someone seize. Feelings of fear and helplessness are common, especially if what’s needed is for characters to stand and wait to see if the seizing individual needs further help. It’s okay for your characters to feel that and react to that.

Things to Know

Epilepsy mostly presents in childhood and in people older than 60, but can arise at any age. Repeated seizures caused by an underlying condition (brain injury, tumors, strokes) are still considered epileptic seizures, and the person that has them, epileptic.

Repeating it once more: If your character seizes more than once, they are medically defined as epileptic.

The vast majority of seizures do not cause brain damage, or any other kind of damage. They can be frightening, distracting, inconvenient, upsetting, confusing - any number of things. But the vast majority do not cause physical harm, besides the bruises or scrapes that may come from muscle contraction or losing awareness.

Some seizures do cause brain damage. If you’re writing this scenario, please do some research into the type of seizure that would cause brain damage and what kind of brain damage that would be. Do not, for instance, have your character experience a tonic-clonic seizure and then come back in a wheelchair with no further explanation.

Sometimes, the muscle contractions of a seizure can cause spit or foam to collect around someone’s mouth. Sometimes, people bite their tongue, and this foam or spit can appear bloody. No internal injuries occur as a result of a seizure. Any bloody foam or spit is a result of a bitten tongue or cheek, and nothing more.

People who are seizing sometimes lose bowel or bladder control. This is not something they have any control over, but can still be embarrassing and is sometimes a reality of living with seizures.

In the United States, driving laws vary from state to state, but generally a person needs to be seizure free for a period of months (usually 3-6) before they are allowed to drive. The restrictions on driving commercially are much stricter.

Someone diagnosed in childhood may grow out of their epilepsy. Some estimates put the number of kids that will outgrow their epilepsy above 50%. If someone is seizure free for 2-5 years, they may begin to lessen their ASD dose, and may continue until they are no longer medicated at all.

Someone diagnosed in old age will not typically have a spontaneous remission of seizures.

Epilepsy can have a genetic basis or it can arise spontaneously. The fact that it can be passed from parent to child has been the basis of discrimination for a very long time. Be aware of this.

For much of human history, having epilepsy has been hugely stigmatized, and people with epilepsy have been routinely persecuted, particularly in the Western world under the banner of eugenics. As recently as the 1970s, many states were still forcibly sterilizing epileptic people. In writing a character with epilepsy, be aware that the diagnosis carries a heavy weight of stigma and painful history.

Though epilepsy and people who have epilepsy have long been stigmatized and persecuted, it has also long been regarded as a mystical illness, closely tied to spirituality and religion. In many places, people who have seizures are considered to be in religious ecstasy, having visions, or are chosen by higher powers. Consider the setting in which your story takes place and if this kind of thinking would realistically occur. Keep in mind that this view of epilepsy and seizures is not necessarily a positive thing.

Accessibility and Treatment

If you are writing a character who only seizes once (and the setting allows for it), proper treatment would consist of visiting whatever medical establishment exists in your universe, and monitoring or testing to determine the cause of a seizure and if another is likely to occur.

Even though your character is not going to seize again and does not have epilepsy, consider how the single seizure may affect your character. What did it mean to them to (perhaps publicly) lose control of their body or brain?

If your character does have epilepsy, their life will change or has always  looked different because of that epilepsy. For example, someone with epilepsy may not be allowed to drive, or may have never learned to drive. It is not safe for someone who has uncontrolled epilepsy to live alone. How would these considerations affect your character’s life and independence?

Think about how having seizures would apply to your character and your setting. Do they feel safe swimming? Spending significant time alone? Are there places that they avoid because it’s too dangerous to seize there?

In real life, people who experience tonic-clonic or atonic seizures often take precautions to ensure their safety should they have a seizure. People who have atonic seizures wear padded helmets to protect their heads. People who experience an aura may get themselves to a safe location, or adjust their surroundings so that they won’t hurt themselves while they seize. What precautions might your characters take to protect themselves?

Seizure triggers. Photosensitivity is a very common one, with flashing lights being especially dangerous for epileptic people. Some seizures have clear, specific triggers, while others seem to arise out of nowhere. Though it may be difficult to tell what exactly triggered a seizure, the modern Western medical establishment believes that all seizures have triggers, though the triggers may not be known. Triggers tend to be environmental cues that the central nervous system over-responds to, like the aforementioned flashing lights. A friend of mine has epilepsy that is triggered by anything coming directly at their face, like balls being thrown towards them. Once, a seizure was triggered by a butterfly flying directly at them.

Seizures can also be triggered by sounds, smells, or sensation, not just sight!

What might your character’s seizure triggers be? Your character may or may not know themselves, but if the triggers are known, how does your character avoid them, or plan their life around them? My friend’s seizure trigger meant that they couldn’t play ball sports, even casually, which kind of sucked. But having a seizure sucked more, so.

In terms of accessible spaces: The more open space, the better, and the softer the surfaces, the better. For instance, people who have seizures may prefer using an accessible bathroom stall, as they are larger, and the person seizing is less likely to become trapped or hurt themselves if they seize unexpectedly in the bathroom. What kinds of spaces does your character seek out, particularly if they are aware they might seize soon?

A properly medicated epileptic character may still have seizures. Medications are intended to control, shorten, and decrease total number of seizures. Sometimes they entirely eliminate seizures, but a person may still seize and that does not mean the medication isn’t working. A character who still seizes frequently and for long stretches of time likely is not properly medicated. Medications should be taken around the same time(s) every day for maximum efficacy.

Life changes, particularly puberty, can make medication less effective.

Proper medication is life-changing for people with epilepsy, and would likely be life-changing for your epileptic character as well. What does the process of getting medicated look like? How does your character feel upon being properly medicated? What in their life changes, and what stays the same?

Are there any drawbacks to being medicated? Side effects? Cost of medication?

If epilepsy is drug resistant, there are a few other options. I’m only going to discuss two, one because it has a long, fraught, and misunderstood history, and the other because it’s Trendy.

Brain surgery is an option for people/character with epilepsy. This is not the scary ice pick lobotomy of the 20th century. Brain surgery is a necessary tool to help epileptic people that are struggling with frequent, severe seizures that do not respond to medication, or when the side effects of medication are intolerable. Surgery can mean removing part of the brain (resecting), killing specific nerve cells where seizures start (lesioning), disconnecting the hemispheres of the brain (corpus callosotomy), or the implantation of a pacemaker-type device that uses electrical signals to block or disrupt seizures.

If your character is getting brain surgery for epilepsy in a contemporary, futuristic, or fantasy setting, please do your own research and ensure that the type of surgery they’re receiving fits their type of epilepsy and their need. Please frame the surgery accurately and avoid falling back on scary tropes about people coming back with different personalities, no personality, or dying in these procedures.

The last treatment option I’m going to discuss here is the ketogenic or keto diet. You may not be aware, but the diet was originally developed to treat children with epilepsy, and there is limited evidence showing that it does decrease or eliminate seizures in children. This diet is extremely high in fat and as low as possible in carbs. The majority of people who believe they are following a keto diet and are in ketosis (body and brain fueled by fat instead of sugar) are wrong. It is extremely difficult to follow a strict keto diet and is absolutely a major life change.

The diet would typically only be recommended for children between 2 and 12 whose epilepsy is resistant to medication.

Why or how the keto diet works to control epilepsy is not well understood. The fact that the brain is fueled by fat products known as ketones, rather than glucose, is thought to be related. If anyone knows more, feel free to contribute that knowledge.

Rethink

If your character gets brain surgery for their epilepsy, and that surgery is framed as negative, think about why that is. I absolutely understand the long, problematic, real-life history behind lobotomies, and I am not telling you not to explore that. Please do think hard about what beliefs you may have, and what messages you may be sending, about people who get brain surgery.

Characters with epilepsy that gives them visions or confers some kind of power. Yes, there are historical associations between epilepsy and religiosity, but remember the real world people who have epilepsy and how this framing may strike them. This is a common trope, so do a little introspection on what about this narrative is compelling to you and what messages you’re consuming and endorsing.

Seizures that occur to add intensity, drama, fear, or risk to the story. What are your characters afraid of? Why are they afraid of it? As always - what messages are you sending about seizures or the people who experience them? How would it feel to read your portrayal as a person who regularly seizes?

A character who seizes but does not have epilepsy. Related to the above - why is a seizure important to your story, but epilepsy is not a part of it?

A character who seizes twice but is not described as/does not identify with epilepsy. For one, this is medically inaccurate, which you should just be aware of. Secondly - what about this diagnosis is undesirable or unnecessary for your story? Why?

Write what you’re going to write, but understand why you’re writing it, and how it might be perceived. In particular, when writing about a complex, widely misunderstood, and stigmatized condition like epilepsy, understand what stigma you may be contributing to, what inaccuracies you may be presenting, and what complexities you may be ignoring, especially by having a character seize without being epileptic.

Resources

A lot of this is written based on my relationships with epileptic people and personal research. I don’t like to recommend media that I haven’t personally read/watched, just because then I don’t know what I’m recommending, but if anyone else has recommendations, please feel free to add them!

How Evan Broke His Head and Other Secrets by Garth Stein is contemporary novel about a Seattle man with epilepsy who is suddenly thrust into parenting a 14-year-old son he didn’t know existed. I read it a while ago and remember it being pretty good, but nothing special (no offense, Garth Stein). Worth noting that while the author is not himself epileptic, his sister does have epilepsy and he likely has better than typical knowledge of the condition.

The Spirit Catches You and You Fall Down by Anne Fadiman is a creative nonfiction book about a Hmong family, their epileptic child, and the medical saga they embark on as the American medical establishment attempts to treat their child. It is written about a real-life immigrant family and their daughter and was extensively researched over eight years, focusing on cultural differences, and xenophobia, racism, and misunderstanding in medicine.

This Podcast Will Kill You, which is free on Spotify, includes an hour and forty minute long episode diving into (some) of the etiology and history of epilepsy.

Maintenance Phase is a podcast that is also free on Spotify and has an episode about the keto diet. The main focus of the episode is the keto diet as it is used for weight loss, but it does include some fascinating backstory on the (invented) narrative that the keto diet is a secret that is being kept from the general public.

Please hit me up with questions, comments, corrections, or requests. Happy writing!

[cryiling]

Little Lineup I did of the Champions from Breath of the Wild

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every time i get on the revalink train, i end up thinking about the way revali says, "feel free to thank me now," and when link doesnt reply and the golden motes start to take link away for teleportation, he says, "or... never mind, just go." and he tells him to go way softer than his usual pompous tone. turns his back so he doesn't have to watch link leave as he says link's job isn't finished and then, "the princess," and revali PAUSES before he continues, "has been waiting an awful long time."

like, here is a haughty bird who got sooooo riled up bc he felt like link never acknowledged him, and then even after giving link the gift of his gale, revali doesn't get the thanks he wants, and instead of needling link about it like he might when they were all still alive and together, he just says never mind.

never mind, you never replied to me anyways (no matter how much i showed off or showed you up).

never mind, there are more important things to do (save the castle like you saved vah medoh--to avenge me?--and succeed where i failed).

never mind, the princess is waiting (and you were always too busy following after her to acknowledge me).

never mind, i'm already dead anyways. (what can i even do about any of this now?)

just go.

(you're already leaving. like always, she's already taking you.)

and then he reminds link of the princess in such a pointed manner that it's so easy to read into it. the princess... has been kept waiting--the princess is who you've always waited on, the princess is who we all died for, the princess might still be alive where i'm not. the princess tried her best, is still trying her best, and you have to go and meet her there because we cannot, and that has always been bigger than any feelings i might have ever held, any feelings i wanted to draw from you, any accolades i might have lauded or spurned, any reaction i might have gotten.

it's been 100 years, i can wait a little longer to help you (both of you) finish the job before going. guess i was wrong about... how lucky he would be.

revali's dead and he's still thinking about how much he thinks about link and feels the need to admit to himself (and to medoh) that he was wrong like aaahhhHHH i rotate his cutscenes over and over in my head like rotisserie chicken (lol).

[cryiling]

he makes me so happy and so profoundly sad at the same time

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No matter what a post on tumblr tries to tell you, your moral and ethical stances will never be determined by what you reblog and what you scroll past. Don’t let manipulation tactics force you into doing anything you don’t want to do.

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actually, I don't know how anyone else would apply this to their writing process, but something that's been working really well for me (<- adhd, focus issues) recently is writing at the piano so I can alternate between writing and practicing? I don't know, there's just something about writing a few lines/paragraphs/whatever until writing starts to feel unbearable, switching to the sequence I'm practicing and playing it through a few times (while the next lines simmer in the back of my mind), and then moving back to the writing when I'm ready that's kept me much happier and engaged than staring into space or attempting to muscle through?

again, not sure how this applies to people who don't play the piano exactly, unless there's maybe a similar activity that's not too engaging that you can switch in and out of easily? felt worth sharing, though

[cryiling]

she nothing on my nothing til i nothing. celibacy

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okay the last post i reblogged kind of brought this up but one of my more text-supported headcanons is that on his own, deku is bad at just about everything. like, his cooking ranges from mediocre to terrible (popular fanon). he can't dance. his social skills are abysmal (ex. that clip of mt. lady interviewing him). etc, etc.

which leads to the second, crucial part of this headcanon: when put into a situation where he has to do these things for other people, this ineptitude just about disappears. when he successfully makes candy apples, it's because they're for eri. when he improves his dancing skills, it's for the sake of his classmates and the school festival. when we see him be profound and comforting, it's because other people need him to tell them everything will be alright. and on the one hand i feel like this is indicative of his heroic spirit. on the other i feel like this is largely how deku kind of views himself: fundamentally worthless, and only useful so long as he can be used. compared with bakugou, who is always striving to improve himself for the sake of his goal, i notice that a lot of the time these same realizations don't kick in for deku until it's something someone else needs from him. character-wise, deku is a hero first and foremost, and a person second.

[cryiling]

[remembers suicide jokes are bad for my mental health] YOU should kill yourself

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"what a nerd lol" i said with barely controlled lust

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hnggggg bakugou katsuki. this is based off that one sunburned photoshoot

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“tik tok is brainrot I’m glad it’s getting deleted” YOU are ignoring an early warning sign of fascism bc silly dances and asmr annoys u. tik tok ban is a part of a MUCH bigger bill that indicates any foreign app, if deemed a threat, can be banned if the owner does not sell it. aka the government is mad bc they cannot censor & their capitalist puppet masters are mad they aren’t making money from it. and if ur ok w that……hm

[cryiling]

I find it so funny, in light of TikTok’s imminent American demise, that even now they aren’t considering moving to tumblr. The last two social media refugee crises (Twitter -> X and whatever happened with Reddit) prompted a wave of wide-eyed new baffled tumblr users to flood this app and yet last I heard all of the tiktokers are flooding en-masse a Chinese social media app. That is entirely in Mandarin. Instead of moving to tumblr.

[cryiling]

AITA for realizing that my best friend is actually a ghost and not telling him because i'm worried that if he realizes he's dead he'll finally be able to accept it and fully pass on and i won't be able to hang out with him anymore?

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Fantasy au BKDK! I had way more fun with this than i expected so I'll probably play with the au designs more in the future

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queen shit