Epileptic Seizure Management at Home

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Seizure is a discrete event characterised by sudden, excessive and abnormal discharge of electrons in the brain that may be accompanied by an abrupt alteration in motor and sensory functions, and consciousness level of an individual. In layman’s term, generally all types of seizure are better known as “fits”.

Most seizures are sudden and transient. A part or all of the brain may be involved. Seizures are classified into two main types: partial seizures that begin in one part of the brain, and generalised seizures that involve electrical discharges in the whole brain.

Partial seizures are further sub-categorised into 3 types; ie. simple, complex or partial seizure with secondary generalisation. In simple partial seizure, one would present with jerking movement of body, muscle rigidity, spasm, head turning to the side, memory or emotional disturbance, and one may experience unusual sensation affecting vision, hearing, taste, smell and touch, or in other words, called auras.

In complex partial seizure, one may present with impairment in awareness level, lip smacking, chewing, fidgeting, walking or any other repetitive, involuntary coordinated movements. One seems to be out of touch and will be staring into space. In partial seizure with secondary generalisation, one evolves into loss of consciousness and convulsions.

Generalised seizures on the other hand are further sub-categorised into six types:
1) Grand mal seizure: One presents with unconsciousness, convulsions and muscle rigidity or body stiffening, after which one goes into a deep sleep. Injuries or accidents such s tongue biting and urinary incontinence may occur at this time.

2) Absence seizure: One experiences brief loss of consciousness; typically interrupting an activity and stares blankly.

3) Myoclonic seizure: Involves sporadic jerky movement of body and causing involuntarily dropping or throwing of object (if one happens to be holding some kind of object in their hand during this time).

4) Clonic seizure: One presents with repetitive rhythmic body movements.

5) Tonic seizure: Includes muscle stiffness and rigidity.

6) Atonic seizure: One faces sudden and general loss of muscle tone in the arms and legs, leading to fall incidence.

Basically in all types of generalised seizure, the person experiencing a seizure may initially cry out or make some sound before their body stiffens and rhythmic body movement occurs. This rhythmic body movement then slows down gradually before stopping completely. Their eyes are generally open or they present with uprollling of both eyes. The person may also turn blue. There may be periods of deep noisy breaths. Returning to consciousness level may be gradual. The person may appear confused for some time, not knowing what actually happened to them. Urine incontinence is very common with generalised seizure.

Of course there are still many other types of seizures known with bombastic medical terms and the lists goes on. Basically the common types are those as briefly discussed above. You may think what epilepsy really is then. Epilepsy is a group of syndrome characterised by recurring seizures. Epilepsy could have been caused by birth trauma, central nervous system infections, head injuries, metabolic and nutritional disorders, circulatory problems, toxicity from carbon monoxide and lead poisoning, brain tumors, brain abscesses or any congenital brain malformation. Cerebrovascular disease (or stroke) is the leading cause of seizures in the elderly. However, in most cases of epilepsy, the cause is unknown (idiopathic).

Be it whatever type of seizure, it is important to know what to do if you witness someone having a seizure attack right in front of you. The victim may be your loved ones, friends or even a stranger. When one experiences seizure attack, the victim is totally helpless as they cannot control what is happening to them and they are mostly unaware of the whole situation at that time. The victim may even be causing danger to him or herself without knowing.

One who witnesses a seizure attack may try to help the victim. However, the good Samaritan may actually end up doing more harm than good to the victim. It makes a difference when someone is around witnessing a seizure attack and knows what to do to prevent undesirable incidences.

So when someone suddenly collapses in front of you due to a seizure attack, here is how you should manage it: if the victim landed on the floor after a seizure attack and there are helpers around, you may carry the victim to the bed. The bed should be at the lowest position and any wheels should be locked to prevent any bed movement. If you are alone and are not able to carry the victim, then just leave the victim on the floor.

At the initial stage of a seizure where the patient starts having generalised jerky body movement:
1) Place a soft pad, folded cloth or a small pillow under the victim's head to prevent it from hitting a hard floor surface.
2) Loosen the victim’s constrictive clothing.
3) Push aside any furniture or objects nearby that may cause injury to the victim during the seizure attack.
4) Immediately turn the victim sideways with head flexed forward. This will allow the victim’s tongue to fall forward (making he airway patent) and promote saliva and mucous drainage.
5) During seizure attack, a victim is at risk for hypoxia (decreased oxygenation level), vomiting and pulmonary (lung) aspiration. By turning victim to side with head flexed, you can avoid all these risks at home.



CAUTION!:
Do not attempt to pry open clenched jaws of a victim experiencing spasm to insert anything into the mouth as you may cause injury to lips and tongues and the victim may end up having broken teeth. In fact, your finger may also get injured during the attempt as the victim may be biting the lips or tongue during the event.

It is a BIG MISTAKE to stuff any cloth packing into the victim’s mouth, thinking by doing this, you can avoid victim from biting his/her lips/tongue. From my my years of experience as a nurse, I have seen a mother stuffing a cloth rolled up like a ball into her child’s mouth during the seizure attack at home until she brought the child to hospital. The child’s mouth was totally occluded with the cloth. This was done as per the advice of her grand aunt. The child was subsequently admitted into the Intensive Care Unit as this action led to hypoxemia (decreased oxygenation level), which also caused imbalances in the child’s blood chemistry. That victim only survived 2 days post the seizure attack and the mother could not stop blaming herself for what she did.

Also, DO NOT attempt to restrain the victim with any sort of restrainers or cloth sheets. Just be beside the victim to ensure that the victim does not get injured by any other means. Muscular contractions tend to become stronger during a seizure attack. Therefore, restraining the victim can lead to further injury due to friction.

Remember to keep the victim faced sideways with head flexed in a forward position until the victim regains consciousness. There is usually a period of confusion after some seizure attack. A short apneic period (a period without breath) may occur during or immediately after a generalised seizure. Do not worry about this. Just remain with the victim and give verbal reassurance. The victim may not be able to hear you during his or her state of unconsciousness, but your verbal assurances can help the victim slowly regain consciousness.

As soon as the victim awakes, ask the victim where he or she is. Reorient the victim to the environment. The victim may be drowsy after waking up and may not remember events that had led up to the episode of seizure. If he or she appears agitated after an attack, use gentle persuasion to calm them down. Let the victim rest as he or she is most probably exhausted after the seizure.



Prevention of seizures:
Bear in mind that seizures are often triggered by many different factors. These factors can be physical, psychosocial, emotional, metabolic and electrolyte imbalances, medication and chemical effects, hormonal variations and environmental effects.

Some of the many triggers known to lead to seizures can include lack of sleep, alcohol consumption, stress, depression, anxiety, anger, pregnancy, ovulation, menstruation cycle, light flashing at a certain speed or the flickering of a computer monitor (in other words, photosensitivity), smoking cigarettes (nicotine in cigarette acts on receptors for the excitatory neurotransmitter acetylcholine in the brain which increases neuronal firing), overexertion of activities, fever, recent head trauma or injury, consuming excess caffeine and sugar intake, dehydration, hyperventilation, low blood levels of glucose, sodium, calcium, and magnesium, sedative agent withdrawals or alcohol withdrawal syndrome, consuming any over the counter drug without proper medical advice, particular smell or odors and even certain types of music.

By avoiding triggers, one can possibly avoid having an attack.



Author: Sudha Karuppiah

Copyright © 2012 Sandhya Maarga Holistic Living Resources
Holistic Living Annex (JULY 2012)

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