Dealing with Epilepsy and Seizures

A person diagnosed with epilepsy has a tendency to have recurrent seizures (fits) that arise from a disturbance in the brain. This chapter does not only deal with patients who are diagnosed with epilepsy however, because one person in 20 will have a seizure at some point in their lives.

There are many causes of seizure (including epilepsy), such as hypoxia, stroke, head injury or even the body’s temperature becoming too high.

Babies and young children commonly suffer seizures from becoming too hot due to illness and fever. This is covered in the topic ‘febrile convulsions’.

Minor Seizures

Minor epilepsy is also known as ‘absence seizures’ or ‘petit mal’ seizures. The patient may appear to suddenly start day dreaming (even mid sentence). This may last just a few seconds before recovery, and the patient might not even realize what has happened. Sometimes a minor seizure may be accompanied by unusual movements, such as twitching the face, jerking of an individual limb, or lip smacking. The patient may make a noise, such as letting out a cry.

Treatment of minor seizures

• Remove any sources of danger, such as a knife or hot drink in their hands.
• Help the patient to sit down in a quiet place and reassure them.
• Stay with the patient until they are fully alert.
• If the patient is unaware of their condition, advise them to see a doctor.

Major Seizures

This type of seizure results from a major disturbance in the brain, which causes aggressive fitting, usually of the whole body.

Witnessing a major seizure can be frightening for the first aider, but calm, prompt action is essential for the patient.

Possible signs and symptoms

A major seizure usually goes through a pattern.

Aura

If the patient has had seizures before, they may recognise that they are about to have one. The warning sign may be anything from a strange taste in the mouth, a smell, or a peculiar feeling. The aura may give the patient chance to seek help, or simply lie down before they fall.

‘Tonic’ Phase

Every muscle in the body suddenly becomes rigid. The patient may let out a cry and will fall to the floor. The back may arch and the lips may go blue (cyanosis). This phase typically lasts less than 20 seconds.

‘Clonic’ Phase

The limbs of the body make sudden, violent jerking movements, the eyes may roll, the teeth may clench, saliva may drool from the mouth (sometimes blood-stained as a result of biting the tongue) and breathing could be loud like ‘snoring’. The patient may lose control of the bladder or bowel.

This phase can last from 30 seconds to hours, although most seizures stop within a couple of minutes. Any seizure (or series of seizures) lasting more than 15 minutes is a dire medical emergency.

Recovery Phase

The body relaxes, though the patient is still unresponsive. Levels of response (page 9) will improve within a few minutes, but the patient may not be ‘fully alert’ for 20 minutes or so. They may be unaware of their actions and might want to sleep to recuperate.

Treatment of major seizures (fitting)

During the seizure

• Help the patient to the floor to avoid injury if possible.
• Gently cushion the patient’s head to help avoid injury.
• This can be done simply with your hands or a folded coat.
• Loosen any tight clothing around the neck to help the patient breathe.
• Move any objects from around the patient that may harm them and ask bystanders to move away.
• If you are concerned about the Airway, roll the casualty onto their side.
• Take note of the exact time the seizure started and its duration.
• Look for identification if you don’t know the patient.

Dial 999 for an ambulance if

• The seizure lasts more than 3 minutes.
• The patient’s levels of response don’t improve after the seizure within 10 minutes.
• The patient has a second seizure.
• The patient is not diagnosed as epileptic or this is their first seizure.
• You are unsure.

As soon as the seizure stops

• Check Airway and Breathing. Resuscitate if necessary.
• Place the patient in the recovery position.
• Keep the patient warm (unless temperature caused the seizure) and reassure them.
• Monitor Airway and Breathing.
• Move bystanders away before the casualty awakes and protect modesty.
• Check the levels of response regularly. Dial 999 if they don’t improve within
  10 minutes (or for any of the reasons mentioned above).

NEVER place anything in the casualty’s mouth (especially your fingers!).
NEVER try to hold the patient down or restrain them.
NEVER move the casualty (unless they are in danger).

Febrile convulsions

In young children and babies the area of the brain that regulates temperature (the hypotha/amus) is not yet fully developed. This can lead to the core temperature of the body reaching dangerously high levels and commonly a child in this situation may fit.

A febrile convulsion can be very frightening for the parents of the child. During the ‘tonic’ phase of the fit the child may stop breathing, because the diaphragm goes rigid, and the lips and face may go blue (cyanosis). It goes without saying therefore, that calm reassurance will be necessary.

The child may have been unwell over the past day or so and will be hot to touch.

Treatment of febrile convulsions

• Remove clothing and bedclothes. Provide fresh, cool air to cool the child down. Take care not to cool the child too much.
• Place the child on their side if possible to protect the Airway.
• Remove nearby objects and use padding to protect the child from injury whilst fitting.
• Pay particular attention to protecting the head.
• Dial 999 for an ambulance.
• If the child is still fitting, sponge them with tepid water to help the cooling process, but take care not to cool them too much.
• Constantly monitor Airway and Breathing until the ambulance arrives.