Seizure
Seizure
Seizure
EPILEPSY
SEIZURES
&
FIRST AID
CONTENTS
Explaining seizures What is a seizure? How are seizures diagnosed? Can tests confirm that a seizure occurred? Blood tests Electroencephalogram (EEG) EEG Ambulatory Monitoring EEG/Video Monitoring Computerized Tomography (CT) Magnetic Resonance Imaging (MRI) Electrocardiogram (ECG) Holter Monitor Loop Monitor Tilt Table Monitor 04 04 04 05 06 06 06 06 06 07 07 07 07 07 08 08 10 11 11 13 13 14 14 15 16 17
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Seizures
are not uncommon and they can occur for the first time at any age. Up to 10% of the population will have a seizure at some time. Approximately 50% of people who have a seizure will not have another. For people at risk of recurring seizures, 60-70% can expect seizure control with medication.
Isnt a seizure and a convulsion the same? What are the different types of seizures? Why do seizures occur? Will there be more seizures? What is the difference between seizures, epilepsy and seizure disorder? Is there treatment for seizures? Is treatment usually prescribed after one seizure? Can all doctors treat seizures? Is it common to feel exhausted or anxious after a seizure? Are seizures dangerous? Who can provide information about seizures? What is the first aid for seizures?
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Explaining seizures
A person who has an unexplained collapse, 'blackout' or 'turn' is usually anxious to know why this happened, but the reason is not always easy to find. Medical tests or a visit to a specialist may be recommended and time can pass before a diagnosis is made. Many people feel that something serious must be wrong and may be surprised to learn that they are quite well. Others feel that too much fuss is being made and may be shocked to learn that they may have had an event such as a seizure. It is common for people to feel confused and uncertain about their health under these circumstances. This booklet answers some frequently asked questions. If a stranger witnessed the event, a written description or a phone number for the doctor to call can be helpful. Tests may be arranged, and these will vary depending upon the doctor's initial assessment. They may include blood tests, an EEG [electroencephalogram], a CT scan [computerized tomography] or an MRI [magnetic resonance imaging]. Sometimes it is very clear why a person has experienced a collapse or 'blackout'. But occasionally, even after all the appropriate tests and a thorough examination of the person's medical history, it is still not possible to make a definite diagnosis. This can be frustrating. Often it is a matter of simply waiting for a definite answer. More events may allow a clear diagnosis, or a further test may provide an answer. It is better to be a little uncertain rather than to jump to conclusions and make a wrong diagnosis.
What is a seizure?
The brain controls the bodys actions, sensations and emotions through nerve cells that carry messages between the brain and the body. These messages are transmitted through regular electrical impulses. A seizure occurs when sudden bursts of electrical activity in the brain disrupt this pattern. The kind of seizure and the parts of the body affected by it relates to the part of the brain in which the irregular electrical activity occurred. Seizures can involve loss of consciousness, a range of unusual movements, odd feelings and sensations, or changed behaviour.
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Electroencephalogram (EEG)
EEG records small electrical signals from the brain onto a computer or paper. Small discs, called electrodes, placed on the scalp with temporary glue, pick up the electrical signals and pass them along wires to the EEG machine. Recordings take about 20 minutes, while patients rest or sleep. At times, patients are required to open and close eyes, breathe deeply or look at flashing lights. EEG tests are safe, painless and do not give electric shocks. For best results, hair must be clean and dry, with no hairspray, mousse, gel or oil. Sometimes, the doctor will request a 'sleep-deprived' EEG and the patient is asked to restrict sleep the night before the test. In drowsy patients, the EEG can occasionally provide additional information.
Electrocardiogram (ECG)
An electrocardiogram measures the electrical activity of the heart. Sensors called electrodes, which detect the electrical currents, are attached to the chest, arms and legs with suction cups or gel. The information is recorded on a screen or paper. The test is safe and non-invasive.
Holter Monitor
A holter monitor is used to carry out an ECG over an extended period. Electrodes are attached to the body with adhesive patches and connected to a small recording device which is worn over the shoulder or on a belt. Holter monitoring may uncover a cardiac rhythm problem which only occurs occasionally or at certain time of the day or night.
EEG/Video Monitoring
Sometimes, it is useful to perform an EEG over an extended period while the patient is monitored by a video camera. If an episode occurs and is recorded, the doctor can view a video of the event and a simultaneous EEG recording of the brain's activity. Video monitoring is performed in hospital as a day procedure or over several days.
Loop Monitor
The Loop monitor is a small device about the size of a matchbox which can be inserted under the skin in the chest area to record heart rhythms over weeks or months. The insertion of the monitor is a short surgical procedure carried out under local anaesthetic.
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Complex partial seizures This type of seizure also affects only one part of the brain but the persons conscious state is altered rather than lost. The person may often appear confused and dazed and may do strange and repetitive actions like fiddling with their clothes, making chewing movements or uttering unusual sounds. These behaviours may also be described as trance-like or robot-like and are called automatisms. The seizure usually lasts for one to two minutes but the person may be confused and drowsy for some minutes to several hours afterwards and have no memory of the seizure or the events just before or after it. This type of seizure can be mistaken for drug/ alcohol-affected behaviour or psychiatric disturbance. At times complex partial seizures can spread to become secondarily generalized seizures.
Seizures which begin in one part of the brain can spread to both sides of the brain to become secondarily generalized seizures.
Seizures which involve both sides of the brain at once are called primary generalized seizures.
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Tonic seizures Tonic seizures greatly increase normal muscle tone and the body, arms, or legs make sudden stiffening movements. These seizures most often occur in clusters during sleep, although they can occur when the person is awake. If the person is standing they will fall quite heavily, often injuring their head. Protective headwear may avoid injury. Seizures usually last less than 20 seconds. Tonic-clonic seizures [ previously called grand mal seizures] During a tonic-clonic seizure a persons body stiffens, air being forced past the vocal cords causes a cry or groan, and they fall to the ground [the tonic phase]. Their limbs then begin to jerk in strong, symmetrical, rhythmic movements [the clonic phase]. The person may dribble from the mouth, go blue or red in the face, or lose control of their bladder and/or bowel as the body relaxes. As consciousness returns, the person may be confused, drowsy, agitated or depressed. They may have a headache and want to sleep. This drowsiness can last for a number of hours. Although this type of seizure can be frightening to watch, the seizure itself is unlikely to seriously harm the person having the seizure. They may, however, vomit or bite their tongue and can sometimes injure themselves if they hit nearby objects as they fall or convulse. Tonic-clonic seizures generally last 1 to 3 minutes. If the active movements of the seizure last more than 5 minutes it is advisable to call an ambulance. Prolonged seizures, or a series of seizures without a normal break in between, indicate a dangerous condition called convulsive status epilepticus and demands emergency treatment.
I had my first seizure at 32 in a restaurant. Having seizures made me feel like my world was falling apart. I had no idea what it would mean for my life. But there was treatment for me and now Im OK.
Mark
seizure type/types and their severity and frequency, the age of onset, the causes of the seizures and whether there is a familial link, the part of the brain involved, electroencephalograph (EEG) activity, seizure provoking factors, and the presence of other disorders in addition to seizures.
By understanding the nature and presentation of a particular syndrome the treating doctor can implement the most appropriate form of treatment and may be able to predict whether seizures will lessen or disappear over time.
I was cutting a clients hair when I had my first seizure. Having one in public was embarrassing and it really affected my self-confidence. What was very helpful was finding health care workers who actually understood not just the seizures but also the personal emotions that a seizure can trigger.
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Candi
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Seizures often happen without any pattern, so it can be frustrating for people to take tablets when they do not have frequent seizures. Where there is uncertainty and medication is recommended, people can be unsure about whether they really need to keep taking tablets. But epilepsy is a silent disorder. You may feel perfectly well for months between seizures, unless they occur in clusters, but this does not mean the epilepsy is cured or is gone. Some people find it helpful to think of their medication as an 'insurance policy' as even one seizure carries risks, especially while driving, or in water, or handling machinery. Taking medication is a personal choice, and patients are encouraged to discuss any concerns with their doctors to ensure that they have a good understanding of why treatment is recommended for them. Any side effects that are thought to be a result of the medication should be discussed with your doctor or epilepsy counsellor. Sometimes the medication can be carefully switched to avoid unwanted side effects.
I had my first seizure, in class, in Year 7 and I was soon diagnosed with focal seizures. Even though the medications slowed me down a little in the early stages, I was determined to not let this stop me from getting on with my life.
Maree
Because a witness to a seizure can describe what happened, it can be advantageous for the patient to take that person along when they visit the doctor. Having a companion can also be helpful to the patient if the doctor is giving a lot of information that might be hard to remember, or if the person is feeling anxious about the experience. If a patient prefers privacy or independence, the companion can leave the room once the doctor has heard the description of the event. Having to stop driving for a period of time after a seizure can create pressure on employment, family, social and educational arrangements. People often feel frustrated and angry, and they may become depressed. Seizures can, in themselves, cause varying degrees of depression. Antiepileptic medication can sometimes help with the depression, but not always. Speaking with an epilepsy counsellor can help identify issues and explore ways these concerns might be managed. Many people wonder if they really had a seizure and think the diagnosis may have been wrong. These reactions are common. Everybody wants to find answers quickly and get back to a normal life.
There are laws about driving after seizures. Generally, people who have had a seizure are required to notify the local licensing body and stop driving until a medical report has been supplied. Most people who have had seizures do get back to driving, but the length of time that a person must stop driving varies among individuals. Swimming alone is not advised and showers are recommended instead of baths. Special care also needs to be taken when using hot water or items that can cause burns. Turning on the cold tap first in the shower, bath or basin, and lowering the temperature of the hot water service are good safety hints for any home. Showers and baths and running water in any context, appear to be conducive to seizures in some people. A precautionary measure is to take medication first thing in the morning, 20 30 minutes before taking a shower. Although many people who witness a seizure fear that the person may be harmed, especially by a generalized convulsion, the risk of brain damage or death from a seizure is low. A person is at most risk of harm if they are doing something dangerous, such as driving, when a seizure occurs. Ensuring that seizures are correctly diagnosed, that treatment plans are followed and that first aid information is available, minimizes risks. You may hear about a phenomenon called SUDEP [Sudden Unexpected Death in Epilepsy] which is the name given to deaths that unexpectedly follow some seizures. You need to remember that deaths occur with many illnesses, from influenza to asthma. While we do not want to side step the truth that recurring seizures or epilepsy can cause death, we need to emphasize that it is uncommon and that working to control any illness is the best way to minimize risk.
Tonic-clonic seizures
A convulsive or tonic-clonic seizure starts when someone loses consciousness, stiffens unexpectedly, falls to the ground and starts jerking. Time the seizure. Protect from injury remove any hard objects from the area. Protect the head place something soft under their head and loosen any tight clothing. Gently roll the person on their side as soon as it is possible to do so and firmly push the angle of the jaw forward to assist with breathing. A person cannot swallow their tongue but the tongue can move back to cause a serious block to breathing. Stay with the person until the seizure ends naturally and calmly talk to the person until they regain consciousness, usually within a few minutes. Reassure the person that they are safe and that you will stay with them while they recover.
Do not restrain the persons movements. Do not force anything into the mouth. Do not give the person water, pills or food until they are fully alert. After the seizure, the person should be placed on their side. Keep in mind there is a small risk of post-seizure vomiting before the person is fully alert. Therefore the persons head should be turned so that any vomit will drain out of the mouth without being inhaled. Stay with the person until he/she recovers (5 to 20 minutes).
In the event of a seizure follow instructions in the individuals seizure care plan. However if you do not know the person, or there is no seizure care plan:
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Absence Seizures
An absence seizure causes loss of awareness and responsiveness for a brief period. The person stares vacantly, the eyes may drift upwards and flicker. It may be mistaken for daydreaming. Recognize that a seizure has occurred, reassure the person and repeat any information that may have been missed.
Prepared for Epilepsy Australia, the national coalition of community based epilepsy associations. Published by the Epilepsy Foundation of Victoria. Tel: +61 3 9805 9111 Email: epilepsy@epilepsy.asn.au Consultant group Rosemary Panelli, Denise Chapman, Russell Pollard, Professor Frank Vajda, Professor Mark Cook, Professor Terence OBrien, Mark Green, Helen Whitehead, Jacinta Cummins, Maree Kearton. Disclaimer This brochure provides general information about seizures. It does not provide specific advice. A diagnosis of your medical condition and treatment advice should be obtained from an appropriate health professional. The Epilepsy Foundation of Victoria December 2009
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