Epilepsy and seizures: FAQ's and more

Introduction

Over the years I have been asked many questions relating to epilepsy.  The following blogs answer most of these "frequently asked questions".  It is a very extensive subject, as those who have seizures are individuals with unique brains and central nervous systems, so I am breaking it down into 3 blogs over the next 3 weeks.  Any questions, or if you are a professional and can add to this subject, please contact me on through the details at the end of this blog.

• What is epilepsy?
• What is a seizure?
• What happens during a seizure?
• Do all seizures have the same causes?
• Types of seizure
• How long do seizures usually last?
• What happens during a seizure?
• Can a person die from epilepsy?
• What is FIRST AID for seizures?

Having spent time at the National Hospital for Neurology and Neurosurgery, and Atkinson Morley Hospital for Neurology and Neurosurgery, albeit 20 years ago, it is a subject very close to my heart, and career, as this was where I first started my career, completed my neuroscience post grad degree, and took my first Sisters post all those years ago.  That said, much is changed in the world of neuroscience, and I'm proud to say these 2 hospitals have been at the forefront of that change.  So my research for this FAQ section is an honour for me to be able to share with you some of the information I've collected and is up to date and relevant today.  So here goes!

What is epilepsy and what is a seizure?

The easiest way to think of seizures, is a "short change in normal brain activity."  Source: (cdc.gov)  For a short period of time that person's electrical brain activity is in chaos!  Epilepsy is a condition characterised by recurrent unprovoked seizures (convulsions). A seizure can result from any cause or combination of causes.  When talking to first aiders about seizures, I always distinguish between what is a seizure, whether generalised, or focal; and when does it become epilepsy. 

Epilepsy is a chronic (long-lasting) medical condition marked by recurrent epileptic seizures. An epileptic seizure is an event of altered brain function caused by abnormal or excessive electrical discharges from brain cells. Epilepsy is one of the most common neurologic disorders, affecting up to 1% of the U.S. population. Source: (webmd.com)

What happens during a seizure?

Seizures have a beginning, middle, and end. Not all parts of a seizure may be visible or easy to separate from each other. Every person with seizures will not have every stage or symptom. The symptoms during a seizure usually are stereotypic (occur the same way or similar each time), episodic (come and go), and may be unpredictable.  Source: (brainline.org)

How long do seizures usually last?

Usually, a seizure lasts from a few seconds to a few minutes. It depends on the type of seizure.  

What happens during a seizure?

Seizures have a beginning, middle, and end. Not all parts of a seizure may be visible or easy to separate from each other. Every person with seizures will not have every stage or symptom described below. The symptoms during a seizure usually are stereotypic (occur the same way or similar each time), episodic (come and go), and may be unpredictable.  Source: brainline.org

Can a person die from epilepsy?

The short answer is yes, but while possible, death from epilepsy is also rare. 

When you hear of someone dying from a seizure, you might assume the person fell and hit their head. This can happen, and does.  I lost 2 patients in A&E from walking near a river without a "buddy" to keep them safe in case of a seizure, both fell in and drowned.

Each year there are 1.16 incidents of sudden death for every 1,000 people with epilepsy, according to the Centres for Disease Control and Prevention (CDC)

Source: (healthline.com)

Sudden Unexpected Death in Epilepsy (SUDEP)

For some people living with epilepsy, the risk of Sudden Unexpected Death in Epilepsy (SUDEP) is an important concern. SUDEP refers to deaths in people with epilepsy that are not caused by injury, drowning, or other known causes.1 Studies suggest that each year there are about 1.16 cases of SUDEP for every 1,000 people with epilepsy, although estimates vary.

Most, but not all, cases of SUDEP occur during or immediately after a seizure. The exact cause is not known, but these are possible factors

A seizure may cause a person to have pauses in breathing (apnoea). If these pauses last too long, they can reduce the oxygen in the blood to a life-threatening level. In addition, during a convulsive seizure a person’s airway sometimes may get covered or obstructed, leading to suffocation. 

A seizure may cause a dangerous heart rhythm or cardiac arrest. 

SUDEP may result from more than one cause or a combination involving both breathing difficulty and abnormal heart rhythm. 

Source: cdc.gov

First aid for seizures

These tips can help you help someone who is unconscious and making jerking movements:

• Protect the person from injury by removing any harmful objects nearby and cushioning their head.
• Loosen any tight clothing from around their neck.
• Look for any identity card or jewellery that might give you advice on what to do.
• Do not attempt to restrain the person or bring them round.
• Do not move them, unless they are in danger.
• Do not put anything into their mouth.
• After the seizure has finished, turn them on their side to help them breathe more easily.
• Do not give them anything to eat or drink.
• Be calm and reassuring, stay with them until they have completely recovered.
• Make a note of how long the seizure lasted.

Call 999 if:

• One seizure follows another without the person recovering in between.
• The seizure continues for more than five minutes.
• The person is injured or seems to need urgent medical attention.
• You think it is the person’s first seizure.

Source: stroke.org.uk

In addition

Call 999 or 112 if:

• The person does not awaken or have normal behaviour after a seizure
• The person had a seizure in water
• The person is pregnant, or has diabetes
• The person does not have a medical ID bracelet (instructions explaining what to do)
• There is anything different about this seizure compared to the person's usual seizures

Source: medlineplus.gov

NEVER forget, although this person is likely to be unaware of what is happening to them, ALWAYS maintain their dignity whenever, and wherever possible, and keep yourself and the casualty safe.

For more information, or to book a First Aid course with me, please go to my website at www.madeleysfirstaidplus.co.uk or Book a First Aid Course or phone me on 07508 834906.  Alternatively you can email me at enquiries@madeleysfirstaidplus.co.uk

Conclusion

Epilepsy is a condition where there are repeated episodes of abnormal electrical activity in the brain. There are many types of epilepsy, including generalized, focal, absence, myoclonic, and psychogenic. Generalized epilepsy affects both sides of the brain equally; focal epilepsy involves one part of the brain only. Some people experience only partial seizures while others have full ones. A tonic-clonic is a typical example of a full seizure, which is also known as grand mal. Other types include complex partial, simple partial, atypical absences, juvenile myoclonic, and gelastic seizures. These are just some examples of the most common types of epilepsy.

A tonic-clonic seizure is characterized by sudden muscle contractions followed by loss of consciousness, involuntary body movement, and sometimes vomiting.

A simple partial seizure begins suddenly and lasts for less than 15 minutes. During the attack, the patient loses awareness of his surroundings and may become confused. This type of seizure often occurs when the person is asleep. Simple partial seizures can occur alone or together with other types of seizures.

Absence seizures begin abruptly and last for several seconds to a few minutes. They are caused by an abnormality in the brain that causes the person to lose awareness of his surroundings. The person usually falls to the ground but remains conscious. He may appear dazed and unaware of what he is doing. It is important to know that these seizures are benign and pose no health risk. However, they can be frightening for the person who experiences them.

Myoclonic seizures are brief jerks of muscles. They are caused by nerve cells firing too quickly. Myoclonus can cause pain and discomfort and interfere with daily activities.

Treatment for epilepsy includes medication, surgery, and behavioral therapy. Medication is used to control seizures. Surgery removes parts of the brain that are causing problems. Behavioural therapy helps patients learn ways to cope with their seizures.

Medications used to treat epilepsy include anticonvulsants, benzodiazepines, barbiturates, and anti-epileptic drugs. Anticonvulsant medications work by reducing the number of seizures. Benzodiazepine medications reduce anxiety associated with having seizures. Barbiturate medications help decrease the frequency of seizures. Anti-epileptic drugs are prescribed to prevent seizures from occurring.

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