Scenario: A 19 year-old female soccer player suddenly comes to a stop and wears a vacant stare on her face for a few seconds quickly followed by a collapse. The athlete first presents with stiffened arms and legs and abruptly begins convulsing. Once coming to a cessation after a minute the player seems tired and confused. What are your steps as a health care provider, friend, parent, or coach before, during, and after this event? Would you be able to provide the correct initial care for this athlete?
A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex1. With the exception of few cases, seizures are easily managed. In cases where victims have multiple episodes, a health care provider may diagnosis them with a disorder called epilepsy. Epilepsy is a disorder that affects the brain’s electrical system, whether it is a portion of it or the entire brain. A seizure, which is brief electrical changes in the brain, results in temporary changes in movement, behavior, sensation, or awareness. These episodes can last from only a few seconds to several minutes. Two or more episodes for one person normally puts them in the category of epileptic.
There is a beginning, middle, and end to a seizure. In some cases a seizure victim may be aware of the forthcoming episode. Telling signs may be deja vu, smell, sound, taste, visual loss or blurring, racing thoughts, strange feelings, dizziness, headache, etc. Go to http://www.epilepsy.com/101/EP101_symptom for a complete list of sensations that are common with seizures. This moment of foreshadowing is termed the aura. Although a few may have the fortune or misfortune of sensing an oncoming seizure, there are also cases where there is absolutely no warning.
The middle portion of the seizure may appear in many different forms. In the case of those who experience auras, the warning signs may continue or possibly transition to a complex partial seizure or the most easily recognized generalized tonic-clonic seizure, formerly grand mal seizure.
Following the middle period of the seizure is the postictal (ictus means seizure) period. This marks the beginning of the recovery of the brain. Which part of the brain and whether or not the victim was currently on anti-seizure medication are deciding factors on how long this period will last which could be anywhere from a few seconds to hours.
Neurologists are still working on classifying the different types of seizures. Two main categories are used by these specialists and they are partial seizures and primary generalized seizures. Primary generalized seizures, as the name implies, affects both sides of the brain. As mentioned earlier the most recognizable primary generalized seizure is the tonic-clonic seizure. Partial seizures stem from an electrical discharge in a specific area of the brain which could be caused by a range of conditions including head injury, brain infection, stroke, or tumor2.
If you are faced with the unfortunate circumstance of being present during a seizure here are some steps to take to ensure safety for yourself and the victim3,
- Time the seizure with a watch.
- Clear the area of anything hard or sharp.
- Loosen anything at the neck that may impair breathing.
- Turn the person on his or her side.
- Put something soft beneath the head.
- Do not place anything inside the mouth.
- Call 911 if a seizure lasts more than 5 minutes, recurs, or the person is pregnant, injured, or diabetic.
If you or a friend is a first time seizure victim, medical help should be sought. Electroencephalogram (EEG), CT, and MRI scans may be used by the physician to better understand what type of seizure the patient had suffered from a possibly the cause of the episode (although many times is unknown). There are anti-seizure medications that are prescribed on a daily basis to epilepsy patients. Two-thirds of people taking these medications become seizure-free. A much more conservative route is the implication of a Ketogenic diet in children with epilepsy. This diet causes the body to burn fat instead of sugar because it is very high in fat and low in carbs. As a result, changes are made in the brain that reduce the likelihood of seizures. In the case of partial seizures, surgery can be utilized to treat the condition. If the before mentioned diagnostic tools yield an underlying cause to the seizures, the specific part of the brain causing the episodes can be removed.
Amidst the frightening signs and symptoms of this condition, patients are still able to live active lives that are normally seizure-free when medications are taken. Research is currently being done on the use of seizure dogs. It is thought that some dogs can sense a seizure before it even begins. In the case of a child these dogs could give warning to parents and also be trained to lie next to the child during the seizure to ensure safety. Although man’s best friend is great, we still recommend you seek further medical attention from a physician if you are not diagnosed with epilepsy and experience one of these episodes.