Seizures and Epilepsy: Frequently Asked Questions James A Whitlock, Jr, MD, Northeast Rehabilitation Health Network (page 2 of 4) Page 2 of 4

The true "petit mal" seizure type (also known as "Absence Attacks" or technically, "Primary Generalized Seizures - Absence Type") is observed almost exclusively in children. It is mentioned in this section only to assist in the campaign for accurate terminology.

Absence seizures are characterized by abrupt and brief interruption of consciousness without convulsion. During the typical, seconds-long episode there is "loss of contact", "spacing out" rarely with chewing, swallowing, or blinking automatisms. Sometimes an individual continues doing whatever they were doing at seizure onset, though in an automatic way. During the episode, interaction is not possible. These episodes can be very brief, subtle and easily missed by a nearby observer. Normally, whatever activity a child was engaged in before the seizure is continued following it. Sometimes children with these seizure types are misdiagnosed with learning or behavioral problems.

There are a host of seizure types which are seen only in children or infants.

If I see someone having a convulsion, what can I do?

First, what NOT to do

1 DO NOT TRY TO PUT ANYTHING IN THE PERSONS MOUTH;

• There is no place for the "tongue blade" at the bedside or in the home. In fact, it is dangerous. Many sticks, teeth, and other things have been broken by persons attempting to prevent "swallowing of the tongue". The same applies to fingers - never place anything in the mouth of a person who is actively seizing/convulsing.
• It is sometimes appropriate to place an oral airway after the seizure has ended, but only if you've been trained in its use (and there happens to be one present). There is another way to deal with the airway during the profound sleepiness which sometimes follows a seizure -- (read on).

2 DO NOT TRY TO RESTRAIN THE CONVULSING LIMBS;

• Soften the surface, remove obstacles/furnishings, get the person to a safe spot, cushion head with your hands, YES. Restrain, NO.

3 IF A PERSON KNOWN TO HAVE 'CONVULSIVE' EPILEPSY SHOWS A COLOR CHANGE TOWARD BLUE IN FACE, LIPS, NAIL-BEDS AT THE ONSET OF A SEIZURE- COUNT TO 60;

• The cyanosis (bluing of lips, nails, skin) that may accompany what in essence is a brief "respiratory arrest" at the beginning of a convulsion is caused by contracted and 'stuck' respiratory muscles. It is not something that can be altered by any bystander/caregiver. It should pass relatively quickly, with improvement in color as the convulsion proceeds.
• If the above state lasts beyond a minute, OR if it is followed by relaxation (instead of convulsive movements) with persistent bluish color, it would probably be wise to assume that this IS a respiratory arrest and NOT a seizure. [In which case the proper response would be Basic Life Support].

4 DO NOT ATTEMPT TO GIVE THE PERSON MEDICATION/FLUIDS WHILE THEY ARE NON-INTERACTIVE;

• The person should be talking before any attempt is made to give anything by mouth.

Now, what TO do. (Sometimes the most important things are the simplest)

• Especially if this is the first seizure you've ever witnessed, or if you don't know anything about the person's medical history, feel for the carotid pulse. Feeling this should provide the necessary reassurance that the individual is not experiencing a cardiac arrest. Hopefully, you can relax enough to remember the following tips -
• Create the safest possible environment for the seizure. Position away from objects which threaten injury. Provide a soft surface, if possible. Cushion head with hands to prevent banging of head against the ground/floor.
• As the seizure ends and a state of deep relaxation ensues, place the person in the "recovery position" (as illustrated below).
• Never should the individual be left flat on their back - that position invites airway obstruction (by a relaxed/swollen tongue dropping to the back of the throat, blood from a bitten tongue, or vomitus). If, after positioning the person as illustrated there is any sign of ineffective breathing (loud snoring type sound, little/no air moving to/from mouth/nose), ensure that there is nothing in the mouth by sweeping your finger through, removing any debris as you do so [NOTE WELL- The seizure has stopped at this point and the person looks as if deeply asleep]. If there are dentures, this is the time to remove them. If after doing the foregoing there is still a loud snoring sound, try extending the neck a bit more. Other options to help open the airway include use of an oral airway or a performance of a "jaw thrust maneuver" (illustrated here).
• Recovery should proceed over minutes, though significant fatigue is likely. If there has not been any injury (eg.- no significant cuts to skin or tongue or concern regarding injurious effects of a fall to ground/floor), the person should be allowed to fulfill their desire to rest.
• Seek medical/hospital treatment if their is any concern about significant injury or if this is the individual's first seizure.

A couple of unusual situations

[Author's note: I doubt that it would be possible to address every contingency pertaining to responses to seizure in any document - even in the ultimate hyperlinked Web-work. Hopefully, the most common scenarios will ultimately be well addressed in these pages.]

There are a couple of unusual circumstances that are worth noting, especially because awareness can have a major impact upon outcome in particularly dangerous situations.

From the Northeast Rehabilitation Health Network. Reprinted with permission. All rights reserved. www.northeastrehab.com.
 

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