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James A Whitlock, Jr, MD, Northeast Rehabilitation Health Network (page 3 of 4) Page 3 of 4
- Concern about possible neck injury in fall during a seizure. Fortunately, it seems to be remarkably rare for serious injuries to accompany seizures. Still, occasionally the fall at seizure onset is a hard drop to a hard surface. Especially in medical settings, such an occurrence tends to reflexively result in taking extra precautions with respect to possible neck injury. This means applying traction to the head in such a way as to minimize flexion/extension movements, especially after the convulsion ends. There is still a need to move the person into the recovery position, the difference being that someone has to continuously hold the head in such a way as to keep the spine straight. This can pose a bit of difficulty for one attendant if the person who had the seizure is having difficulty breathing. This situation calls for a "jaw thrust", with the caveat that the neck should not be extended.
- Seizures which are prolonged or which occur one after another... are a special circumstance in that they may hurt the brain. Emergency medical attention should be sought immediately.
What observations about a seizure (or what I think was a seizure) might be important to my physician?
The observations of a witness are generally key to diagnosing the various forms of seizure and in distinguishing seizures from episodes that can be confused with them (such as faints, various forms of tremor, and a host of unusual causes of episodic behavioral phenomena). While patients can often provide key information (or all the information necessary when there is no interruption of consciousness), a witness/observer is the only one who can provide the information which leads to an accurate diagnosis. Specific observations have particular relevance depending upon the whether this is a person's first seizure, a recurrent seizure or an episode differing from past seizures.
In general, it might be good to write down your observations soon after the episode while memory is fresh, using the following as a guide. [Some questions would best be directed to the person who had the episode, others to a witness].
First Seizure
- What was the person doing immediately before the episode?
- Has there been any traumatic loss of consciousness in the recent (or remote) past? [Be able to provide details]. Has there been any recent illness (fever, "flu")?
- Did the person seem to have a feeling that something was about to happen before the episode? Was it even more specific than a 'feeling'?
- As the seizure began, what did you see first? Was there any color change in skin, lips or nail-beds? Were there movements of eyes to one side? If so, which side? Did one side of the face twitch before the other? Did one limb start jerking before another? [In general, if any movements or postures were seen more on one side than another, it can be helpful to know which side did what.]
- In non-convulsive episodes, a description of exactly what the person did/said during and shortly after the episode would be helpful. Note the duration of the spell; between onset and resolution of any confusional period which follows.
- Was there passage of urine? of stool? Any vomiting?
- Was there any bleeding in the mouth?
- How long did the jerking part of the episode last?
- After the episode, what did the person do?
Recurrent Seizure
- Did this seizure look the same as prior ones?
- Was it longer or shorter than average?
- Have there been any recent medication changes or missed doses of medication?
- Has there been any recent change in sleep habit (eg.- up all night preceding the day of the seizure)?
- How much (if any) recent alcohol, caffeine, marijuana, or cocaine has been used? When was it last used in relation to the time the episode/seizure happened?
- Are there any new medications (prescription or non-prescription) being taken? Any herbal remedies?
- Have there been any unusually stressful events in life recently?
- Has there been any major change in weight since the last seizure? [Occasionally, a significant weight change may be associated with a change in blood anticonvulsant level in an individual who had long shown a stable blood level].
Recurrent Seizure, but Different from Previous Seizures
In addition to answers to questions, from the above section ("Recurrent Seizure") please consider the following:
- Exactly how was the episode different from previous ones? Was there a different 'warning' or "aura"? Did the spell involve a different part or side of the body? Did it start differently?
- Has there been any recent illness, new symptom of a possible illness? Any recent injury - especially blow to the head?
"Should an extra dose of anticonvulsant be given as soon as possible after a seizure?"
In someone who is taking anticonvulsant/anti-epileptic medication, a "breakthrough" seizure may be a sign of a blood anticonvulsant level which has fallen too low. But occasionally (uncommonly) a seizure can be a manifestation of toxicity from too much anticonvulsant in the system. Thus, unless there have been prior directions from a physician covering this contingency, or it is known that a scheduled dose of medication was missed, it is probably most wise to seek direction from your physician/neurologist before giving any extra medication.
"I haven't had a seizure in years but I still take medication to prevent seizures. Am I supposed to take this for the rest of my life?"
It is easier for a physician to provide well-grounded advice regarding starting an anticonvulsant when a seizure disorder has developed or when a person is at unusually high risk for having seizures. Providing advice regarding when to discontinue medication in the absence of seizures is much more difficult. There needs to be a reasoned weighing of ongoing risk of seizure recurrence against factors such as medication side-effect(s), cost of medications, potential drug interactions, willingness to defer driving during and for a while after the withdrawal of anticonvulsant. These are matters best discussed with your physician/neurologist.
"Is there anything other than medication that can be done to help prevent seizures?"
From the Northeast Rehabilitation Health Network. Reprinted with permission. All rights reserved. www.northeastrehab.com.
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