Epilepsy is a chronic neurological disorder with which the person suffers seizures.
Interesting and useful links:
Epilepsy Action
Epilepsy Society
Youth Health Talk - Epilepsy
Epilepsy.com
The information below is sourced from www.epilepsysociety.org.uk a website with a huge wealth of information on the subject of Epilepsy.
Types of epileptic seizures and what to do/First aid
Epileptic seizures can be divided into two main types: partial seizures and generalised seizures. Seizures can vary from one person to another and how people are affected and how they recover after seizures varies.
Partial seizures
In partial seizures the seizure starts in, and affects, just part of one side of the brain. What happens during the seizure depends on where in the brain the seizure happens and what this part of the brain normally does.
Simple partial seizures
In a simple partial seizure (SPS) the person is conscious (awake) and aware of what is happening to them. A SPS could be twitching of one limb or part of a limb, an unusual smell or taste, a strange feeling such as a ‘rising’ sensation in the stomach or ‘pins and needles’ in part of the body or a sudden intense feeling of fear or joy.
What to do during the seizure:
- although the person is awake and aware, SPS can feel unsettling so giving gentle reassurance may be helpful.
Complex partial seizures
A complex partial seizure (CPS) affects a bigger part of the brain than a SPS. In a CPS the person’s consciousness is affected and they may be confused. You might notice them wandering around or behaving strangely and they may not know what they are doing. They may pick objects up for no reason, fiddle with their clothes or make chewing movements with their mouth. Afterwards, they may need to sleep or they might be confused for some time. CPS may last from a few seconds to a few minutes.
What to do during the seizure:
- do not restrain them as this may upset or confuse them;
- gently guide them away from any danger (such as walking into the road); and
- speak quietly and calmly so that they are not startled. They may be confused, so if you speak loudly or act forcefully this may confuse them more. They may mistake your help for being hostile, and be upset or respond in an aggressive way.
After the seizure stops:
- they may feel tired and need to sleep;
- it may help if you remind them where they are because they may be confused and not fully aware of their surroundings; and
- stay with them until they have recovered, and can safely return to what they were doing before the seizure.
Some people recover quite quickly after their seizure but others may take longer to feel back to normal again.
Secondarily generalised seizures
For some people SPS and CPS develop into a generalised seizure (see below). When this happens the person becomes unconscious and will usually have a tonic clonic seizure.
This is called a secondarily generalised seizure because it starts as a partial seizure and then becomes a generalised seizure. Some people call their partial seizure an ‘aura’ or ‘warning’ because it warns them that a generalised seizure may follow.
What to do during the seizure:
- if the person is aware of a warning, they may need help to make themselves safe before the generalised seizure starts.
Generalised seizures
Generalised seizures affect btoh sides of the brain. The person becomes unconscious, and afterwards will not remember what happened during the seizure.
Absences (sometimes called petit mal)
During an absence a person becomes unconscious for a short amount of time, usually a few seconds. They may look blank and not respond to what is happening around them. For example, if they are walking they may continue to walk, but will not be aware of what they are doing.
What to do during the seizure:
- stay with the person and, if necessary, gently guide them away from any danger.
Tonic and atonic seizures
In a tonic seizure the person’s muscles suddenly become stiff. If they are standing they often fall backwards and may injure the back of their head. In an atonic seizure (sometimes called a 'drop attack') the person’s muscles suddenly relax, and they become floppy. If they are standing they often fall forwards and may injure their face or head. Both tend to be very brief and happen without warning so you cannot help during the seizure itself. People usually recover quickly.
What to do after the seizure:
- as the person recovers they may need reassurance. If they have been injured, they may need medical help.
Myoclonic seizures
Myoclonic seizures involve the jerking of a limb or part of a limb, and often happen shortly after waking up from sleep. They are brief and can happen in clusters with many happening close together in time. As they are so brief, there is nothing that needs to be done to help the person other than making sure they haven’t hurt themselves.
Tonic clonic (convulsive) seizures (sometimes called grand mal seizures)
During a tonic clonic seizure the person goes stiff, usually falls to the ground and make shakes or makes jerking movements (convulses). Their breathing can be affected and they may go pale or blue, particularly around their mouth. They may also bite their tongue. Some people have just clonic (convulsive) seizures.
Although this can be frightening to see, these seizures are not usually a medical emergency. Usually, once the jerking has stopped, the person recovers and their breathing goes back to normal.
What to do during the seizure:
- try to stay calm;
- check the time to see how long the seizure is going on for (because there may be a risk of status epilepticus - see below);
- move objects, such as furniture, away from the person if they might hurt themselves. Only move them if they are in a dangerous place; for example, at the top of stairs or in the road;
- put something soft (like a jumper) under their head, or cup their head in your hands, to stop it hitting the ground;
- do not restrain them, allow the seizure to happen;
- do not put anything in their mouth - there is no danger of them swallowing their tongue during the seizure; and
- try to stop other people from crowding around.
What to do when the jerking (convulsing) has stopped (recovery):
- roll them on to their side into the recovery position;
- wipe away any spit and if their breathing is difficult check their mouth to see that nothing is blocking their airway, like food;
- try to minimise any embarrassment. If they have wet themselves deal with this as privately as possible; and
- stay with them, giving reassurance, until they have fully recovered.
Some people recover quickly after these seizures but more often the person will be very tired, may want to sleep and may not feel ‘back to normal’ for several hours or sometimes days.
How to put someone into the recovery position (when they are lying on the floor)
- Place their arm nearest to you at a right angle to their body, with the palm facing upwards.
- Lift their other arm across their body putting the back of their hand against their cheek nearest you. Hold it there with your hand.
- Using your other hand, lift the knee furthest from you, and pull it upwards so that their leg is bent and their foot is flat on the floor.
- Keeping their hand against their cheek, pull the bent knee towards you. This will roll them onto their side. Keep the knee bent and position this leg at a right angle to their body.
- Make sure their airway is open: gently tilt their head back and lifting their chin. Check that nothing is blocking their throat that and they are breathing.
- Stay with them. If you are not happy with how they are recovering, call for an ambulance.
Status epilepticus
Most people's seizures last the same length of time each time they happen, and usually stop by themselves. However, sometimes seizures do not stop, or one seizure follows another without the person recovering in between. When a seizure goes on for 30 minutes or more it is called status epilepticus, or 'status' for short.
Status can occur in any type of seizure and the person may need to see a doctor. However, status in a tonic clonic (convulsive) seizure is a medical emergency. It is important to call for an ambulance before the seizure goes on too long. Do not wait until it has lasted 30 minutes before calling for help. See when to dial 999.
Some people who go into status are prescribed emergency medication, either rectal diazepam or buccal midazolam, to stop their seizures. Carers will need training on how to give emergency medication and it is important to have a written protocol (plan) for each individual, for the carer to follow.
Checking the length of a seizure is essential in avoiding status (see above). Another important reason to check the time and note the length of a seizure is so that you can pass this information on afterwards to the person who has had the seizure. Many people keep a record of their seizures, and a description of the seizure and how long it lasted can be vital information for them to record, and pass on to their specialist.
