First Aid for Convulsion & Epilepsy

Hello Airclinicians and Steemians,

it's Friday again and I would love to take the chance to revive First Aid Friday today.

During the last month I have missed the AirClinic content a lot. Being a long-term user of Twitter I found DrOlufunmilayo who is really active addressing health topics and has a lot of followers in Nigeria and West-Africa. When he brought the topic on epilepsy yesterday there was a lot of questions. By means of this article I want to address some because it's an important topic. (In fact, while preparing this article, I found a chart of epilepsy-caused deaths in the world which displayed much higher numbers than I had expected.) Therefore, please feel free to post any questions in the comments too.

Introduction

When epilepsy is talked about often there's that image of person moving in an uncontrolled way, maybe shouting incomprehensibly and loudly.

This is called a grand mal or generalized seizure and by far not the only way epilepsy can display. However, the more silent forms do not offer so much challenges in first aid and psychology. I have learned from yesterday's and today's discussions that there's still people believing epilepsy is caused by some kind of spirit inhabiting somebody's body and that there's also people believing this spirit could wander to others if the person with epilepsy is touched. I have to admit there have been similar beliefs all over the world in the past too.

But I don't want to talk about personal beliefs any longer. :)

What is epilepsy?

Epilepsy as a medical term refers to recurring seizures caused by sudden electrical activity in the brain. There's a lot of criteria for differing between all kinds of epilepsy - if you're interested, check out Wikipedia for a list. Some seizures are restricted to a certain area of the brain and referred to as focal epilepsy for that reason. Other criteria refer to the outcome of the electrical activity, whether the person shakes or tenses up or both alternatingly (this is called tonic-clonic epilepsy). Most seizures come along with a loss of conscience and after a generalized seizure (affecting the entire brain) people remain unconscious and sleepy, unable to be awaken, for up to an hour or even two. During this time more seizures can occur, prolonging the time till the person is awake again.

Risk factors for epilepsy (all kinds of it) include:

• lack of oxygen before or at birth
• deformations of the brain
• infections of the brain
• recurring injuries of the head and brain (sometimes caused by domestic violence, i.e. excessive shaking of crying babys and toddlers, but also by contact sports like ice-hockey or American Football)
• brain tumors
• arteriosclerosis in the brain

A single unprovoked seizure is not referred to as epilepsy yet; the recurrence is a major criterion for the diagnosis.

Risk factors and causes for single seizures include:

• drug and alcohol abuse (or sudden withdrawal)
• massive and recurring lack of sleep
• fever (especially in children)
• excessive physical work
• low levels of electrolytes
• low blood sugar, especially in diabetes
• misuse of psychotropics

In the western world, most people with epilepsy have a regular prescription of medicine inhibiting further seizures, they live a normal life and some even drive a car regularly. Those who don't respond to medication are mostly unemployed as they need many breaks and a lot of sleep; some protect themselves with a special helmet (which are available for kids also) and some try to get along with some diet. If an organic cause can be found (via imaging of the brain), patients may be taken into account for surgery. Also, there's research on neuro-stimulation as a means of treatment.

What to do when you witness a seizure

Keep away from the person. That sounds a bit strange but as the affected person has no conscience during the seizure (and often even still some time after) you never know how he or she moves next. Mind your own safety! If you can keep the person from falling on a hard surface or from a greater height (anything above 1m) try to do it. But mind your own safety too.

As soon as possible call an ambulance if available. The doctor might bring some anti-convulsant (a medication stopping the seizure) and can address a cardiac or respiratory arrest too if they occur.

If there is any potential trigger - strong or fluctuating light and/or lot of noise - try to shed the affected person away from it.

If the person has a seizure while taking a bath (maybe induced by the warm water) hold his head above the water; if you're at a lake, get him or her out of the water as soon as possible. (And again: mind your own safety. Some things are better done with some help from others.)

Wait with the person till the seizure is over. Any report of a bystander is helpful as the affected person himself has no memory of the seizure. Especially the duration and quality of the seizure is valuable information.

After the seizure people usually sleep and cannot be awaken. This is a good time to check the person's breathing and airways, treat wounds and keep the people warm. Put them on the side with a lower-leveled head if there's fluid in their mouth to keep them from swallowing it. If you're unsure about another upcoming seizure hold their head as long as they are at rest so that the fluid can get out and place the head safely on a pillow again after.

If there's no ambulance to come to you, try to get to a hospital when the person is fully awake again. Even after a first seizure, seeking help is appropriate.

What you should not do

Don't try to intervene by holding them or their arms and legs, by shaking them or by slaying them.

Don't try to keep their airway free by using a spoon holding the tongue at the front area of the mouth. Due to the lack of conscience most protective reflexes are off. Which means they might bite themselves or block their airway anyway. However, the body still might react to the increased about of carbon dioxide in their blood and come back to breathing autonomously.

Don't put anything in their mouth at all. Putting a stick into a convulsing person's mouth has been common advice for quite some time but it is no longer.

Don't make them drink anything before the person is fully awake again. Most probably the given fluid would to directly into the lungs instead of the stomach as the swallowing reflex fails.

Thanks for reading.Yours,Anne @isarmoewe

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