MANILA, Philippines - The International League Against Epilepsy (ILAE) defines epilepsy as a brain disorder characterized by an enduring predisposition to generate epileptic seizures. The abnormal and excessive cortical brain discharge may also manifest as altered behavior and cognition, and may have neurologic, psychological, and social consequences.
There are different seizure types. It may be focal, originating from some point within neural networks limited to one cerebral hemisphere, or generalized wherein abnormal cortical discharges originate at one specific point in the brain but rapidly engages both cerebral hemispheres.
Contrary to the notion that all seizures would present with a loss of consciousness, there are seizures where consciousness is not lost during an attack. Focal partial seizures are just such an example wherein a patient may have a subjective sensory or psychic phenomena or an aura, or a patient may have automatisms such as lip smacking or simple motor presentations such as twitching of the hand.
The generalized seizure type may take the commonly known tonic-clonic type, or it may present as an absence seizure where a patient may suddenly stop what he or she is doing and stare blankly for a brief period of time. A myoclonic seizure as well as atonia are also classified under this category.
A seizure can occur at any time. It can be unpredictable. Often, people not accustomed to seeing a seizure get frightened and panic. What should one do when faced with such a case?
DO NOT PANIC!
This is the first rule for when one gets anxious and alarmed or is horrified with a seizure attack, one could not be expected to function to help the individual having a seizure attack.
The next thing to bear in mind is the need to keep the seizing person safe and away from incurring any injury. After this, one has to know how to determine if such an individual needs immediate hospitalization or emergency care.
When a patient seizes, one has to determine what kind of seizure the individual is having. A focal seizure wherein consciousness is not lost or impaired may not require hospitalization. One needs to speak calmly to the patient. One has to reassure the individual. One also has to stay with the person until the event ends. Timing the attack is also important. If the occurrence of such seizures is becoming more frequent or lasts longer than usual, then this has to be brought to the attention of a physician.
In instances where the seizure type is accompanied by an impairment of one’s consciousness, the same general rules of staying with the patient and timing the event apply. When the patient regains consciousness, one has to reassure the patient. Help has to be offered also when the patient is distressed. If the seizure type of the patient is a non-convulsive one wherein a patient wanders off, one has to stay with the patient and keep the individual safe from any accidents. The common practice of restraining the patient does not help end the seizure episode.
The easily determined convulsive seizure can appear scary and startle people around the patient. Again, one has to be calm and level-headed. Timing the event is once more paramount. If the event lasts for five minutes, then the individual has to be brought to an emergency room posthaste!
When a person has a convulsive seizure, their body, arms, and legs will be shaking. To prevent them from hitting something nearby and thus sustain a traumatic injury, objects near the patient must be placed out of the way. If a patient is about to fall, catch the patient and gently lay the patient on the floor. Cushion the head and neck with a soft object to prevent any injuries to the head. One also has to place the seizing individual on his side to prevent any aspiration from happening. This is also done to prevent asphyxiation after the attack.
No object has to be attempted to be placed in the person’s mouth during an active attack. The belief that the tongue may be swallowed or be cut off is a fallacy. The act of placing an object in the mouth in the belief that it would prevent an injury would actually cause injury to the patient. A tooth may be broken and be dislodged. It could compromise breathing. Furthermore, the jaw may be broken when the object is forcefully placed into the mouth.
Comfort the patient as the individual starts to wake up. He or she has to be cleaned up if spontaneous urination or defecation occurred during the attack.
When a seizure episode occurs in water or if any chance that the individual swallowed water, an immediate emergency room (ER) consult has to be made. An ER consult must also be done if breathing is erratic after an attack.
The occurrence of two successive generalized tonic-clonic seizures without consciousness being regained in between the said attacks also requires immediate and emergent medical attention. It is common that after an attack, a patient may feel drowsy or sleepy and may be confused and also complain of dizziness or headache. The patient would often wish to have a rest. The instance that consciousness is not regained in between two successive seizure episodes clinically places the patient to be having status epilepticus. The patient may not be convulsing anymore but it is possible that the reason why the person has not regained consciousness is because the brain continues to have abnormal neuronal firing and that what is seen is a non-convulsive seizure.
Lastly, when an unexpected seizure occurs in a person not diagnosed to have epilepsy, an immediate medical consult has to be made.
It is hoped that the yearly celebration of Philippine National Epilepsy Awareness Week every first week of September would further help everyone in the proper treatment of people with epilepsy.