Epilepsy and Seizure

Management

This product was developed with support from the Centers for Disease Control and
Prevention under cooperative agreement number 5U58DP000606-05. Its contents are
solely the responsibility of the authors and do not necessarily represent the official views
of the CDC.
 A Seizure is:

A symptom of abnormal brain function.

The electrical system of the brain

malfunctions. Instead of discharging
electrical energy in a controlled manner,
the brain cells keep firing
 Seizures
Seizures may be caused by many different
things. Causes include:
•Brain malformation
•Lack of oxygen to brain at some point in life
•Fevers
•Infections (meningitis)
•Congenital Conditions (Downs Syndrome)
•Low levels of blood sugar, blood calcium, blood
magnesium or other electrolyte disturbances
•Brain tumors
•Head trauma
•Poisons (such as lead)
 Seizures
A common cause of seizures is epilepsy
–Epilepsy (also known as a ‘seizure disorder’) is
a chronic neurological disorder characterized
by recurring seizures that are not otherwise
provoked by an acute injury or health
emergency.
 Epilepsy is
Not contagious, it is not a mental
illness, or a cognitive disability.
The neurological
dysfunction seen in epilepsy can
begin at birth, childhood,
adolescence, or even in adulthood.
 Epilepsy

 Over 3 million Americans of all ages have

epilepsy.
 There are many different types of epilepsy.
People may experience just one type or more
than one.
 Approximately 200,000 new cases of seizures
and epilepsy occur each year.
 Ten percent of the American population will
experience a seizure in their lifetime
Epilepsy may occur with:

 Cerebral palsy  Developmental

 Cognitive disabilities
impairments  Autism
 ADD/ADHD
 Epilepsy
… but the majority of people who have epilepsy do
not have other impairments and live very normal
lives.
 Seizures
In a generalized
seizure
the electrical
disruption affect
both cerebral
hemispheres
(sides of the
brain)
Tonic-Clonic Seizure -“grand mal”
 Loss of consciousness, fall and stiffening
of limbs, followed by rhythmic shaking.
 Breathing may stop temporarily -
skin, nails, lips may turn blue
 Loss of bladder/bowel control may occur
 Generally lasts 1 to 3 minutes
 Followed by confusion, sleepiness
 First Aid for Tonic-Clonic Seizure
-“grand mal”
First Aid for Generalized Tonic-Clonic
Seizures
• Prevent further injury. Place something soft under the
head, loosen tight clothing and clear the area of sharp or
hard objects.
• Do not force objects into the person's mouth.
• Do not restrain the person's movements, unless they
place him or her in danger.
• Turn the person on his or her side to open the airway
and allow secretions to drain.
 Cont. First Aid for Tonic-Clonic
Seizure “Grand mal”
• Stay with the person until the seizure ends.
• Do not pour any liquids into the person's mouth or offer
any food, drink or medication until he or she is fully awake.
• If the person does not resume breathing after the
seizure, start cardiopulmonary resuscitation (CPR).
• Let the person rest until he or she is fully awake.
• Be reassuring and supportive when consciousness
returns.
 Cont. First Aid for Tonic-Clonic
Seizure “grand mal”
 A convulsive seizure is usually not a
medical emergency unless it lasts longer
than five minutes, or a second seizure
occurs soon after the first, or the person is
pregnant, injured, diabetic or not
breathing easily. In these situations the
person should be taken to an emergency
medical facility.
 Myoclonic Seizures
 rapid, brief contractions of bodily muscles, which
usually occur at the same time on both sides of
the body
 People usually think of them as sudden jerks or
clumsiness (like sudden jerk of foot in sleep)
 May be mild and affect only part of the body, or
be strong enough to throw the child abruptly to
the floor
 May occur as a single seizure or a cluster of
seizures
 Myoclonic Seizures
First aid is usually not needed.
However, a person having a myoclonic
seizure for the first time should receive
a thorough medical evaluation.
 Atonic Seizures
 Other names for this type of seizure
include drop attacks, astatic or akinetic
seizures
 Produce an abrupt loss of muscle tone
(head drops, loss of posture or sudden
collapse)
 They seizures tend to be resistant to drug
therapy
 Atonic Seizures
Because they are so abrupt—without any warning
—and because the people who experience them
fall with force, atonic seizures can result in injuries
to the head and face. Children and adults may
need to use protective headgear to prevent injury.

These types of seizures do not usually need first

aid care, unless a person is injured from falling or
if it their first time experiencing this type of
seizure.
 Tonic Seizures
 Produce a stiffness or rigidity in all
muscles, last 5–15 seconds, and if the
person is standing, may also result in a fall
with injuries
 May occur during sleep
 Also resistant to drug therapy
 Seek medical care if first time
experiencing this type of seizure
 Absence Seizures
 Sometimes called “Petit-mal” seizures
 Characterized by lapses of awareness,
sometimes with staring, that begin and
end abruptly, lasting only a few seconds
 Frequently so brief that they escape
detection
 More common in children than in adults
 May have 50-100 lapses a day
 Absence Seizures
No immediate first aid is usually necessary,
but a medical evaluation is indicated to try
to prevent these seizures from recurring
In a partial seizure
the electrical
disruption is limited
to a specific area
of one cerebral
hemisphere (side
of the brain).
 Partial Seizures
Key things to remember about partial
seizures are:
They don’t last long (recovery can take longer than the
seizure)
They end naturally (except in rare cases)
You can’t stop them (let seizure run its course and just
try to protect person from injury)
They are not dangerous to others (movements
produced by a seizure are almost always too vague, too
unorganized and too confused to threaten the safety of anyone
else)
 Simple Partial Seizure
Seizure activity in the brain causing:
• Rhythmic movements - eyes move from side to
side, blinking, unusual movement of the
tongue,
isolated twitching of arms, face, legs
• Sensory symptoms - unpleasant tastes,
tingling, weakness, unusual
sounds, smells, feeling of upset
stomach, visual distortions, sensation of goose
bumps, sweating, flushing
• Psychic symptoms -
déjà vu,
hallucinations, feelings of fear or anxiety, anger, may
feel like they are having an out body experience.
 Simple Partial Seizures
 People who have simple partial seizures
do not lose consciousness
 Can usually remember exactly what
happened to them while it was going on
 Usually last less than one minute
 May precede a generalized seizure
 Complex Partial Seizure
Complex partial seizures affect a larger
area of the brain than simple partial
seizures and they affect consciousness
Characterized by:
 altered awareness
Confusion, inability to respond
Automatic, purposeless behaviors such as
picking at clothes, chewing or mumbling.
Emotional outbursts
 Complex Partial Seizures
 May be confused with:
Drunkenness or drug use
Willful belligerence, aggressiveness
 Typically starts with a blank stare and loss of
contact with surroundings
 The person may wonder around during
 Seizure can last between 30 seconds to 2
minutes
 Complex Partial Seizures
First Aid for:
• Do not restrain the person.
• Remove dangerous objects from the person's path.
• Calmly direct the person to sit down and guide him or
her from dangerous situations. Use force only in an
emergency to protect the person from immediate harm,
such as walking in front of an oncoming car.
• Observe, but do not approach, a person who appears
angry or combative.
• Remain with the person until he or she is fully alert.
 Partial Seizures
 Partial seizures take many forms and medical
treatment does not always control them. People who
live with frequent complex partial seizures may face
many challenges. One involves personal safety.

 Things like fire, heat, water, heights, certain

machinery and sharp objects are all potential hazards
when people are unaware of what they're doing and
don't feel pain.
 Partial Seizures
However, there may be ways to reduce obvious
risks. For example:
•Using a microwave oven for cooking instead of a gas or
electric range
•Taking plates to the oven or stove to serve oneself to
avoid having to carry pans of hot food or liquid
•Using a regular knife for carving, not an electric knife or, if
possible, leaving the carving to someone else
•Keeping electric mixers and other electric appliances far
away from the sink or source of water
 Partial Seizures
• Setting the water heater low enough to prevent scalding
during a seizure and taking sit down showers if drop
attacks are frequent;
• Making sure open fires have guards and that electric or
other space heaters can't be tipped over;
• Not smoking and not carrying lighted candles or hot
ashes from the fireplace through the house;
• Limiting ironing as much as possible;
• Padding sharp corners and carpeting floors
 Seizures
Exposure to flashing lights at certain intensities or
to certain visual patterns can trigger seizures. This
condition is known as photosensitive epilepsy.

Photosensitive epilepsy is more common in

children and adolescents, especially those with
generalized epilepsy, in particular juvenile
myoclonic epilepsy. It becomes less frequent with
age, with relatively few cases in the mid twenties.
 Photosensitive Seizures
May be triggered by:
•exposure to television screens due to the flicker or rolling images
•to computer monitors
•to certain video games or TV broadcasts containing rapid flashes
or alternating patterns of different colors
•intense strobe lights like visual fire alarms.
•by natural light, such as sunlight, especially when shimmering off
water, flickering through trees or through the slats of Venetian
blinds.
 Seizures
Other types of seizures include:
Non-epileptic seizures which are episodes that briefly
change a person's behavior and may look like epileptic
seizures (aka pseudoseizures)
Gelastic seizures are called the “laughing seizure” because
they may look like bouts of uncontrolled laughter or
giggling.
Dacrystic seizures are called the “crying seizure.” The
vocalization has a crying quality and the facial contraction
resembles a grimace.
Gelastic and dacrystic seizures are most commonly found
in people with hypothalamic hamartomas
 Status Epilepticus
 Prolonged or clustered seizures sometimes
develop into non-stop seizures (seizure
lasting longer than 30 minutes)
 It is a medical emergency
 It requires hospital treatment to bring the
seizures under control.
 Can lead to brain damage or possibly even
death if unable to stop seizure activity
 Epilepsy Syndromes
Epileptic syndromes include hypothalamic
hamartomas; febrile convulsions; West syndrome
(infantile spasms); Lennox-Gastaut syndrome;
childhood absence epilepsy; juvenile myoclonic
epilepsy; Benign Rolandic epilepsy; Landau-
Kleffner syndrome; Rasmussen's encephalitis
(syndrome); progressive myoclonic epilepsy;
temporal lobe epilepsy, and frontal lobe epilepsy
Anti-epileptic Medications
• Depakote (Valproic acid)
• Felbatol (felbamate)
• Gabatril (tiagabine) •Neurontin (gabapentin)
• Keppra (levetiracetam) •Tegretol (carbamezepine)
• Lamictal (lamotrigine) •Trileptal (oxcarbazepine)
• Dilantin (phenytoin) •Topamax (topiramate)
• phenobarbitol
•Zonegran (zonisamide)
•Lyrica (pregabalin)
 Vagus Nerve Stimulator
 An implanted device that
sends regular, mild electrical
pulses to the brain via the
vagus nerve
 May also be activated
by
an external magnet
 Functioning of the VNS may be affected by
the use of a taser device.

More information about the VNS can be found at:

www.cyberonics.org
Patients with epilepsy may
still have seizures due to:
 Failure to take medication correctly
 Variation in medication effectiveness
 Sleep deprivation
 Stress/ Illness
 Hypoglycemia/dehydration
 Alcohol/drug use or withdrawal
 Hormonal fluctuations
 Flashing lights or other triggers
Some epilepsy patients never achieve
effective seizure control and may
experience varying degrees of financial,
social and legal problems.
 Diastat
The only FDA-approved treatment
currently for acute repetitive
seizures at schools is rectal Diastat
 Diastat
 Diastat comes in a prefilled, rectal delivery
system
 Dosage is based on weight in kilograms and
age
 It is recommended that Diazepam rectal gel
be used to treat no more than five episodes
per month and no more than one episode
every five days
 Follow the physician orders for when
appropriate to give Diastat
 Diastat
Mild side effects include:
Drowsiness
Dizziness
Diarrhea
Unsteadiness
 Diastat
Serious, but unlikely side effects include:
Slow/shallow/difficult
breathing
Mental/mood changes (e.g. anxiety, restlessness)
Slurred speech
Trouble walking

Also watch for symptoms of an allergic

reaction (e.g. rash, itching/swelling, trouble breathing)
 Diastat
Important information about Diastat:
If you don’t see the green “ready” band it
means that the medicine in your Diastat
Acudial is not properly locked in. If you notice
this please contact parent immediately. They
will need to take back to pharmacy immediately
to be corrected. Do not use! It means that the
correct dose is not properly locked in.
Contact the Epilepsy Foundation for more information:

1-800-332-1000
www.epilepsyfoundation.org

Or Click Here to Contact your Local Epilepsy Foundation Affiliate