Guide to helping someone having a seizure
9 Jun 2021
-Dr. Dyuti Datta Gupta
The human brain bears the complex circuit all along. Typically, it produces orderly patterned, continuous, tiny electrical impulses that travel along the brain cells’ neurons throughout the body via its chemical messenger called a neurotransmitter to regulate muscle tone, movement, and posture. In Seizure, a sudden alternation of behaviour occurs because of a momentary change in the brain’s electrical activity resulting in temporary abnormalities in muscle tone like stiffness, shaking, twitching or limpness, and sometimes losing consciousness. It is usually confused with Epilepsy, but there is a primary difference between these two.
A seizure is a single occurrence, whereas epilepsy is a neurological disorder characterised by two or more unprovoked convulsions. A seizure is a short-term change in the brain’s electrophysiological activity, but the occurrence of multiple recurrent episodes is a significant sign of epilepsy. Both can happen in adults and among children. Seizures are mainly classified into two major categories: primary generalised seizure and partial seizure. Primary generalised seizures begin with a widespread electrical discharge involving both sides of the brain at once. On the other hand, partial seizures start with an electrical discharge only in a limited brain area. In Epilepsy, attacks begin from both sides of the brain simultaneously and are called primary generalised epilepsy. Hereditary factors are essential in partial generalised epilepsy, a condition in which seizures arise from a limited brain area.
Before the onset of a seizure, different symptoms can happen, which include a sudden feeling of fear or anxiousness, feeling of being sick in the stomach, dizziness, a vision change, a jerky movement of the arms and legs that may cause to drop things and out-of-body sensation with a headache.
There are different types of seizures a person can experience. They are tonic, clonic, tonic-clonic, myoclonic, absence, and atonic seizures. Tonic seizures produce constant muscle contractions, and the person may turn blue if breathing is impaired. Clonic attacks involve shaking of the limbs accordingly. In tonic-clonic seizures, contraction of limbs occurs followed by extension and arching of the back for 10–30 seconds. The limbs then begin to shake in unison. It may take 10–30 minutes for the person to return to normal. Myoclonic seizures involve spasms of muscles in either a few areas or throughout the body. Absence seizures can be subtle, with only a slight turn of the head or eye blinking. The person rarely falls over and may return to normal right after the seizure ends. However, there may also be a period of post-ictal dis-orientations like feeling tired, headache, difficulty in speaking, and abnormal behaviour. Psychosis (delusions, hallucinations, incoherent speech and behaviour) often occurs after a seizure, and people rarely remember what happened at the time of onset and throughout. Sometimes in case of severity, falling occurs with losing consciousness, drooling or frothing at the mouth started with clenching teeth and biting the tongue. Making unusual noises, such as grunting and losing control of bladder or bowel function, may also occur.
Factors that increase the risk of seizures may include meningitis, encephalitis, neurocysticercosis, a brain injury or brain defect during childbirth, brain tumour, vascular abnormality and poor oxygenation of the brain, cerebral palsy, head trauma, choking, electrolyte imbalance, electric shock, extremely high blood pressure, low blood glucose level, kidney or liver failure and epilepsy. The limiting factors that increase the risk of onset include stress, sleep deprivation or fatigue, insufficient food intake, mental disability, drug abuse or withdrawal, failure to take prescribed anticonvulsant medications, etc.
It is pretty difficult to diagnose “seizure type.” Doctors perform several lab tests for the diagnosis of seizure. These tests may include blood tests to check electrolyte imbalances, a “spinal tap” to rule out infection, a toxicology screening to test for drugs, poisons, or toxins. An Electroencephalogram (EEG), CT scan or Magnetic resonance imaging (MRI) of the brain is performed to measure brain waves and detect the abnormalities present like blocked blood flow, internal bleeding and tumour. For treatment, medications and ketogenic or modified Atkin’s diet, which is specially made of high-fat, adequate-protein, and low carbohydrate. Positron emission tomography (PET may show abnormalities in advanced cases even if the brain MRI is normal). Single-photon emission computed tomography (SPECT identifies the area of seizure’s onset), Wada test, several nervous stimulations and surgery are used to regulate the situation.
Regarding management of seizure, the area around the patient should be cleared to prevent possible injury. The patient should be placed on their side, known as recovery position. Further choking can be prevented by loosening tight clothing and providing cushioning for their head so that saliva or vomit leaks out of their mouth instead of going down through the windpipe. If a seizure occurs during standing position, by holding them in a hug or gently guiding them to the floor, falling and injuring can be prevented. While having a seizure, it is not recommended to put anything into the person’s mouth or hold them down. As soon as the onset of symptoms, time tracking is necessary because if it will last for over three minutes, hospitalisation is urgently required. When the seizure is over, the patient’s mouth should be cleaned, and an attendant with a safe, comfortable area to rest should be provided to the patient until they became fully alert and awake. Water and food should only be given just after they are fully conscious. It is necessary to tell them to recognise themselves, ask them about the day, and make them fully alert and awakened.
After the primary storm is over, the patient should find a suitable doctor, take necessary medication religiously if required, and bring lifestyle changes. The patient should do yoga, meditation, deep breathing exercise regularly. Enough sleep, eating a healthy diet and stay well hydrated is required. Illegal drugs, alcohols should not be taken, and engagement in stress-reducing techniques should be mandatory to avoid the frequent onset of this disease.