Seizure First Aid: Essential Steps to Ensure Safety During Seizures

Seizures are neurological events that are alarming and potentially life-threatening if not properly managed. Understanding the nature of attack, their different types, causes, and appropriate first aid measures is crucial in ensuring the safety and well-being of individuals experiencing them. This article will explore the various aspects of seizures and how to respond effectively to someone having a seizure.

What is a seizure?

A seizure is a sudden, uncontrolled surge of electrical activity in the brain, disrupting its normal functioning. This abnormal electrical discharge causes a wide range of physical and behavioral manifestations, which vary depending on the specific area of the brain affected and the intensity of the spasm.

In a seizure, symptoms like convulsions, muscle rigidity, involuntary movements, consciousness changes, and sensation alterations are common. These manifestations are alarming to witness and often appear as involuntary jerking or shaking movements accompanied by changes in awareness, behavior, or sensations.

Attack last a few seconds to several minutes and is sometimes followed by confusion, fatigue, or headache. Recognizing these signs and responding appropriately is essential to ensure the person's safety during a seizure.

What are the 2 types of seizures?

The two main types of seizures are focal seizures  (known as partial seizures) and generalized seizures.

Focal Seizures

Focal seizures or partial seizures start in one area of the brain and only impact that part. The manifestations of focal seizures vary widely depending on the part of the brain involved:

1. Simple Focal Seizures: These seizures affect a specific part of the brain and often result in altered sensations, emotions, or movements. The person  remains conscious during these spasm.
2. Complex Focal Seizures: These attack originate in a specific brain area but lead to altered consciousness or awareness. People experiencing complex focal seizures display unusual behaviors, automatisms (repetitive, involuntary movements), or confusion.

Generalized Seizures

In generalized seizures, the whole brain is affected by unusual electrical activity. Unlike focal seizures, generalized seizures affect both sides of the brain from the beginning of the episode. There are different types of generalized seizures, including:

1. Tonic-Clonic Seizures: Tonic clonic grand mal seizures are the most widely recognized type of generalized seizure. They involve loss of consciousness, stiffening of the body (tonic phase), and rhythmic jerking movements (clonic phase).
2. Absence Seizures (Including Petit Mal Seizures): These are brief, non-convulsive seizures that primarily affect children. During an absence seizure, the person appears to be staring blankly into space, with a sudden interruption in their activities. They usually last only a few seconds.
3. Atonic Seizures: These spasm cause muscles to suddenly weaken, making a person fall or their head to drop. They are sometimes referred to as "drop attacks."
4. Myoclonic Seizures: These spasm involve sudden, brief muscle jerks or twitches. They affect a single muscle group or the entire body.
5. Clonic Seizures: Clonic grand mal seizures are characterized by repetitive, rhythmic jerking movements, similar to the clonic phase of a tonic-clonic seizure.
6. Tonic Seizures: Tonic seizures cause sudden muscle stiffening, often leading to falls or postural changes.
7. Generalized Tonic-Clonic Seizures: This term is used when an attackstarts as a generalized seizure involving both sides of the brain without any preceding focal seizure activity. It includes the typical features of tonic and clonic phases.
8. Infantile Spasms (West Syndrome): These are specific attack in infants and young children. They involve sudden, symmetric, brief muscle contractions, often with a characteristic head nodding.

What causes seizures?

Seizures are caused by various factors, and identifying the underlying cause is crucial for appropriate treatment and management. Some potential causes of seizures include:

• Epilepsy: Epilepsy is a chronic neurological disorder characterized by recurrent attack. Genetic factors cause it or occur due to unknown causes.
• Brain Injuries: Traumatic brain injuries resulting from accidents or falls that lead to seizures. The brain's structure and function is altered, triggering abnormal electrical activity.
• Infections: Infections such as meningitis, encephalitis (brain inflammation), or brain abscesses cause seizures by affecting the brain tissue and its normal functioning.
• Metabolic Disorders: Certain metabolic disorders, including hypoglycemia (low blood sugar), electrolyte imbalances, or kidney failure, disrupt the brain's electrical activity and trigger attack.
• Brain Tumors: Benign or malignant tumors in the brain cause seizures by putting pressure on brain tissue or interfering with normal electrical signals.
• Stroke: Strokes, which occur due to disrupted blood flow to the brain, damage brain tissue and lead to spasm.
• Genetic Factors: Some genetic conditions or mutations predispose individuals to seizures, even without any underlying cause.
• Withdrawal from Substances: Seizures occur during withdrawal from drugs, alcohol, or certain medications.
• Neonatal Causes: Seizures occur in newborns due to complications during birth, lack of oxygen, or infections passed from the mother.
• Idiopathic Seizures: In some cases, attack occurs without an identifiable cause. These are referred to as idiopathic seizures and the underlying reason remains unknown.

‍

Can seizures be a symptom of other medical conditions?

Yes, seizures can be a symptom of various medical conditions beyond epilepsy. Medical conditions that involve seizures include metabolic disorders, brain infections, traumatic brain injuries, brain tumors, and certain genetic or developmental disorders. Attack occur in the context of fever, known as febrile seizures, especially in young children. Additionally, drug withdrawal, electrolyte imbalances, and certain toxic exposures triggers seizures. It is crucial to identify the underlying cause of seizures for appropriate treatment and management. Individuals experiencing seizures should seek medical evaluation to determine the specific medical condition contributing to this symptom.

How to Identify Signs of a Seizure

Seizures manifest in various ways, and the signs and symptoms differ based on the type of seizure and the area of the brain affected. Here are some common signs and symptoms associated with seizures:

• Convulsions: Convulsions are involuntary, rhythmic body movements, often involving jerking of the arms and legs. This is a characteristic symptom of generalized tonic-clonic seizures, during which the person loses consciousness and experiences both tonic and clonic phases.
• Loss of Consciousness: Many seizures result in a loss of consciousness. The person suddenly stop what they are doing, stare blankly, and become unresponsive. This occurs in various types of seizures, including complex focal seizures and generalized seizures.
• Altered Awareness: Some seizures, particularly simple focal seizures change a person's awareness without causing a loss of consciousness. Individuals  experiences unusual sensations, emotions, or perceptions during these seizures. They might feel detached from reality, experience déjà vu, or have strange tastes or smells.
• Repetitive Movements (Automatisms): Automatisms are repetitive, purposeless movements that occur during certain types of seizures. These movements might include lip-smacking, hand rubbing, or picking at clothes. Automatisms are commonly seen in complex focal seizures.
• Muscle Stiffness or Rigidity: Muscle stiffness, known as tonic activity, occurs in various types of seizures. During tonic seizures, the muscles suddenly become stiff, leading to rigidity. This causes the person to fall if they are standing or sitting.

What is the difference between seizures and epilepsy?

Seizures and epilepsy are related terms, but they have distinct meanings. A seizure is a sudden, uncontrolled electrical disturbance in the brain that results in various symptoms, such as convulsions, altered consciousness, or repetitive movements. Seizures are caused by various factors, including fever, head injury, or certain medical conditions.

Epilepsy, on the other hand, is a neurological disorder characterized by recurrent, unprovoked seizures. It is diagnosed when an individual experiences two or more unprovoked seizures unrelated to an acute medical condition. In essence, all people with epilepsy have had seizures, but not everyone who experiences a single seizure has epilepsy. Epilepsy often requires ongoing management with medication, lifestyle modifications, or other treatments to control and reduce the frequency of seizures.

‍

How are seizures diagnosed?

Seizures, including epileptic seizure are diagnosed through a comprehensive process that includes a thorough medical history, neurological examination, and various tests. The key diagnostic tools often include an electroencephalogram (EEG) to measure brain activity, brain imaging (MRI or CT scans) to identify structural issues, and blood tests to assess metabolic factors. Additional tests such as video EEG monitoring or genetic testing is employed in some cases. The goal is to identify the underlying cause of the seizures and determine whether the individual has epilepsy or if the seizures are a result of another medical condition. Consulting with a neurologist or epilepsy specialist is crucial for an accurate diagnosis and the development of an appropriate treatment plan.

What are the 3 stages of seizure?

Seizure is categorized into different stages, each with distinct characteristics. Understanding these 3 stages helps recognize and respond to seizures effectively. Here are the typical stages of a seizure:

1. Aura (Prodrome): Some individuals experience warning signs or auras before a seizure occurs. These include changes in mood, sensation, or perception. Auras vary widely among individuals and are a precursor to an impending seizure.

2. Ictal Phase: The ictal phase is the actual seizure period when abnormal electrical activity occurs in the brain. This phase varies in duration and intensity. During this stage, the person exhibits various symptoms, such as loss of consciousness, muscle jerking, altered awareness, or repetitive movements.

3. Postictal Phase: Following the ictal phase, there is a recovery period known as the postictal phase. During this stage, the person appears confused, disoriented, or fatigued. They might experience headaches, muscle aches, or memory difficulties. The duration of the postictal phase varies, ranging from minutes to hours.

First Aid for Seizures

Providing first aid for seizures involves specific steps aimed at ensuring the person's safety and well-being during the episode. Here's a guide on how to respond effectively to someone experiencing a seizure:

Safety Measures for the Person Having a Seizure

Ensuring the safety of someone experiencing a seizure is critical. It's essential to clear the immediate area of any potential hazards, like sharp objects or breakable items, to ensure safety.

Put something soft, like a cushion or clothes, under the person's head to prevent head injuries. It's essential to loosen any tight clothing, especially around the neck, to facilitate easier breathing and comfort.

Gently turn the person onto their side to maintain an open airway, ensuring they breathe easily and prevent choking on saliva or vomit. Avoid restraining their movements, except in situations where they are in immediate danger, to prevent further injury. Keep track of the seizure's duration, noting the time, especially if it exceeds 5 minutes, as this requires immediate medical attention.

Calling for Professional Help

If the seizure persists for more than 5 minutes or the person experiences another seizure immediately after the first, it is crucial to call emergency services. Additionally, If it's the person's first attack or if they show signs of difficulty breathing or distress, promptly seek medical assistance. For pregnant individuals, especially those with underlying health conditions such as diabetes, seek immediate medical help for their safety.

Combining CPR with Seizure First Aid

When the person stops breathing or their heartbeat becomes irregular, combining CPR with seizure first aid is necessary. Start by checking for breathing and a pulse; if absent, begin CPR immediately. Initiate chest compressions at a rate of 100-120 compressions per minute, allowing the chest to fully recoil between compressions. Continue CPR until professional medical help arrives or until the person resumes breathing and has a regular heartbeat. Combining CPR with first aid is be life-saving, especially when swift and efficient actions are taken.

When to Start CPR During a Seizure

Start CPR if the person is not breathing or if you can't feel their pulse, showing their heartbeat is not regular. In these situations, it's essential to start chest compressions immediately, maintaining the correct rate and depth to ensure adequate circulation. Initiating CPR promptly during a seizure significantly improves the person's chances of survival and reduces the risk of complications. Always prioritize the person's safety and well-being, following the appropriate CPR and first aid protocols.

‍

What is the current research on the causes of seizures?

Ongoing research on the causes of seizures is multifaceted, delving into genetic, molecular, and neurobiological aspects. Scientists are investigating how genetic factors contribute to susceptibility, aiming to identify specific genes and mutations associated with various seizure disorders. Additionally, research explores the role of neurotransmitters, ion channels, and neuronal networks in triggering seizures. Advanced imaging techniques and technologies are aiding in the understanding of structural abnormalities in the brain that leads to seizures. Overall, the current research landscape is dynamic and involves a comprehensive exploration of the diverse factors contributing to seizures.

‍

Are there new treatments being developed for seizure disorders?

Continuous developments in the treatment of seizure disorders include the exploration of novel medications, innovative therapeutic approaches, and advancements in neuromodulation techniques. Researchers are actively working on identifying targeted therapies based on the specific mechanisms underlying different types of seizures. Gene therapies and anti seizure medicine approaches are emerging as potential avenues for more personalized and effective treatments. The evolving field reflects a commitment to improving seizure management and enhancing the quality of life for individuals with epilepsy.

‍

How do genetics influence the risk of seizures?

Genetics significantly influences the risk of seizures. Research has identified specific genetic mutations and variations associated with an increased susceptibility to epilepsy and other seizure disorders. Familial studies and genome-wide association studies (GWAS) contribute to our understanding of the genetic basis of seizures. The identification of these genetic factors aids in risk assessment and provides insights into potential therapeutic targets. The interplay between genetic predisposition and environmental factors is an active area of investigation in deciphering the complexities of seizure disorders.

‍

What is the role of brain activity in seizures?

Seizures are fundamentally characterized by abnormal electrical activity in the brain. Researchers are focused on unraveling the intricate details of this abnormal neural activity, including the involvement of specific neural circuits, neurotransmitters, and ion channels. Advanced imaging technologies, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), contribute to mapping brain activity during seizures. Understanding the dynamics of neural networks and the factors that contribute to hyperexcitability is essential for devising targeted interventions to modulate brain activity and prevent seizures.

‍

Age-Specific Considerations for Providing Seizure First Aid

There are age-specific considerations for providing seizure first aid. For children, it's crucial to be gentle when guiding them to the ground during a seizure to prevent injuries. t's very important to put something soft under their head and remove any sharp objects close by.

In older adults with conditions like osteoporosis, extra care should be taken to prevent fractures during a fall. Additionally, for elderly individuals, post-seizure confusion might be more pronounced, requiring patience and reassurance.

‍

How do seizures in children differ from those in adults?

In children, seizures are often associated with age-specific factors, such as febrile seizures commonly occurring in young children during episodes of fever. Additionally, certain types of seizures and epilepsy syndromes are more prevalent in specific age groups. The impact of seizures on cognitive and developmental aspects vary, and the manifestations of seizures differs based on the child's age and stage of neurological development.

‍

What are the signs of seizures in infants and young children?

The signs of seizures in infants and young children vary widely but include:

• Staring spells or unresponsiveness
• Repetitive movements, such as lip smacking or hand clapping
• Jerking movements of the arms or legs
• Loss of consciousness or awareness
• Changes in muscle tone, such as stiffness or limpness
• Breathing difficulties or unusual vocalizations
• Gastrointestinal symptoms, like vomiting or drooling

It's important for parents and caregivers to be attentive to any unusual behavior and seek medical attention if seizures are suspected.

‍

How do seizures affect a child's development and learning?

Seizures have varying effects on a child's development and learning, depending on factors such as seizure frequency, type, and underlying cause. Frequent or prolonged seizures impacts cognitive function and academic performance. Children with epilepsy face challenges in attention, memory, and executive functions. Early intervention and appropriate management, including medication and support services, are crucial to minimizing potential developmental delays and optimizing a child's learning environment.

‍

What are the treatment options for seizures in children?

The treatment of seizures in children often involves a combination of approaches:

• Antiepileptic Medications: These medications help control and prevent seizures. The choice of medication depends on the type of seizures and the child's individual characteristics.
• Ketogenic Diet: In some cases, a ketogenic diet that is high in fats and low in carbohydrates  recoismmended, as it has been shown to be effective in reducing seizures in some children.
• Vagus Nerve Stimulation (VNS): VNS is a non-drug therapy that involves the implantation of a device to stimulate the vagus nerve, helping to prevent seizures.
• Surgery: In certain cases where seizures are not well-controlled with medications, surgical options, such as resective surgery or corpus callosotomy, is considered.

‍

Early diagnosis, a tailored treatment plan, and ongoing monitoring are essential to managing seizures in children and promoting their overall well-being and development. Parents should work closely with healthcare professionals to address the specific needs of their child and optimize the treatment approach.

Is it Safe to Put Something in the Mouth of a Person During a Seizure?

No, it is not safe to put anything in a person's mouth during a seizure. This is a common misconception. Placing an object in the mouth causes teeth, jaw, or airway injury. It's essential to ensure the person's safety by clearing the area and turning them on their side to prevent choking. The myth of swallowing the tongue during a seizure is not true; there's no need to put anything in the person's mouth.

Can Seizures be Fatal?

While most seizures are not fatal, they lead to complications, especially if proper first aid is not administered. For instance, injuries sustained during a seizure, such as falls or accidents, are serious. Additionally, if a seizure leads to losing consciousness while swimming or driving, it is life-threatening.

In rare instances, seizures lead to SUDEP, a sudden, unexplained death in a person with epilepsy, often linked to a seizure. However, it's important to note that SUDEP is extremely rare and occurs in a small percentage of individuals with epilepsy. Proper management, medication adherence, and seizure safety precautions significantly reduce the risks associated with seizures.

Medications for seizure control

Medications known as antiepileptics or anticonvulsants are given to people with epilepsy to help reduce their seizures. The choice of medication depends on the specific type of seizure and the individual's overall health.

Common medications include Carbamazepine (Tegretol), Valproic Acid (Depakote), Phenytoin (Dilantin), Lamotrigine (Lamictal), Levetiracetam (Keppra), and Topiramate (Topamax). Each medication targets specific seizure types and requires careful monitoring for effectiveness and potential side effects. Proper management and adherence to medication regimens are crucial for controlling seizures and improving the quality of life for individuals with epilepsy.

How to assist someone taking seizure medication?

To assist someone with seizure medication, make sure they take it as prescribed and on schedule. Encourage a consistent routine, use pill organizers, and help with medication refills. Monitor for any side effects and support them in communicating concerns to their healthcare provider. Emotional support and understanding are essential in helping them maintain their medication regimen effectively.

Which type of seizure requires the most immediate response?

Status epilepticus is the most critical type of seizure that demands an immediate response. Status epilepticus is a medical emergency where a seizure lasts for more than 5 minutes or when a person experiences consecutive seizures without regaining consciousness in between. This condition requires urgent medical intervention, including administering emergency medications and seeking immediate professional medical help. Status epilepticus is life-threatening, emphasizing the need for a swift and appropriate response to ensure the person's safety and prevent complications.

How does epilepsy relate to seizures?

Epilepsy and seizures are closely related, but they are not the same. Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. In other words, epilepsy is a condition in which a person experiences a tendency to have seizures due to abnormal electrical activity in the brain. Seizures, on the other hand, are the visible or perceptible signs of this abnormal electrical activity.

Epilepsy is diagnosed when a person experiences two or more unprovoked seizures. Unprovoked means that a specific trigger, such as fever, head injury, or drug withdrawal, does not cause the seizures. It is important to note that not all seizures are due to epilepsy. Specific factors provoke some seizures and don't recur once the underlying cause is treated or removed.

Are there any common triggers for seizures?

Yes, there are several common triggers that provoke attack in individuals with epilepsy. It's important to note that triggers vary from person to person, and what affects one individual doesn't affect another. Some common triggers for seizures include:

1. Missed Medications: Skipping or missing doses of anti-epileptic medications disrupt the balance of chemicals in the brain, potentially triggering seizures.
2. Lack of Sleep: Sleep deprivation or irregular sleep patterns lower the threshold, making a person more susceptible to seizures.
3. Stress and Anxiety: Emotional stress, anxiety, and other strong emotions trigger attack in some individuals.
4. Flickering Lights: Intense or flashing lights, such as those from strobe lights or video games, trigger seizures in susceptible individuals. This condition is known as photosensitive epilepsy.
5. Alcohol and Drug Use: Excessive alcohol consumption and certain recreational drugs lower the seizure threshold and trigger seizures.
6. Hormonal Changes: Hormonal fluctuations, especially in women during menstruation, pregnancy, or menopause, trigger seizures.
7. Illness and Fever: High fever, especially in children, sometimes triggers febrile seizures. Other illnesses, particularly those causing high fever and dehydration increase the risk of seizures.
8. Low Blood Sugar (Hypoglycemia): Severe blood sugar levels drop, often seen in individuals with diabetes, trigger seizures.
9. Certain Medications: Some medications, including certain antidepressants and antipsychotics, lower the threshold and trigger the attack.
10. Specific Stimuli: Certain smells, sounds, or tastes trigger seizures in some individuals. This phenomenon is known as reflex epilepsy.

Individuals with epilepsy must identify and avoid their specific triggers whenever possible. This helps manage and reduce the frequency of seizures. Keeping a diary, which records events, activities, sleep patterns, and other factors, helps identify potential triggers and patterns. Additionally, working closely with a healthcare provider or neurologist is essential in managing epilepsy effectively.

What are the most effective seizure prevention strategies?

Managing epilepsy and preventing seizures often involves a combination of strategies tailored to the individual's specific needs and triggers. Here are some of the most effective prevention strategies:

• Stick to your medication: Regularly taking your prescribed anti-epileptic drugs as your doctor advises is key to preventing attack.
• Identifying Triggers: Identifying and avoiding specific triggers, such as lack of sleep, stress, or flashing lights, reduces the risk of seizures. Keeping a seizure diary to track activities and potential triggers is helpful.
• Healthy Lifestyle: Maintaining a regular sleep schedule, managing stress through relaxation techniques or counseling, and adopting a healthy diet and regular exercise routine contribute to overall well-being and help manage attack.
• Avoiding Alcohol and Recreational Drugs: Alcohol and certain recreational drugs lower the seizure threshold. Avoiding these substances reduces the risk of seizures.
• Seizure Response Plans: Developing and sharing a response plan with family, friends, and coworkers ensure that people around the individual know how to assist during a seizure, minimizing potential injuries.
• Medication Review: Regularly reviewing medications with a healthcare provider is important to assess their effectiveness and potential side effects. Adjustments in dosage or changes to different medications  are necessary.
• Medical Identification: Wearing a medical alert bracelet or necklace that indicates the individual has epilepsy is essential in emergencies. It provides crucial information to healthcare professionals about the person's condition and medications.
• Vagus Nerve Stimulation (VNS) Therapy: VNS therapy is a treatment option that involves a small device implanted under the skin of the chest. It sends regular, mild pulses of electrical energy to the brain via the vagus nerve, potentially reducing the frequency and severity of spasm.
• Ketogenic Diet: In some cases, following a ketogenic diet, which is high in fats and low in carbohydrates, help control attack, especially in individuals who do not respond well to medications.

What are the legal rights of people with seizure disorders?

People with seizure disorders are protected by various laws that prohibit discrimination and ensure equal opportunities. In the United States, the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities, including those with epilepsy. This legislation ensures equal access to employment, public services, and accommodations. Individuals are entitled to reasonable accommodations in the workplace or educational settings to help facilitate their participation and success.

‍

How schools and workplaces accommodate individuals with seizures?

Schools and workplaces provides accommodations for individuals with seizure disorders to ensure their safety and equal participation. Examples of accommodations include:

• Training staff and colleagues on first aid.
• Developing individualized action plans.
• Allowing flexible schedules or work-from-home options if needed.
• Ensuring a safe environment, such as padded flooring or seizure-safe equipment.
• Providing additional time for assignments or exams if cognitive effects impact learning.

Open communication and collaboration between patients, their healthcare providers, and school or workplace authorities are crucial for implementing effective accommodations.

‍

What social support is available for people with seizures and their families?

Several organizations and support groups offer social support and resources for individuals with seizures and their families. Examples include the Epilepsy Foundation, local epilepsy organizations, and online communities. These groups provide a platform for sharing experiences, obtaining information, and connecting with others facing similar challenges. Healthcare providers offers guidance and connect individuals with appropriate support services.

‍

How awareness about seizures be increased in the community?

Raising awareness about seizures is essential to dispel myths, reduce stigma, and promote understanding. Strategies for increasing awareness include:

• First Aid Training: Schools, workplaces, and community organizations enroll or host educational programs that cover essential information about seizures, their causes, and first aid measures. Basic First aid training empowers community members to respond effectively in case of a seizure.
• Community Events: Participating in or organizing community events dedicated to epilepsy awareness, such as walks, seminars, or information sessions,  helps disseminate accurate information and encourage community engagement.
• Social Media Campaigns: Leveraging social media platforms to share educational content, personal stories, and resources contributes to reaching a broader audience and promoting informed discussions.
• Collaboration with Healthcare Providers: Encouraging healthcare providers to actively engage in community education and outreach, including organizing workshops or training sessions on seizure first aid, enhances community preparedness and responsiveness.

By incorporating first aid training into awareness initiatives, communities increase understanding and equip individuals to provide immediate assistance when someone experiences an attack, ultimately contributing to a safer and more supportive community environment.

‍

Sources:

Shellhaas RA. Seizure classification, etiology, and management. Handb Clin Neurol. 2019;162:347-361. doi: 10.1016/B978-0-444-64029-1.00017-5. PMID: 31324320.

Jiménez-Villegas MJ, Lozano-García L, Carrizosa-Moog J. Update on first unprovoked seizure in children and adults: A narrative review. Seizure. 2021 Aug;90:28-33. doi: 10.1016/j.seizure.2021.03.027. Epub 2021 Mar 30. PMID: 33840584.