Epilepsy - First Aid, Treatment and Self-Care - Fact Sheet

“Epilepsy” is the term commonly used for a seizure disorder due to a disorder in brain functioning. One seizure alone is not enough for a diagnosis of epilepsy and may be a once-off occurrence. There are also other conditions, including an elevated temperature or chemical toxicity, which can cause seizures but which do not result in a diagnosis of epilepsy.

What to do if you have a seizure

See a doctor. A seizure may indicate a serious medical condition that needs urgent treatment. If the seizure is severe, you or somebody else should call an ambulance. If you are alone and have a severe seizure, it may take you some time to recover but you should still call an ambulance as soon as you are able to: A severe seizure that you were not expecting should be treated as a cause for concern.

There is frequently an “aura” before a seizure, which can include sensory hallucinations, dizziness or light-headedness, feelings of panic or déjà vu. On the other hand, there may be no warning at all. Recognising and acting upon pre-seizure sensations can be an important technique for preventing serious physical injury.

The diagnosis of epilepsy is not a simple process. It requires an intensive examination and, as stated above, the presence of one seizure may not lead to full epilepsy. Diagnosis may take some time, so be patient, and be prepared to try different medications until the most effective medication or combination of medications is found.

First aid for a seizure

The best form of assistance that you can provide to someone with epilepsy is to assist them with their medication if needed. In particular, you should assist them to adhere to the prescribed regime. If you have regular contact with someone who has epilepsy, such as a family member, you should acquire a first aid certificate and update your CPR qualifications annually.

An absence seizure should not normally result in any aid being necessary, but a tonic-clonic seizure is a cause for concern.

The fundamental rule for first-aid is always to make sure that you yourself are not injured. If someone is having a violent tonic-clonic seizure, you may need to let it run its course. Somebody having a tonic-clonic seizure can exhibit great strength and unpredictability of movement, and attempting to restrain them can result in serious injury to the first-aider or to the person being restrained. If you are able to provide treatment for a tonic-clonic seizure, the basic rule is to pad the head with a cushion or pillow if safe and feasible, move fragile or dangerous objects out of reach and be ready to call an ambulance if required. Do not attempt to force anything between the jaws to prevent biting or swallowing of the tongue – this used to be taught, but has been retracted. There is a much greater risk of injury with an object in the mouth, and there is no risk of swallowing the tongue – it is attached firmly to the back of the throat. In particular, never use your fingers – they could get bitten off.

After the seizure has run its course, or for a minor tonic-clonic seizure in which there is no violent movement but there is a loss of consciousness or conscious control, place the person in the lateral recovery position. Due to the structure of the lungs, placing them on their left side is slightly safer. If you do not know what the recovery position is, acquire or update your first aid certificate.

After the seizure

After the seizure has passed, the person will probably experience a period of confusion or tiredness and should be spoken to in a calm and quiet manner and protected from self-injury. Make sure that the person remains horizontal or otherwise in a safe position until they have recovered sufficiently to avoid a risk of falling. If they are unconscious or only partly unconscious, place them in the recovery position if you have not already done so. When they are lucid and no longer experiencing confusion or disorientation, advise them to seek medical aid. If there was any injury at all, call an ambulance.

Treatment

There is usually no cure for epilepsy but anticonvulsant medications are the most common treatment. Used correctly they can be very effective in preventing seizures. A medication must be taken when specified to maintain a constant level in the blood. A regular blood test is usually done to measure the amount of drug in the blood stream. Too much may have side effects such as dizziness or an upset stomach. Too low and there may be an increased risk of seizures. Keep track of the frequency of your seizures and notify the doctor or nurse of medication side effects in case the medication needs adjusting. Interactions may occur between an anticonvulsant and other medications. For example some anticonvulsants alter the action of birth control pills. It is important to tell any doctor prescribing medication for you that you are also taking anticonvulsants.

Surgery

Surgery may be considered if medications are not effective at controlling seizures. Obviously, if seizures are due to a malignant tumour or a life-threatening abnormality, treatment will be swift and surgery may be a first-choice option. The goal of surgery is to identify an abnormal area of brain cortex from which the seizures originate and remove it without causing any major functional impairment. Surgery is not a guarantee of a cure, and patients may either not improve or have fewer, more easily controlled seizures. Surgery may also result in a brain injury and the effects of that must be weighed against the benefits of the surgery.

In some cases where a seizure may begin in one half of the brain and spread to the other hemisphere, the spread can be prevented through a corpus callosotomy. The corpus callosum is a band of nerve fibres that connects the two hemispheres and allows them to share information. Cutting the corpus callosum can prevent seizure activity from spreading. As it also prevents normal information from spreading, the potential side-effects must be weighed against the benefits.

Diet

Some people with epilepsy may also benefit from a “ketogenic diet” as a short-term treatment. A ketogenic diet is high in fats and oils and low in carbohydrates and works by deliberately stressing the body into burning fat for energy. This induces a state called ketosis, normally only seen in chronic starvation, in which a side-effect of the consumption of fat is the build-up of chemicals called ketones in the body and brain. How this helps with epilepsy is not yet known, but it has been observed to be useful in cases where multiple drug therapies have not worked. It is most useful for children and for primary epilepsy, so may have limited use for adults who acquire epilepsy as a result of a brain injury. It can have serious adverse health effects if not well managed and should only be tried under strict medical supervision and dietary discipline. It is still a controversial treatment, in part due to a lack of research.

Living with Epilepsy

Having to cope with epilepsy as well as other problems from an ABI is not easy. But there are steps you can take to have some control over the situation:

• Take your medication on time and avoid alcohol, coffee and other stimulants
• Sleep well and minimise stress
• Avoid conditions that trigger seizures.
• Wear a Medic-Alert bracelet
• Get medical advice before driving.
• Inform your family and friends openly about epilepsy. They will feel more comfortable around you and be able to assist if you have a seizure.

Further Information

1. Epilepsy Queensland
http://www.epilepsyqueensland.com.au/
2. Epilepsy Action of Australia
http://www.epilepsy.org.au/
3. Epilepsy.com: Epilepsy and seizure information for patients and health professionals
http://www.epilepsy.com
4. First aid for Epilepsy
http://www.epilepsynse.org.uk/PAGES/info/leaflets/firstaid.cfm
http://www.epilepsy.org.au/first_aid.asp