What is the difference between Epilepsy and a seizure?
Epilepsy is a disorder characterized by recurring seizures
A seizure is a brief, temporary disturbance in the electrical activity of the brain. This disruption results in the brain’s messages becoming halted or mixed up.
A seizure is a symptom of epilepsy
The brain is responsible for all the functions of the body, so experiences during a seizure will depend on where in the brain the epileptic activity begins and how widely and rapidly it spreads.
There are many different types of seizure and each person will experience epilepsy in a way that is unique to them.
- In the UK, there are over 600,000 people with epilepsy.
- Epilepsy is more common in children and people over 65, but anyone can develop epilepsy
- There are over 40 types of epilepsy, so just knowing that a person ‘has epilepsy’ tells you very little information about their epilepsy and the seizures that they have.
- Epilepsy can develop because of brain damage caused by a difficult birth, a severe blow to the head, a stroke, or an infection of the brain such as meningitis.
- In around six out of ten people, doctors don’t know the cause of their epilepsy.
- (Epilepsy Action, 2013)
Classification of Seizures
Seizures can be divided into two main groups:
Focal/ Partial Seizures
Generalised Seizure Types
Focal/ Partial Seizures
Symptoms can last from seconds to 1 – 3 minutes can
- mumbling or uncontrolled laughter
- Sucking, chewing or swallowing movements
- Plucking at or removing clothing
- May wander around as if drunk
Management of Focal/Partial Seizures
- Stay calm
- Guide the patient from danger
- Stay with the patient until recovery is complete
- Reassure and explain anything they have missed
- Restrain the patient
- Act in a way that could frighten them, such as making abrupt movements or shouting at them
- Give the patient anything to eat or drink until they are fully recovered
Tonic -Clonic Seizures
- Most common of the generalised seizure
- May have an aura leading into the tonic/clonic seizure
- Lose consciousness
- Usual duration 1-2 minutes
- May follow on from a focal seizure
Typical Absence Seizures
- Generally a childhood disorder
- May look blank and stare, lasting a few seconds
- Eye lid fluttering/blinking may occur
- May have minor facial movements or head drop
- Able to continue normal activity almost immediately
- Management of Absence Seizures
Record the time of day and frequency
Reassure if necessary
Repeat information that the patient may have missed
Seizures in a wheelchair – What should we do?
If a person with epilepsy uses a wheelchair or has mobility problems, their GP or epilepsy specialist should give them a care plan. This should include advice on how to help the person if they have a seizure. General advice about how to help someone who is having a seizure in a wheelchair.
- Put the brakes on, to stop the chair from moving
- Let them remain seated in the chair during the seizure (unless they have a care plan which says to move them). Moving them could possibly lead to injuries for both you and them
- If they have a seatbelt or harness on, leave it fastened
- If they don’t have a seatbelt or harness, support them gently, so they don’t fall out of the chair
- Cushion their head and support it gently. A head rest, cushion or rolled up coat can be helpful
- The person’s care plan should give advice on what to do after the seizure has finished. Eg it should say if it is safe to move them from the wheelchair to put them in the recovery position.
- Restrain their movements
- Put anything in their mouth
- Give them anything to eat or drink until they are fully recovered
- Attempt to bring them round
When should you call for an Ambulance?
You think the patient needs urgent medical assistance
The patient has any breathing difficulties following a seizure
It is a first seizure
The seizure continues for longer than normal
One seizure follows another without regaining consciousness
Usually seizures stop by themselves. However, if a seizure continues for more than 30 minutes (or one seizure follows another with no recovery in between) this is known as status epilepticus or ‘status’.
Status during a tonic clonic (convulsive) seizure is a medical emergency. For some people, missing doses of their medication can trigger status.
The emergency medication used for the treatment of status is usually a sedative
Sedative drugs have a calming effect on the brain and can stop a seizure. The point at which emergency medication is used depends on how long someone’s seizures usually last.
There are two most commonly used emergency medications;
Rectal diazepam – is given rectally (into the bottom).
Buccal midazolam – is given into the buccal cavity (the side of the mouth between the cheek and the gum) (can terminate seizure, can prevent further seizures)
As both these drugs are sedatives, they can cause breathing difficulties so the person must be closely monitored.
Carers require specialist training to give emergency medication. It is important that every individual who is prescribed these has a written plan (or protocol) for their carers to use.
Currently there is no cure for epilepsy. However, with the right type and dosage of anti-epileptic medication, approximately 70% of people with epilepsy could have their seizures completely controlled.
Anti Epileptic Drugs
- These drugs make the brain less likely to have seizures by reducing the excessive electrical activity (or excitability) of the neurones (nerve cells) that normally cause a seizure.
- Different drugs work in different ways, but they all aim to stop seizures happening.
What might trigger a seizure?
- Missed medication (Number 1 reason)
- Hormonal changes
- Lack of sleep/extreme fatigue
- Drug/alcohol use
Seizure Management Plan
- Seizure Management Plan should be in place & available agreed by:
- ¨patient’s Epilepsy Nurse Specialist
- Original Copy to travel with the patient (Epilepsy Passport)
- Updated yearly or more often if required
- Be aware of who is responsible for first aid
- Parent/carer should be informed of seizure ASAP
- Record seizure
IT WILL PROVIDE:
Description of seizure
Usual duration of seizure
Management of seizure
- What type or types of seizures did the person have?
- How long did their seizures last?
- When did the seizure happen?
- Warnings – were there any warnings before the seizure such as:
- a change of mood
- any sensations such as a ‘strange’ taste in the mouth or smelling a ‘strange’ odour, seeing spots or flashing lights or colours
- a strange feeling in the stomach, weakness, numbness, tingling, ‘pins and needles’ in the arms, legs or face
- Any sounds such as crying out or mumbling?
- Where there any triggers such as being tired or photosensitivity (seizures caused by flashing lights or moving patterns)?
Where were they and what were they doing when the seizure occurred? Were they:
- standing, sitting or lying down
- walking or sleeping
- What else where they doing?
- During the seizure;
- Did they fall down?
- Did they lose consciousness and, if so, for how long?
- Did their colour change such as:
- become pale
- become flushed
- become blue around the mouth or face
- How was their breathing?
- After the seizure did they
- Recover quickly and carry on with activities?
- Become confused and , if so, for how long
- Become agitated, aggressive, restless
- Need to sleep and, if so, for how long?
- Did they injure themselves and, if so, what were the injuries and how were they treated
- How long did it take for them to recover fully?
- How did they feel afterwards?
- Did they need to sleep afterwards?
- What medication are they taking? (This may be helpful if the person is taken to hospital).
- Is there anything else that may be helpful to know about their seizures?
- The National Society for Epilepsy
- The Brain and Spine Foundation
- The Equality Act (2010)
- The Equality and Human Rights Commission
- Brain Thunders
- The DVLA