How to Manage Seizures

A seizure is a transitory disturbance in consciousness or in motor, sensory, or autonomic function that is due to the uncontrolled electrical discharges in the brain. The electrical abnormality may arise from the central areas of the brain and immediately affect consciousness, or it may be restricted to the part of the cortex and produce signs and symptoms characteristic of that anatomical focus. The electrical abnormality may also begin in a localized area of the cortex, and then spread to the central brain, producing unconsciousness. Symptoms can include:

• Loss of consciousness
• Staring unresponsively
• Limb, head, or body stiffening or shaking
• Odd sensations in taste, smell, vision, sound, and touch
• Inability to interact with the environment through speech or understanding

Precipitating Factors

It is important to recognize predisposing factors for seizure activity and implement actions to prevent them, when possible. They include:

• Abnormal blood sugar levels
• Altered arterial blood gas levels
• Electrolyte imbalance
• Dehydration
• Endocrine changes
• Fatigue
• Emotional stress
• Illness, both febrile and non-febrile
• Nutritional deficiency
• Consumption of alcohol or other illicit substances
• Flashing lights (strobe, computer terminal, TV, movies)
• Medications and supplements that lower the seizure threshold

Types of Seizures

The Epilepsy Foundation groups seizures into two categories: primary generalized and partial seizures. They differ in how and where they begin in the brain.

Primary generalized seizures involve both sides of the brain at once and affect both sides of the body simultaneously. They include varying types, including:

• Absence (formerly known as petit mal)
• Tonic-clonic or convulsive (formerly known as grand mal)
• Atonic (also known as drop attacks)
• Clonic
• Tonic
• Myoclonic

Partial, or focal, seizures involve one side of the brain and there is a focal point where the seizure begins. The lobe of origination will determine the symptoms you see. The types of focal seizures, according to Epilepsy Ontario (2016), are seizures with awareness retention and awareness loss. The categories of partial or focal seizures can also be broken down into:

• Simple partial, during which consciousness is maintained but the localization may spread to other areas.
• Complex partial, during which consciousness is affected.
• Partial with secondary generalization, during which the local focus spreads to other areas of the brain.

Seizures and Traumatic Brain Injury

According to the Centers for Disease Control and Prevention (2016), seizures develop in the general population at a rate of 1-3%. Seizures are one of the most common medical complications seen in post-acute brain injury rehab. Statistically, seizures occur in:

• 5-7% of persons with traumatic brain injury (TBI)
• 11% of persons with non-penetrating but severe TBI
• 35-50% of persons with penetrating TBI

Seizures may result in alteration of awareness, muscular movements, sensory distortions, or combinations of the three. Explosive or violent behavior may also indicate an underlying, unrecognized seizure episode.

Seizures that happen within the week of brain injury should be treated promptly to prevent further brain damage. Seizures that happen later than one-week post-injury should also be treated, but preventing them is also important as they have a tendency to recur and are termed epileptic seizures.

Managing a Generalized Tonic-Clonic Seizure

This type of seizure is the most dramatic and can have the most significant consequences. To effectively manage a tonic-clonic seizure, you should:

• Ease the individual to the floor to prevent injury.
• Place them on their side to keep their airway clear when convulsing stops.
• Remove their eyeglasses.
• Protect them from nearby hazards.
• Loosen tight clothing around their neck.
• Protect their privacy.
• Check their pulse and respirations periodically.
• Offer verbal reassurance.
• DO NOT attempt to restrain them.
• DO NOT force anything into their mouth.
• DO NOT try to give liquids during or just after the seizure.

Take note of the:

• Onset (Was it sudden or preceded by an aura or specific activity?)
• Duration
• Parts of the body involved and symmetry of movements
• Strength of the seizure activity
• Occurrence of bowel or bladder incontinence
• State of consciousness (arousability, duration of unconsciousness, confusion, memory of the event)
• Pupillary changes
• Teeth (clenched or open)
• Gastrointestinal response, such as vomiting, belching, or flatulence
• Development of unusual behavior

After the seizure, continue to observe the person until they are fully alert, and follow your organization’s post-seizure protocols.

Status Epilepticus

Status epilepticus is a series of any type of seizures occurring in rapid succession or a prolonged seizure that has no end. It is an acute medical emergency that must be stopped immediately before cerebral hypoxia causes irreversible brain damage. If a seizure last longer than five minutes, emergency treatment should be initiated.

If you are in a community setting and observe someone having a seizure, you should abide by organizational procedure and activate EMS services when:

• An injury occurs.
• The seizure does not stop in 4-5 minutes.
• A second seizure occurs.
• The person requests an ambulance.

Managing a Complex Partial Seizure

Some important guidelines for managing a complex partial seizure include:

• Do not attempt to restrain the individual.
• Guide them gently away from harmful objects or dangerous situations.
• After the seizure, remain with them until they are fully alert.

Seizure Precautions

There are precautions that can be taken to minimize injury during seizure activity. Guidelines for safety you can implement in the healthcare setting include:

• Accurately administering prescribed medications and therapies.
• Utilizing appropriate injury prevention practices, such as padded side rails, as recommended by the IDT.
• Using a night light in the room.
• Having suction equipment available.
• Having an oral airway available for emergencies.
• Ensuring frequent nursing assessment.
• Encouraging regular physical exercise that is not overtaxing.
• Providing consistent opportunities for adequate sleep.
• Encouraging good nutrition.
• Limiting their alcohol and caffeine intake.
• Avoiding or minimizing environmental triggers.
• Encouraging showers instead of baths to avoid a drowning risk.
• Preventing constipation, fever, anxiety, and stress.