Drug Seizures - Epilepsy First Aid

[Micklemouse]

Epileptic seizures are unfortunately a fact of life, & with the increased use of psychoactives, are only going to become more so.


As is being explored in the Epilepsy & drugs (http://www.drugs-forum.com/forum/showthread.php?t=19790) thread, there are many flavours of epilepsy/seizure-like activity, and many possible causes.


In brief though, the main causes when talking about drug use are overheating, overdose, poorly managed withdrawal from benzodiazepines or alcohol, the use of strobe lighting or 'brain machines' at raves, or a preexisting condition in combination with the above.


Please remember that one seizure does not an epileptic make. However, if you do have a seizure, it is worth checking out whether an underlying condition has come to the fore.


For clarity's sake, I'm going to be looking at what to do when faced with the scariest & most dramatic of seizures - the Tonic/Clonic or Grand Mal seizure. We're talking full on convulsions, loss of consciousness, incontinence, confusion & a distinct loss of dignity here folks. Hold on to yer hats, kittlings...


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



So, you're there with your mates, having a giggle, doing what you do, when all of a sudden one of the group starts to feel a little bit woozy for no apparent reason, maybe has a bit of difficulty speaking or is just a little bit too twitchy. Then - BANG! - they go stiff, cry out, they're on the floor, eyes rolling back, convulsing. Congratulations (not!), you're witnessing a seizure. Scary, aint it?


So, what to do?


Rule Number 1 - don't panic! Even if the person appears to stop breathing - erratic breathing is a common feature, & usually sorts itself out.

Rule Number 2 - make sure the person having the fit has plenty of space around them. Clear away any potential hazards - furniture, glasses & other breakables, people. The last thing your mate is going to want is to come round to a group of people gawking; s/he is going to need plenty of air around them, and not only that, but people get hurt if caught in the crossfire

Rule Number 3 - under no circumstances try to restrain the person having the fit, or try to stick your fingers or other objects into their mouth in attempt to stop them swallowing or biting their tongue. People having seizures of this nature are incredibly strong, and you run the risk of getting seriously hurt, as well as potentially hurting the person having the seizure. People have lost fingers after putting them in the mouth of someone having a seizure - don't do it!

Rule Number 4 - protect the head if possible. If it's safe to do so (usually after the seizure has ended, but sometimes possible during) try to get a thin cushion or some clothing under the person's head. Again, do not try to restrain the head - you could very easily end up breaking the person's neck.

Rule Number 5 - take notes. Grab a pen & paper & a watch. Time & note the length of the seizure. If it lasts for longer than 5 minutes call an ambulance. Also take note of the length of time it takes to recover (i.e. regain consciousness) - this can be from a minute or two to an hour or so. So long as the person is breathing there is no need to worry. If the person goes into another fit before regaining consciousness (Status Epilecticus), make a note of the time again, and call an ambulance. If the person is having fits in rapid succession, time & note the duration of each fit, & the length of time (if any!) between them. Again, call an ambulance. You could save their life. This is no time to be worrying about getting into trouble kittlings - be honest with the ambulance crew, telling them what, if anything the person has taken, or if they are withdrawing from anything.

Rule Number 6 - as soon as it's safe to do so, i.e. when the seizure is over, move the person into The Recovery Position (http://www.health.harvard.edu/fhg/firstaid/recovery.shtml)

Rule Number 7 - keep talking to the person who's had the fit in as reassuring a manner as possible, considering how freaked out you're going to be. Although they may be unconscious for all intents & purposes, many people report having an awareness of what is going on post seizure, & appreciate that someone was there telling them what was going on, & that everything is going to be o.k. A common feature of people regaining conscousness after a fit is confusion - having a constant, calm voice talking to them throughout the episode and afterwards has been known to lessen this. Memory loss is also common, with people being unable to remember events immediately preceding the seizure, & sometimes not being able to remember events going back for days & occasionally weeks. Again, reassurance & patience is needed - these memories will return.

Rule Number 8 - if possible have a blanket & a change of clothes handy. Another common feature of tonic/clonic seizures is incontinence. It is important to preserve as much dignity as possible for the person who's had the fit - when in The Recovery Position (http://www.sja.org.uk/firstaid/info/recoveryPosition.asp) cover the person with a blanket in case they do have a 'little accident'.

Rule Number 9 - no food or drink until the person is fully recovered - i.e. fully conscious & aware of their surroundings, what day it is, who they & you are - & absolutely no more drugs or alcohol unless given by a doctor or paramedic!

When to call an ambulance - it is generally a good idea to call an ambulance if this is the person's first seizure, although if the person makes a good recovery, with no subsequent seizures, it's not always necessary - do get the person checked out at the earliest possible opportunity though - a random seizure could be the result of anything from overheating or overstimulation to an indication of lesions or worse on the brain. It does become necessary, however, if -

1) the person sustains injury during the fit, especially to the head. Concussion isn't fun, & heightens the chances of further fits & other complications.

2) the person's fit lasts longer than 5 minutes.

3) the person has another fit before regaining consciousness.

5) the person is known to be withdrawing from alcohol or benzodiazepines.

4) you feel it is the best thing to do in the circumstances.


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


As stated earlier, this 'care-plan' only covers tonic/clonic seizures. there are many other forms of seizure, most involving changes in consciousness or behaviour...

From http://www.epilepsy.org.uk/info/firstaid.html



Seizures involving altered consciousness or behaviour
Simple partial seizures
Twitching, numbness, sweating, dizziness or nausea; disturbances to hearing, vision, smell or taste; a strong sense of deja vu.

Complex partial seizures
Plucking at clothes, smacking lips, swallowing repeatedly or wandering around. The person is not aware of their surroundings or of what they are doing.

Atonic seizures
Sudden loss of muscle control causing the person to fall to the ground. Recovery is quick.

Myoclonic seizures
Brief forceful jerks which can affect the whole body or just part of it. The jerking could be severe enough to make the person fall.

Absence seizures
The person may appear to be daydreaming or switching off. They are momentarily unconscious and totally unaware of what is happening around them. DO...
Guide the person from danger
Look for an epilepsy identity card or identity jewellery
Stay with the person until recovery is complete
Be calmly reassuring
Explain anything that they may have missedDON'T...
Restrain the person
Act in a way that could frighten them, such as making abrupt movements or shouting at them
Assume the person is aware of what is happening, or what has happened
Give the person anything to eat or drink until they are fully recovered
Attempt to bring them round Call for an ambulance if...
You know it is the person's first seizure
The seizure continues for more than five minutes
One seizure follows another without the person regaining consciousness between them
The person is injured during the seizure
You believe the person needs urgent medical attention More links...

MedlinePlus Medical Encyclopedia: Epilepsy (http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm)

MedlinePlus: Epilepsy (http://www.nlm.nih.gov/medlineplus/epilepsy.html) (Links galore in this one!)

Epilepsy - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Epilepsy)

E-epilepsy - Epilepsy and memory (http://www.e-epilepsy.org.uk/pages/articles/show_article.cfm?id=100)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Any questions?

[IHrtHalucingens]

Very good micklemouse, as a person who has had epilepsy in the past, i can say that these are good tips. Particularly the giving them space after they regain conciousness and talking in a reassuring manor, having a seizure can be a very traumatic experience and if everyone else is freaking out its only natural for the person who suffered it to do so as well.

[bewilderment]

I think it would be nice to add that perhaps if one has anticonvulsants around the house then it may be a good idea to give the person a dose if the person is not in a situation where an ambulance needs to be called. At least, I think that would be a good idea since they immediately IVed me valium in the ambulance when I had a grand mal seizure in 2001 that was not related to drugs.

And, yes, it is traumatic so keep in my mind the person probably won't understand what exactly is going on for awhile. When I had mine, I couldn't seem to recall about an hour's worth of time (the time directly before my seizure) and I never did recover the memory of that hour. When I regained consciousness I still thought I was where I had been an hour ago, which was not my home, even though I was sprawled out on the floor of my home. It took me a little while to even understand that I'd had a seizure...all I knew was that my mother and stepdad seemed to be somewhat frantic and I couldn't make sense of what was going on and then I saw the paramedics...I still didn't know what had happened until I was settled on the stretcher and someone could calmly explain what had happened and it still didn't really make sense to me. People kept asking if the experience was frightening, but I'd have to say "no, because I didn't have a clue what was going on and I didn't remember anything traumatic or strange like auras or anything." It was a trip, but not one I'd like to repeat :P

[Micklemouse]

I think it would be nice to add that perhaps if one has anticonvulsants around the house then it may be a good idea to give the person a dose if the person is not in a situation where an ambulance needs to be called. At least, I think that would be a good idea since they immediately IVed me valium in the ambulance when I had a grand mal seizure in 2001 that was not related to drugs.



It would be nice. It could also be dangerous. Not advisable unless you have medical training or the person is under medical supervision. Apart from the benzo's used in epilepsy, anticonvulsants (Carbamazepine, Sodium & Semi-Sodium Valproate, etc) are a nasty class of drug, requiring careful titration & monitoring due to the long list of side effects & interactions. You may not know what other medication the person is on, or what other physical conditions they may have.

Again - no drugs, not even valium, until checked out by a medic.

[Jatelka]

No Questions: Advice spot on as always. Will however stress though:

NOTHING IN THE PERSONS MOUTH. SWIJ has seen broken teeth and a severed finger as a result!

SWIJ would definitely agree: No drugs until checked by a medic.

There are so many different sorts of epilepsy (which respond to many different drugs) that self medication can NOT be recommended.

This is too serious to self diagnose/medicate people.

[old hippie 56]

As a caregiver for my spouse, have witness many grand mal type seizures. The best advice is try to stay calm. The first one I seen was bad, wasn't prepared for it. Always got a seizure kit laying around. Again, no meds until checked out. It will throw off their blood level in case a dose change is needed.

[bewilderment]

Yeah, I was wondering about the safety of administering anticonvulsants, but was unsure. I think that a benzo like valium or xanax may be safe, but others definately should not be used. I was just suggesting perhaps it may be something to help so long as one knows the person well and knows if they are on any sort medications and knows that person's medical history. But, you're right, it's probably best not to give anything to the person unless a medic has already assessed the situation and says that it's okay. I suppose there could be any number of things going wrong physically that could cause a seizure and if one had already been on drugs which caused the seizure then it's best not to do any self-diagnonsense.

[Micklemouse]

From http://www.epilepsy.org.uk/info/firstaid.html


Status Epilepticus A prolonged seizure or series of seizures without regaining consciousness is called ‘status epilepticus’ and is a medical emergency.


Lack of normal respiratory movements combined with extreme muscular contractions during a seizure puts stress on the cardiovascular system. The continuing lack of oxygen may lead eventually to brain damage.


Status epilepticus is usually convulsive, but sometimes it can be non-convulsive ie. absence or complex partial status. This will need intervention, although the urgency is not as great. Status epilepticus is a rare occurrence, except in a very few patients with difficult to control epilepsy.


When status epilepticus occurs a doctor will usually give an intravenous injection of diazepam at the scene of the seizure or in hospital. Other intravenous compounds may be used as an alternative.


Diazepam can now also be given in the form of a rectal application. It can be administered by a trained, competent and willing individual, who has received permission from the person or the parents of the person with epilepsy.
It is reassuring for some parents to feel they can use this treatment at home. Ultimately it is safer and quicker in an emergency situation and allows the person with epilepsy to lead a broader lifestyle and participate in a wider range of activities.


(The above is based on the availability and use of diazepam in the UK - the practice in other countries may vary.)


Once again, with regards to medication, don't try this at home unless you a trained and named care-giver for the person with epilepsy, and only if this part of the person's care-plan for a diagnosed condition.

Do Not try shoving Valium up your friends anus.

Do not attempt this if it is the person's first seizure & you do not know what you are doing.

If someone goes into Status Epilepticus, call an ambulance immediately!

You could save their life.