Epilepsy

I was in another training session for First Aid (with the Red Cross) today and we were discussing causes of unconsciousness and talked about Epilepsy. After a friend suggested to me and as I've had a fair bit of experience dealing with Epilepsy, I decided it would be my next post! As there's so much to say about Epilepsy, I'll focus on my experiences with epilepsy, but will provide basic information about other types.

Epilepsy is a complicated condition - once again one not fully understood. Sometimes damage to the brain is detected and this is believed to cause the seizures (or "fits"). This is Symptomatic epilepsy and an example would include a lady who had become epileptic after suffering head trauma (a patient who's consultation I sat in on while on Work Experience). However in other cases, epilepsy occurs with other conditions, such as learning disabilities (all my other experience dealing with epilepsy comes under this category). The learning disability hints there is some sort of brain damage, however no brain damage can be found. This is Cryptogenic epilepsy. In many cases, no obvious cause for the seizures can be found - that is, no brain damage. Seizures occur when neurones in the brain are disrupted, which causes the electrical impulses to cause the seizures.

There are many types of epilepsy. These are divided up into Partial and Generalised Seizures. The type of seizure depends on how much of the brain is affected. In Generalised Seizures, most or all of the brain is affected and, not surprisingly, in Partial seizures, only part of the brain is affected.


Partial Seizures
Partial seizures can be simple or complex. In simple partial seizures, the person will be conscious throughout the duration of the seizure, and so will remember it. In complex seizures, the person is unconscious for the seizure and can display unusual behaviours.

Generalised Seizures
There are 6 types of Generalised Seizures: Absences, Clonic, Atonic, Tonic Clonic, Myoclonic and Tonic. My experiences so far have involved Absences and Tonic Clonic seizures - so I'll focus on these in a minute. In Myoclonic jerks, the person experiences twitches as if being electrocuted. When these jerks persist and the person usually becomes unconscious, then they are experiencing a Clonic seizure. In a Tonic seizure, your muscles suddenly contract, which can cause you to fall over. In an Atonic seizure, the muscles relax, causing the person to fall to the ground.

Absences are very common and are seizures I have witnessed multiple times! During an absence, the person loses consciousness and appears to be daydreaming (which is why a lot of the time these seizures are missed). During a seizure, the person will not respond and will stare into space. Clients I work with who experience absences don't respond to name or any sort of visual stimulus (e.g. waving a hand in front of their eyes), have dilation of the pupils, cyanosis of the lips and can drop their head into their chest and blink rapidly. These seizures have also appeared to cause sudden changes in behaviours and the mood of the client, however do not always. When an absence occurs, the general approach is to quietly call their name until they come back round, especially as they can be disorientated after an absence.

Tonic Clonic seizures are what most people commonly associate with an "epileptic fit" and it is the most common type of seizure in people with epilepsy. Contractions and twitches cause the person to fall to the floor and jerk. This can involve banging their head, biting (it has been known for a person to bite their tongue very hard during a tonic clonic) and jerking their arms and legs. These normally last for up to 5 minutes, but vary depending on the person. In my experiences, they have lasted between 1 and 4 minutes. After a Tonic Clonic seizure, the person is normally fairly tired and will lay down for 10-45 minutes to recover. During a seizure, it is important to remove as many hazards as possible (without putting yourself in danger). Examples of this may include moving furniture to avoid the person causing injury to themselves or removing any objects that could cause injury. If possible, some people also put a soft object, such as a pillow, underneath the person experiencing the seizure's head in an attempt to prevent damage from repeatedly banging their head of the floor. Common drugs to be administered for Tonic Clonic include Diazepam (either rectally or through injection) and Buccal Midazolam (squirted onto the inside of the cheeks in the mouth). Thankfully, I've never had to administer either of these so far!

Status Epilepticus is where the person remains unconscious from a seizure for more than half an hour. This can be a single seizure or multiple (clusters). Medication is normally administered when this occurs or and ambulance is called as there is a risk of brain damage from a prolonged seizure.

While there is no cure for epilepsy, some people do seem to "grow out" of this condition. Most people learn to cope with it and the effects on their lives vary. For example, depending on your last seizure, you may or may not be eligible for a driving licence. AEDs (Anti-Epileptic Drugs) are prescribed to try to lessen the frequency of seizures.

There are multiple triggers, many of which are more common than the stereotypical "flashing lights" (photosensitive epilepsy), such as stress, blood sugar levels, dehydration and lack of sleep.