12.2 Seizure types, first aid, and safety measures

Seizures can be scary, but knowing how to help is crucial. We'll look at different types of seizures, from tonic-clonic to absence seizures, and learn how to spot them. Understanding seizure emergencies and what happens after a seizure is key to providing proper care.

Managing seizures is about more than just first aid. We'll explore epilepsy, seizure precautions, and anticonvulsant medications. This knowledge helps us create safer environments for those with seizure disorders and respond effectively when seizures occur.

Types of Seizures

Generalized and Focal Seizures

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• Generalized seizures involve both sides of the brain and cause loss of consciousness
• Include tonic-clonic seizures (formerly known as grand mal seizures) which involve muscle rigidity (tonic phase) followed by muscle contractions (clonic phase)
• Also include absence seizures (formerly known as petit mal seizures) which involve brief lapses in consciousness without muscle activity (staring spells)
• Focal seizures (formerly known as partial seizures) begin in one area of the brain and may or may not cause loss of consciousness
• Simple focal seizures do not cause loss of consciousness but can cause sensory, motor, or psychic symptoms (auras)
• Complex focal seizures cause loss of consciousness and may involve repetitive movements (automatisms) such as lip smacking or hand wringing

Tonic-Clonic and Absence Seizures

• Tonic-clonic seizures are the most common type of generalized seizure
  • Tonic phase involves muscle rigidity and may cause the person to fall to the ground
  • Clonic phase involves rhythmic muscle contractions and may cause the person to bite their tongue or lose bladder control
  • Typically last 1-3 minutes but may be longer in some cases
• Absence seizures most commonly occur in children and are characterized by brief lapses in consciousness
  • May involve staring, eye blinking, or slight muscle twitching
  • Typically last less than 10 seconds but may occur frequently throughout the day
  • Can be mistaken for daydreaming or inattentiveness

Seizure Emergencies

Status Epilepticus

• Status epilepticus is a life-threatening condition characterized by a seizure lasting longer than 5 minutes or multiple seizures without regaining consciousness in between
• Can cause brain damage or death if not treated promptly
• Treatment involves administering anticonvulsant medications (benzodiazepines) to stop the seizure
  • If seizure does not stop with initial treatment, additional medications may be needed (phenytoin, levetiracetam)
  • In some cases, general anesthesia may be necessary to stop the seizure

Postictal State

• The postictal state occurs after a seizure and is characterized by confusion, drowsiness, and memory loss
• Can last minutes to hours depending on the type and severity of the seizure
• During this time, the person may be disoriented and have difficulty communicating or following commands
• It is important to stay with the person and provide reassurance until they have fully recovered
• In some cases, the person may experience postictal paralysis (Todd's paralysis) which is temporary weakness on one side of the body

Seizure Management

Epilepsy and Seizure Precautions

• Epilepsy is a chronic neurological disorder characterized by recurrent seizures
• Treatment involves taking daily anticonvulsant medications to prevent seizures
  • Common medications include carbamazepine, valproic acid, and levetiracetam
  • Medication adherence is important to maintain therapeutic levels and prevent breakthrough seizures
• Seizure precautions involve taking steps to prevent injury during a seizure
  • Avoid activities that could be dangerous during a seizure such as swimming or climbing ladders
  • Wear a medical alert bracelet or carry a card indicating that you have epilepsy
  • Inform family, friends, and coworkers about your condition and how to respond if a seizure occurs

Anticonvulsant Medications

• Anticonvulsant medications work by reducing the excitability of brain cells and preventing the spread of seizure activity
• There are many different types of anticonvulsant medications, each with its own mechanism of action and side effect profile
  • Some medications work by blocking sodium channels (carbamazepine, phenytoin) while others enhance the activity of GABA, an inhibitory neurotransmitter (benzodiazepines, valproic acid)
  • Side effects can include drowsiness, dizziness, nausea, and weight gain
• Medication selection is based on the type of seizure, age of the patient, and other medical conditions
• Regular follow-up with a neurologist is important to monitor medication effectiveness and adjust dosage as needed
• In some cases, surgery may be considered for patients with medication-resistant epilepsy