EPILEPSY IN THE HOME

by Epilepsy Association of Scotland

Everyone faces potential hazards in the home. Accidents can be caused by unguarded fires, badly fused plugs, carelessness with chip pans, etc. Good safety procedures are important for everybody. For the person with epilepsy, additional risks may exist.

Those whose seizures are well controlled may need to take few extra precautions. However, those whose attacks continue to be frequent and unpredictable need to exercise particular care, especially if there is likely to be a sudden loss of consciousness with little or no warning. In such cases it may be appropriate to seek advice from an occupational therapist.

Safety measures
Fires

Substantial fireguards are essential. These should be securely fixed to wall or floorboards so they cannot be knocked over during a seizure. Light-weight, free-standing, heaters are better avoided. Radiator guards may also-be necessary. Smokers should consider the fire hazards connected with smoking whilst in an armchair, in bed, or at any time when on their own.

Electrical gadgets

Trailing electrical flexes are dangerous. They can result in an appliance being pulled over during a seizure, which could cause a fire. Kettle guards, and cordless kettles and irons, are available and may help to prevent accidents. Always exercise great caution with all electrical gadgets and power tools.

Cookers

Pot handles should always be turned away so that pots cannot be accidentally knocked over during a seizure. Avoid carrying dishes of hot food or liquid about. Take the plates to the saucepan when dishing up, not the saucepan to the plates. Kettle tippers and pourers are available, to avoid carrying containers of hot liquid about.

If cooking for a small number of people, use several small dishes instead of one large one, so as to minimise the risk attached to lifting a large dish of hot food from the oven. A cooker guard can help to minimise the danger, while a microwave may be a suitable alternative to gas or electric cookers. A toaster may avoid the danger of a grill being left on.

Furniture and flooring

The risk of injury from falling during a seizure can be reduced by fitting shaped plastic pieces (available from ironmongers and supermarkets) over sharp corners of furniture.

Avoid very hard floor surfaces, which may cause injury in a seizure. Carpets with a high wool content are less likely to cause friction burns than those with a high synthetic content. Sealed cork tile or vinyl cushion floor can be used in wet areas (such as bathrooms and kitchens).

Glass doors

Toughened glass is available for glass doors, low windows, etc., and can greatly reduce the risk of injury if a seizure occurs nearby. Alternatively, rolls of safety film can be purchased (e.g. from Mothercare), and applied to glass surfaces, to prevent dangerous splintering in the event of impact.

Baths

Water is always a potential hazard, and extra care needs to be taken when bathing. Keep the depth of water in the bath to just a few inches, and do not use very hot water. Do not get into the bath until the taps have been turned off.

A shower is a good alternative to a bath, although it is not entirely risk-free. To avoid the possibility of scalding if a seizure occurs, ensure that the water temperature control is effective, and never use very hot water. Avoid a shower with a high lip, where the water could be trapped if a fall resulted in a blocked exit pipe. Ideally, attach a shower fitting to the bath taps, and take a shower sitting down in the bath without the plug in. If seizures are frequent and unpredictable, let someone know when you are taking a bath or shower.

Bathroom/toilet doors

If possible, it is wise to hang the door so that it opens outwards. Hence the door will not be blocked if a person falls behind it. Locks are better avoided, so that help can be quickly at hand if required. Some families use special safety locks that can be operated from outside in an emergency. Others find that a cardboard "engaged" notice hung over the outside door handle is all that is needed.

Bedrooms

For people who have seizures during sleep, a bed placed against a wall, or with protective cushions around it, can help to minimise injury caused by falling out of bed. Sharp objects such as bedside tables and cabinets should be kept away from the bed.

Soft pillows can be dangerous if seizures occur at night, and some people with epilepsy choose to sleep without one. Others use special safety pillows, such as those manufactured by either Melco Products (High Street, Tottington, Bury, Lancs) or Helpful Hands (2 Chester Road, Macclesfield, Cheshire).

Television

A small proportion of people with epilepsy are photosensitive, i.e. their seizures may be triggered off by flashing or flickering lights. Such people need to take special care when watching television. The set is best placed at eye level, at least three metres away from the viewer, with a small illuminated lamp on top.

Stairs

For those who have frequent and unpredictable seizures, stairs can be a major hazard. It is diffiucult to avoid using the stairs, although with planning it can perhaps be kept to a minimum number of occasions. Stair gates at both the top and bottom of stairs may be useful in preventing accidents.

Some people with epilepsy also have mobility difficulties, and need the assistance of a stair lift or vertical lift. Neither of these options is risk-free. Where a vertical lift is used, it should (if possible) have a padded interior, since the confined space could be hazardous in the event of a seizure. Safety straps used in a stair lift should be kept to simple lap straps, as a full harness could cause injury during a seizure.

There is no perfect solution where stairs and stair lifts are concerned, and to a certain extent it is a matter of arriving at a compromise between the different needs of the person and what is practicable in the home.

Protective headgear

For those who have frequent, unpredictable seizures with the possibility of injury to the head and/or face, protective helmets are available. The hospital consultant can prescribe such equipment where it is felt appropriate.

Alarms

There are a number of different types of alarm available, which may be effective for a particular individual:

• personal alarms, suitable for alerting another person in close proximity
• telephone alarms, which can be operated by remote control
• fall alarms, sensitive to a person falling to the ground
• bed alarms, which can pick up unusual sound or movement during sleep
• baby intercom alarms, which can alert someone in another room to a sleep seizure

In certain cases, an alarm may neither be suitable or helpful. For example, there must be someone else available to hear a fall alarm, and generally a person needs to have warning of a seizure in order for a telephone alarm to be useful.

Garden

If a parent has epilepsy and there are young children in the family, it is important to make sure that the children cannot wander off unsupervised should a seizure occur. Garden gates need effective locks. The advisability of using steps and ladders should be assessed on an individual basis.

Identification

Many people with epilepsy feel reassured by carrying some form of identification with them. Cards can be carried in a pocket, wallet, or handbag, and special jewellery is available. For example, bracelets and necklaces are available from either the Medic-Alert Foundation (12 Bridge Wharf, 156 Caledonian Road, London N1 9UU) or SOS Talisman (21 Grays Court, Ley Street, Ilford, Essex IG2 7RQ).

Medication

Remember that medication is a potential hazard for small children. Pills and tablets are easily mistaken for sweets, and the child who has watched a parent take medication may attempt to follow suit. Anti-epileptic and other drugs should be securely locked away. If there is an inquisitive toddler about, then be safety conscious about pills carried around in pockets and bags.

Perspective

Sometimes a diagnosis of epilepsy leads to over-reaction in the family, so that the person with epilepsy becomes hedged around with unnecessary restrictions. Relatives should remember that over-protection can undermine self-confidence. It is most important that people with epilepsy are encouraged to lead as full and active a life as possible. With this perspective in mind, safety precautions should be sensible, and relevant to the particular case of epilepsy involved.

It is advisable for all households to have a first aid kit and a first aid guide. "First Aid Manual", the authorised guide of St John Ambulance, St Andrew's Ambulance Association, and The British Red Cross is recommended.