EPILEPSY - HOW BEST TO HELP

by Epilepsy Association of Scotland

Recognising epilepsy

Epilepsy is a tendency to have recurrent seizures (also called "fits" or "epileptic attacks"). These result from disturbances in the brain's normal electrical activity.

Seizures vary greatly from person to person. The nature of the seizure depends upon the part of the brain first affected, and on where and how fast the disturbance spreads.

One person in every 200 has epilepsy. Epilepsy affects people of both sexes, all levels of intelligence, all social backgrounds, and all racial groups. It is common in childhood and adolescence, but the onset can be at any age.

Epilepsy is not a disease, nor is it a mental illness. In most cases it can be effectively controlled with medication. Anyone can develop epilepsy after a head injury (e.g. at sport or in a road accident). Epilepsy can develop in the elderly when the blood supply to the brain diminishes because of ageing.

For most people with epilepsy, the attitude of others towards them is a much greater handicap than the epilepsy itself. What people with epilepsy most need is understanding and acceptance from the public.

Common types of seizure
Major convulsive seizures

In this type of seizure, also known as "tonic-clonic attacks", the person suddenly stiffens and may cry out, as air is forced out of the lungs by contracting muscles. He or she loses consciousness and falls down. Muscles soon relax, and breathing begins again. Limbs and body may jerk violently. The mouth fills with frothy saliva, occasionally bloodstained if tongue or cheeks have been bitten. The person may wet or soil himself. The jerking subsides, and the person becomes limp and pale. Consciousness returns spontaneously.

Some people recover quickly from a seizure. Others are dazed and confused, have a bad headache, and may need to sleep or rest.

Absence seizures

These consist of brief periods of interrupted consciousness easily mistaken for day-dreaming. The person (often a child) stops activity, remains motionless, and stares into space. Soon he or she resumes normal activity, and may not be aware that an attack has occurred.

Partial fits

These occur when a seizure involves nerve cells in part but not all of the brain. There may be involuntary movements, alterations in consciousness, slurring or loss of speech, inappropriate actions, and confusion. Sometimes a partial seizure develops into a generalised tonic-clonic seizure.

First aid for major seizures

A major seizure may appear dramatic and frightening to an observer. It is important to remember that the person affected normally feels no pain during the seizure, and will probably have little or no memory of it afterwards.

If you see a major seizure, keep calm and prevent others from acting rashly. You cannot stop a seizure once it has started. Let it run its course, and be ready to provide reassurance and an accepting attitude afterwards. The correct procedure is to:

• note the time
• clear a space around the person having the seizure
• cushion the head (e.g. with a rolled-up jacket)
• loosen tight neckwear
• remove spectacles, if worn
• as soon as possible, turn the person onto his/her side into the shock recovery position to aid breathing (see below)
• clear any excess of frothy saliva from the mouth

Reassure the person during the period of confusion which may follow the regaining of consciousness.

It is vital that you do not:

• move the person while the seizure is in progress, unless he/she is in immediate danger (e.g. in a busy road, at the top of stairs, at the edge of water, near a fire or hot radiator)
• restrict movements
• attempt to lift the person
• put anything between the teeth
• try to give medication while the seizure is in progress
• give anything to drink
• interfere unnecessarily with the person in the period immediately after the attack; let them recover in peace and quiet, but stay with them until confusion has passed

It is not usually necessary to call a doctor or an ambulance when a person known to have epilepsy has a seizure that follows the usual pattern for him or her.

Medical help

Call for proper medical help:

• if the seizure lasts considerably longer than is usual for the person concerned
• if one major seizure follows another without full recovery in between
• if the patient hit his/her head during the seizure, and there is no sign of consciousness being regained within ten minutes of the convulsions ceasing; unconsciousness could be due to concussion (some people sleep after a seizure; a person asleep responds when shaken, an unconscious person does not)
• if there is an injury that you cannot deal with (e.g. if you cannot stop bleeding)

If an infant is convulsing with high fever, medical help should be obtained quickly. Reduce temperature by removing clothing, sponging with tepid water, and using a cold fan.

The new recovery position

The guidelines for life saving have been altered to standardise the recommendations throughout Europe. The main change is to the recovery position. This is the position in which any unconscious casualty should be placed.

Other types of attack
Absence seizures

No action needs to be taken with this type of attack. The absences are usually very brief, and often pass unnoticed. If you witness an absence attack, stay with the person for a while, to make sure that they do not suffer any injury.

Complex partial seizures

Some people have seizures which put them temporarily into a state of altered consciousness. Behaviour may seem inappropriate (for example, lip-smacking or clutching at clothing). They may wander around purposelessly with a glazed expression.

During this type of seizure, the person should be accompanied and gently led away from any source of danger. Otherwise the seizure should be allowed to run its natural course.

Do not interfere unnecessarily with the person having the seizure, who may be feeling dazed or confused. Offer reassurance and acceptance afterwards.

Key points

Epileptic symptoms vary from person to person:

• seizures may occur frequently or rarely
• seizures may last for only a few seconds or for several minutes (not often longer)
• seizures may be mild or severe
• there may be partial or total loss of consciousness
• there may be only slight movement in part of the body or visible shaking of the whole body
• the same person can have more than one type of seizure