HOW BEST TO RECORD SEIZURES

by Epilepsy Association of Scotland

It is important to keep a record of seizures. Few doctors ever see their epileptic patients having a seizure, and they rely heavily on the account of an observer (a relative, colleague, worker, teacher, instructor) in making a diagnosis. There are many different types of seizure, and a precise diagnosis is easier to make if a clear description of the seizures is available.

In addition, after diagnosis the doctor will welcome an on-going record of seizures, detailing the frequency of seizures and any changes that may occur in the pattern of the seizures or in the seizure type. Such information helps the doctor to prescribe appropriate treatment.

If you are caring for a person who has epilepsy you will need to know what to look for. You may miss important details if you do not understand their relevance. Parents may soon grow to recognise the features of epilepsy in their child. Others, such as care staff, may look after a number of people with epilepsy who are all affected differently. To ensure consistency of information in such instances, it may be advisable to develop a standard form of recording seizures.

Seizure stages

There may be several stages in a seizure, and each should be carefully observed and recorded.

Build-up and onset

This may last for several days in the form of a build-up of tension, or for only a few minutes. In some instances an "aura" (a partial seizure) consisting of odd sensations, such as an unpleasant smell, tingling feeling, or "butterflies" in the stomach, may precede a major convulsive seizure.

The seizure

This may be one of many types. Each seizure is individual to the person who has it (see "Introduction" for a description of seizure types).

After the seizure

Recovery may be immediate, quick, or may take a few hours. On rare occasions, effects may last for as long as several days in the case of an elderly person. After major convulsive seizures there is often confusion and drowsiness, and sometimes unsteady gait, headache, or slurred speech. The following questions should help you in gathering the information the doctor needs.

• What was the date of the seizure?
• What was the exact time of day?
• What was the person doing at the time?
• Had the person just fallen asleep, or woken up?
• What called your attention to the seizure (a cry, fall, stare, head turn)?
• Did the seizure progress slowly or quickly?
• How long did each stage of the seizure last?
• What parts of the body were affected?
• Was one side affected more than the other?
• Did the body become stiff?
• Did it jerk, twitch, or go into convulsions?
• Was the person unconscious?
• If not, was there any alteration in awareness?
• Did the skin show changes (e.g. flushed, clammy, signs of blueness)?
• Did the breathing change?
• Did the person talk, or perform any actions during the seizure?
• Was the person incontinent of bladder or bowel?
• Did the person vomit during the seizure?
• Did any injuries result from the seizure?
• How did the person behave after the seizure (alert, drowsy, confused)?
• After recovery did the person remember any unusual sensations before or at the onset of the seizure?
• How long did the person take to recover completely?
• If the person takes medication, when was the last dose before the seizure?
• Anything else associated with the seizure you think the doctor should know?

If you can answer all these questions you will provide a very full picture of the person's epilepsy. A complete account such as this can be very useful at the onset of epilepsy, or at times of change (e.g. a change in medication, or a change in the pattern of seizures). At other times it may only be necessary to keep a summarised record. At all times, the recording of information should be discreet, so that each seizure does not look more important than it is.