Epilepsy

Alternative names:

seizure disorder

Treatment:

If a seizure occurs, give appropriate emergency first aid.

EMERGENCY FIRST-AID TREATMENT, during generalized tonic-clonic seizure:

• Protect the person from injury. Do not attempt to force a hard object (such as a spoon or tongue depressor) between the teeth, because you can cause more damage than what you are trying to prevent!
• Clear the area of furniture or other objects that may cause injury from falls during the seizure. Do not attempt to restrain or hold the person down during the seizure.
• Protect from aspiration (inhaling) of vomit or mucus. Turn the person onto the side if vomiting occurs. Keep the person on the side while he or she sleeps after the seizure is over.

If the person having seizures turns blue or stops breathing, turn him or her to the side to keep the airway open and prevent the tongue from obstructing the airway. Breathing usually starts on its own once the seizure is over. CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure. Repeated or prolonged seizures (status epilepticus) may cause severe lack of oxygen in the body and are an emergency situation requiring immediate professional assistance.

EMERGENCY MEDICAL TREATMENT (status epilepticus):

• Obtain professional medical assistance immediately.
• Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as appropriate.
• Intravenous glucose may be administered to the person on the chance that low blood sugar is responsible for the seizure.
• Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications (such as phenytoin and phenobarbital) may be used to control prolonged, repeated, generalized seizures. They are usually injected into a vein. Other medical treatment may be indicated, including use of general anesthesia with neuromuscular blockade ("muscle paralyzers").
• After status epilepticus is controlled, oral anticonvulsants are begun and tests are performed to determine the cause of the condition.

AFTER A SEIZURE
Record details of the seizure to report to the health care provider. Important details include date and time of the seizure, how long it lasted, which body parts were affected, the type of movements or other symptoms, possible causes, and other factors noted.

Isolated seizures are treated as specific for the type of seizure and the suspected cause (see the specific seizure type for details). Generally, this includes treatment of the cause and/or use of anticonvulsant medications.

Treat any injuries from bumps or falls.

AFTER DIAGNOSIS OF EPILEPSY (seizure disorder):
Treatment of causes, if a cause has been identified, may stop the occurrence of seizures. This may include medical treatment of disorders, surgical repair of tumors or brain lesions, or other treatments.

Oral anticonvulsants prevent or minimize the number of future seizures. Response is individual, and the medication used and dosage may have to be adjusted repeatedly.

Types of seizures and the corresponding medications:

• Petit mal seizures usually respond best to valproic acid or ethosuximide. Clonazepam or other medications may also be used.
• Grand mal seizures usually respond best to phenytoin, carbamazepine, valproic acid, or phenobarbital. Primidone or other medications may also be used.
• Focal seizures or partial complex seizures usually respond to phenytoin or carbamazepine.

Follow-up for re-evaluation should occur at least yearly. Monitoring of plasma drug levels is important for the continued control of seizures and the reduction of side effects. Pregnancy; lack of sleep; skipping doses of medications; use of drugs, medications or alcohol; or illness may cause seizures in a person with a previously well-controlled seizure disorder.

Use of informational jewelry or cards (such as Medic-Alert or similar) that indicate a seizure disorder may be advised to aid in obtaining prompt medical treatment if a seizure occurs.

Support groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See epilepsy - support group.

Expectations (prognosis):

Seizure disorder (epilepsy) is a chronic, usually lifelong condition. In some cases, the need for medications may be reduced or eliminated over time. A seizure-free period of 4 years may indicate that reduction or elimination of medications is possible.

Death or permanent brain damage from seizures is rare but can occur if the seizure is prolonged or 2 or more seizures occur in proximity (status epilepticus). Death or brain damage are most often caused by prolonged lack of breathing and resultant death of brain tissue (infarction) from lack of oxygen (ischemia).

Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment, so these activities may be restricted for people with poorly controlled seizure disorders.

Infrequent seizures may not severely restrict the person's lifestyle. Work, school, and recreation do not necessarily need to be restricted.

Complications:

• prolonged seizures or closely occurring seizures (status epilepticus)
• injury from such actions as falls, bumps, biting self
• injury from having a seizure while driving and/or operating machinery
• aspiration of fluid into the lungs and subsequent aspiration pneumonia
• permanent brain damage (stroke or other damage)
• difficulty with learning
• side effects of medications (with or without observable symptoms)

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if this is the first time the person has had seizures or this is a new type of seizure for the person; the seizure lasts longer than 2 to 3 minutes; or repeated seizures occur (over any amount of time). Two or more seizures that occur over a few minutes or when consciousness is not regained between them (status epilepticus) is an emergency situation.

Call your health care provider if questions or concerns arise or if any new symptoms occur, including possible side effects of medications such as changes in mental status (such as drowsiness, restlessness, confusion, and sedation), nausea/vomiting, a rash, loss of hair, tremors or abnormal movements, and problems with coordination.