Introduction
A seizure is a sudden surge
of electrical activity in the brain. A seizure usually affects how a person
appears or acts for a short time. Many different things can occur during a
seizure.
of electrical activity in the brain. A seizure usually affects how a person
appears or acts for a short time. Many different things can occur during a
seizure.
Based on the type of behaviour
and brain activity, seizures are divided into two categories:
and brain activity, seizures are divided into two categories:
·
Generalized
Generalized
·
Partial
Partial
With these different
classes it tells when a patient has epilepsy.
classes it tells when a patient has epilepsy.
Generalized seizures are
produced by electrical impulses from throughout the entire brain. Partial
seizures are produced at least initially by electrical impulses in a relatively
small part of the brain the part of the brain generating the seizures is
sometimes caused the “focus”.
produced by electrical impulses from throughout the entire brain. Partial
seizures are produced at least initially by electrical impulses in a relatively
small part of the brain the part of the brain generating the seizures is
sometimes caused the “focus”.
Some common types of
generalized seizures
generalized seizures
There are six types of
seizures
seizures
a. Grand mal or generalized
tonic clonic
tonic clonic
b. Absence
c. Myoclonic
d. Clonic
e. Tonic
f.
Atonic
Atonic
Grand mal generalized tonic
clonic
clonic
In this case patient loses
consciousness and usually collapses and this is followed by generalized body
stiffening. During grand mal seizures, injuries and accidents may occur such as
tongue biting and accidents may occur such as tongue biting and urinary incontinence.
consciousness and usually collapses and this is followed by generalized body
stiffening. During grand mal seizures, injuries and accidents may occur such as
tongue biting and accidents may occur such as tongue biting and urinary incontinence.
Absence seizure
This seizure causes a short
loss of consciousness within a few seconds with few or no symptoms. If in the
case of a child, it interrupts the present activity of the child and the child
stares blankly. It may occur several times a day. Patients are not usually
aware that they are having a seizure, except that they may be aware of losing
time.
loss of consciousness within a few seconds with few or no symptoms. If in the
case of a child, it interrupts the present activity of the child and the child
stares blankly. It may occur several times a day. Patients are not usually
aware that they are having a seizure, except that they may be aware of losing
time.
Myoclonic seizure
This seizure consists of
sporadic jerks, usually on both sides of the body. Patients describe it as
brief electrical shocks, when violent, these seizures may result in dropping or
involuntarily throwing objects.
sporadic jerks, usually on both sides of the body. Patients describe it as
brief electrical shocks, when violent, these seizures may result in dropping or
involuntarily throwing objects.
Clonic seizures
These are repetitive,
rhythmic jerks that involve both sides of the body at the same time.
rhythmic jerks that involve both sides of the body at the same time.
Tonic seizure
These seizures are
characterized by stiffening of the muscles and rigidity.
characterized by stiffening of the muscles and rigidity.
Atonic seizure
This consists of a sudden
and general loss of muscle tone, particularly in the arms and legs, which often
results in a fall.
and general loss of muscle tone, particularly in the arms and legs, which often
results in a fall.
Common types of partial
seizure
seizure
Partial seizures are
divided into simple, complex and those that evolve into secondary generalized
structures. The difference between simple and complex seizures is that during simple
partial seizures, patients retain awareness, during complex partial seizure
they lose awareness.
divided into simple, complex and those that evolve into secondary generalized
structures. The difference between simple and complex seizures is that during simple
partial seizures, patients retain awareness, during complex partial seizure
they lose awareness.
Simple partial seizures
are: further divided
into four categories according to the nature of their symptom
are: further divided
into four categories according to the nature of their symptom
·
Motor
Motor
·
Autonomic
Autonomic
·
Sensory
Sensory
·
Psychological
Psychological
Motor symptoms include;
movements such as jerking and stiffening.
movements such as jerking and stiffening.
Sensory symptoms caused by
seizure involve unusual sensations affecting any of the five senses and when
simple partial seizures cause sensory symptoms only, they are called “auras”.
seizure involve unusual sensations affecting any of the five senses and when
simple partial seizures cause sensory symptoms only, they are called “auras”.
Autonomic symptoms affect
the autonomic nervous systems which is the group of nerves that control the
functions of our organs e.g. heart, stomach, bladder. A common example of
autonomic symptom is a peculiar sensation in the epilepsy called temporal lobe
epilepsy.
the autonomic nervous systems which is the group of nerves that control the
functions of our organs e.g. heart, stomach, bladder. A common example of
autonomic symptom is a peculiar sensation in the epilepsy called temporal lobe
epilepsy.
Psychological symptoms are
characterized by various experiences involving memory(the sensation of déjà-vu)
emotions (such as fear or pleasure), or other complex psychological phenomena.
characterized by various experiences involving memory(the sensation of déjà-vu)
emotions (such as fear or pleasure), or other complex psychological phenomena.
Complex partial seizures
include impairment of awareness. Patient seems to be out of touch, or staring
into space during these seizures. There may also be some complex symptoms
called “automatisms”.
include impairment of awareness. Patient seems to be out of touch, or staring
into space during these seizures. There may also be some complex symptoms
called “automatisms”.
Automatisms consist of
involuntary but coordinated movements that tend to be purposeless and
repetitive examples include lip smacking, chewing, fidgeting and walking.
involuntary but coordinated movements that tend to be purposeless and
repetitive examples include lip smacking, chewing, fidgeting and walking.
The third kind of partial
seizure is one that begins as a focal seizure and evolves into a generalized
convulsive (grand-mal) seizure. Most patients with partial seizures that cannot
be treated with drugs can often be treated surgically.
seizure is one that begins as a focal seizure and evolves into a generalized
convulsive (grand-mal) seizure. Most patients with partial seizures that cannot
be treated with drugs can often be treated surgically.
Causes of seizures
There are many causes of
seizures. The factor that lead to a seizure are often complex and it may not be
possible to determine what causes a particular seizure, what causes it to
happen at a particular time, or how often seizures occur.
seizures. The factor that lead to a seizure are often complex and it may not be
possible to determine what causes a particular seizure, what causes it to
happen at a particular time, or how often seizures occur.
Diet
Malnutrition and over
nutrition many increase the risk of seizures e.g. vitamin B1 and B12
deficiency was reported to cause seizures in alcoholics and adults as well as
infants.
nutrition many increase the risk of seizures e.g. vitamin B1 and B12
deficiency was reported to cause seizures in alcoholics and adults as well as
infants.
Drugs
Seizure may be a side
effect of certain drugs;
effect of certain drugs;
·
Aminophylline
Aminophylline
·
Caffeine
Caffeine
·
Clozapine
Clozapine
·
Corticosteroids
Corticosteroids
·
Insulin
Insulin
·
Lidocaine
Lidocaine
Use of certain recreational
drugs may also lead to seizure in some especially when used in high doses or
for long periods of time e.g cocaine, tramadol.
drugs may also lead to seizure in some especially when used in high doses or
for long periods of time e.g cocaine, tramadol.
Alcohol
Heavy drinking has been
shown to have some effects of seizure in epileptics. Consuming alcohol with
food is less likely to trigger a seizure than consuming it without.
shown to have some effects of seizure in epileptics. Consuming alcohol with
food is less likely to trigger a seizure than consuming it without.
Fever
Children between the ages
of 6months and 5years having a temperature of 380C or higher may lead
to a seizure known as “febrile seizure”
of 6months and 5years having a temperature of 380C or higher may lead
to a seizure known as “febrile seizure”
Lights
In some epileptics,
flashlights, disco-lights can be responsible for the onset of a tonic, clonic,
absence or myclonic seizure. This condition is known as photo sensitive
epilepsy and sometimes they can have it from watching television or blinking
one’s eyes.
flashlights, disco-lights can be responsible for the onset of a tonic, clonic,
absence or myclonic seizure. This condition is known as photo sensitive
epilepsy and sometimes they can have it from watching television or blinking
one’s eyes.
Head injury
Severe head injury can
result in one or more seizures that can occur immediately or up to a
significant amount of time later. It could be hours, days or even years
following the injury.
result in one or more seizures that can occur immediately or up to a
significant amount of time later. It could be hours, days or even years
following the injury.
A brain injury can cause
seizure because of the unusual amount of energy that is discharged across of
the brain when the injury occurs and thereafter. When there is damage to the
temporal lobe of the brain, there is disruption of the supply of oxygen.
seizure because of the unusual amount of energy that is discharged across of
the brain when the injury occurs and thereafter. When there is damage to the
temporal lobe of the brain, there is disruption of the supply of oxygen.
For preventive measures a
patient who has suffered a head injury is given anticonvulsants, even if no
seizures have occured or to prevent them in the future.
patient who has suffered a head injury is given anticonvulsants, even if no
seizures have occured or to prevent them in the future.
Hypoglycemia
Due to inadequate supply of
glucose to the brain when brain glucose level is sufficiently low, seizures may
result. Hypoglycemic seizures are usually an insulin or oral medications excessive
secretion of insulin may also lead to it.
glucose to the brain when brain glucose level is sufficiently low, seizures may
result. Hypoglycemic seizures are usually an insulin or oral medications excessive
secretion of insulin may also lead to it.
Menstrual cycle
In catamenial epilepsy,
seizures become more common during a specific period of the menstrual cycle.
seizures become more common during a specific period of the menstrual cycle.
Ø
Sleep deprivation
Sleep deprivation
Ø
Stress – anger and anxiety.
Stress – anger and anxiety.
Ø
Hypoxia
Hypoxia
Ø
Stroke
Stroke
Ø
Hypo-perfusion
Hypo-perfusion
Symptoms of seizures
Ø
Losing consciousness, which is followed by
confusion
Losing consciousness, which is followed by
confusion
Ø
Having uncontrollable muscle spasms
Having uncontrollable muscle spasms
Ø
Drooling or frothing at the mouth
Drooling or frothing at the mouth
Ø
Falling
Falling
Ø
Having a strange taste in your mouth
Having a strange taste in your mouth
Ø
Clenching your teeth
Clenching your teeth
Ø
Biting your tongue
Biting your tongue
Ø
Having sudden, rapid eye movement
Having sudden, rapid eye movement
Treatment for seizures
Seizure are majorly
controlled by medication particularly anticonvulsant drugs. The type of
treatment prescribed will depend on several factors, including the frequency
and severity of the seizures and the person’s age, overall health and medical
history.
controlled by medication particularly anticonvulsant drugs. The type of
treatment prescribed will depend on several factors, including the frequency
and severity of the seizures and the person’s age, overall health and medical
history.
Drugs that can be used include;
·
Diazepam
Diazepam
·
Phenobarbital
Phenobarbital
·
Primidone
Primidone
·
Lacosamide
Lacosamide
·
Valproate
Valproate
·
Phenytoin
Phenytoin
·
Felbamate.
Felbamate.
EMS response to seizures
Seizure are one the most
common EMS dispatches. On arrival to the scene, the paramedics must make sure
the scene is safe, after this the first priority is airway as well as
evaluating a level of consciousness. AVPU can be used;
common EMS dispatches. On arrival to the scene, the paramedics must make sure
the scene is safe, after this the first priority is airway as well as
evaluating a level of consciousness. AVPU can be used;
A-Awake and alert
V-Responsive to verbal
command
command
P-Responsive to painful
stimuli
stimuli
U-Unresponsive.
Ø
The C-Spine should be immobilized as well as any
injury should be noted.
The C-Spine should be immobilized as well as any
injury should be noted.
Ø
Administer high flow, high concentration oxygen,
if the patient is hypoxic.
Administer high flow, high concentration oxygen,
if the patient is hypoxic.
Ø
Establish intravenous access initiate normal
saline or lactated ringer’s solution at a keep open rate. Do not use dextrose
solutions; emergency department personnel may later administer dilantain which
is incompatible with dextrose solutions.
Establish intravenous access initiate normal
saline or lactated ringer’s solution at a keep open rate. Do not use dextrose
solutions; emergency department personnel may later administer dilantain which
is incompatible with dextrose solutions.
Ø
Determine the blood glucose level give 50%
dextrose if hypoglycemic.
Determine the blood glucose level give 50%
dextrose if hypoglycemic.
Ø
Never attempt to restrain the patient. This may
injure him but protect the patient from hitting objects in the environment.
Never attempt to restrain the patient. This may
injure him but protect the patient from hitting objects in the environment.
Ø
Maintain body temperature
Maintain body temperature
Ø
Position the patient on his left side after the
clonic tonic phase.
Position the patient on his left side after the
clonic tonic phase.
Ø
Suction if required
Suction if required
Ø
Monitor cardiac rhythm, oximetry and capnography
Monitor cardiac rhythm, oximetry and capnography
Ø
History should be taken, re-evaluated and should
be relayed to the next level of care.
History should be taken, re-evaluated and should
be relayed to the next level of care.
Other forms of seizure
·
Status epilepticus
Status epilepticus
·
Syncope
Syncope
·
Headaches
Headaches
Status epilepticus
This is a series of two or
more generalized motor seizures without an intervening return of consciousness
more generalized motor seizures without an intervening return of consciousness
Causes
·
Hypoxia
Hypoxia
·
Pyrexia
Pyrexia
·
Increased intracranial pressure
Increased intracranial pressure
·
Fracture
Fracture
Syncope
This is also known as
fainting; it is a short loss of consciousness and muscle strength,
characterized by a fast onset, short duration and spontaneous recovery. It is
due to a decrease in blood flow to the entire brain usually from low blood
pressure. Sometimes there are symptoms before loss of consciousness e.g.
sweating, pale-skin, light headedness, nausea, vomiting.
fainting; it is a short loss of consciousness and muscle strength,
characterized by a fast onset, short duration and spontaneous recovery. It is
due to a decrease in blood flow to the entire brain usually from low blood
pressure. Sometimes there are symptoms before loss of consciousness e.g.
sweating, pale-skin, light headedness, nausea, vomiting.
Conclusion
Pre-hospital providers must
focus on identifying and treating seizures early via effective pharmacological
treatment. Early aggressive treatment has significant benefit including a
higher likelihood of successful seizure termination. Early termination
simplifies airway management and reduces the risk of hypoxia and other severe
complications. All level of EMS must recognize and see immediate life threats
so as a paramedic you must be prepared, confident and be the reason your
patient arrives at the hospital without complications.
focus on identifying and treating seizures early via effective pharmacological
treatment. Early aggressive treatment has significant benefit including a
higher likelihood of successful seizure termination. Early termination
simplifies airway management and reduces the risk of hypoxia and other severe
complications. All level of EMS must recognize and see immediate life threats
so as a paramedic you must be prepared, confident and be the reason your
patient arrives at the hospital without complications.
References
Sporer KA and Johnson NS. Detailed analysis of
prehospital interventions in medical priority dispatch system determinant
prehospital interventions in medical priority dispatch system determinant
Mcmullan J, Pinnawin A, Jones E, et
al,.pre-hospital emergency Inpress.
al,.pre-hospital emergency Inpress.
