BRAIN WAVES
Hollywood’s depiction of a seizure is most often someone thrashing around, incoherently… possibly foaming at the mouth, and then lapsing into unconsciousness. Dramatic and MOST often, totally false. But what is a SEIZURE? How many different types of seizures are there? At what point is a seizure life-threatening? The definition of a seizure is “An abnormal, unregulated electrical discharge that occurs in the brain’s cortical grey matter”; It’s often referred to as “An Electrical Storm Of The Brain”.
There are several different types of seizures as well as other “brain disturbances”, and some of them you won’t even realize are happening. When you are called to the scene of a patient having a seizure, stroke, or epileptic “fit”, you need to assess AS BEST YOU CAN what is happening and IF the patient will need transport to the hospital. (By all means, if the patient or family demands transport, do it).
There are three main classifications of a seizure: Tonic (muscles straighten and stiffen), Atonic (muscles become flaccid), and Clonic (muscles flex repeatedly); there is also Tonic-Clonic (muscles alternate with flexion) and Myoclonic (small muscle twitches). More common in children are Petit-Mal seizures, the child may appear quiet, still, blinking, and “daydreaming”. Usually with Petit-Mal, everything seems to return to normal approximately 15 to 30 seconds after it begins. Pre-eclampsia, a condition of hypertension during pregnancy, can cause seizures and could be life-threatening to both the mother and baby – a woman experiencing hypertension and possible seizures should be under medical care and possibly hospitalized until delivery. If a patient experiences two or more UNEXPLAINED seizures, doctors will often diagnose Epilepsy, a CT scan MAY expose tumors or cysts that will trigger Epileptic seizures.
Sometimes post-seizure, the patient will feel or present with numbness in one limb and possibly will have difficulty with hearing, vision, or speech, and complain of a headache. Although you may believe the patient has experienced a Stroke/CVA, the patient will experience numbness in ONLY one limb, not an entire body side, facial expressions are equal on both sides, and the tongue is still midline; This is referred to as Postictal Paralysis and will usually subside in under 48-hours. Most often, Postictal Paralysis will occur in patients with Epilepsy. However, if the patient appears to have had a Stroke, they require emergency care and immediate transport and very often lengthy rehabilitation.
Some patients experience seizures and recover quickly, but if seizures happen frequently within a short period or it is a lengthy episode, difficulty breathing, pregnancy, or evident altered mental status, transport to a medical facility is recommended. During the seizure, protect the patient as much as possible (without restraint), do NOT put anything in the patient’s mouth, and utilize an appropriate airway ONLY AFTER the seizure has ended. While transporting a patient, support the airway, monitor blood pressure, check glucose if possible, and continue an ongoing assessment. If ALS is available, they may be able to administer medications to help the patient. If the patient becomes combative, protect yourself AND the patient – consider asking for police assistance if necessary.
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