One of the special difficulties which anyone who has epilepsy faces is that they may be involved in an accident or found unconscious after a seizure and be given inappropriate treatment by someone who knows nothing of their condition.
Using the Medic-Alert service can help to avoid this danger. Medic-Alert is an organization which runs a special service to protect people with epilepsy. The organization provides a stainless steel bracelet or necklace engraved with the Medic-Alert emblem on one side, and on the reverse, a warning that the wearer has epilepsy, a serial number and an emergency telephone number.
Medic-Alert keep a file with details of your medication, your doctor’s phone number, and any other information that may be relevant. In an emergency they will give this information to any doctor or authorized person who telephones them. Calls can be made, reverse charge, at any time and from anywhere in the world. Life membership (which includes the bracelet or necklet) is ?13.80.
An alternative is to carry the necessary information about your epilepsy on your person at all times. SOS Talisman make a range of jewellery, which can be bought from most jewellers, incorporating a water-tight locket-style capsule containing an information strip giving your identity and any medical information which would be relevant in an emergency. Or you may prefer just to carry one of the identification cards issued by the British
Epilepsy Association. These are clearly headed I Have Epilepsy and give instructions about what should be done if you are discovered unconscious or during a fit.
DEALING WITH AN EPILEPTIC FIT
Most epileptic fits demand no action on the part of the bystander. Even a tonic clonic grand mal convulsion is not a medical emergency, though it is frightening to watch, especially if you have never seen one before. All you need to do is to let the fit run its course, making sure that the person is in no physical danger and that their airway is kept clear while they are unconscious. Remember that, however frightening it looks, this may have happened to the person many times before and they have always survived without your help!
What to do
Don’t try to hold the person down or restrain their movements. You may need to move them gently away if they are in immediate danger (by being too near an open fire, for example). Otherwise, simply move any pieces of furniture so that there is a clear space around them, or put padding round any immovable objects which might cause injury.
Do not try to force the person’s mouth open or wedge anything between their teeth. They will not choke during the fit and although there is a small risk of them biting their tongue, there is a much greater risk that you will break a tooth by trying to prise their jaws apart. A sore tongue will heal, a broken tooth will not.
Undo any tight clothing around the person’s neck if you can do so easily, and put something soft beneath their head.
Once the violent movements of the convulsion have stopped, gently turn the person onto their side into the recovery position so that their breathing will not be obstructed while they are unconscious. Wipe any froth from their mouth.
Most people recover quite quickly after a fit, but some need to rest quietly for a while or may even fall deeply asleep. Let the person wake naturally if they are sleeping. Sometimes bladder or bowel control are lost during the fit and one of the most helpful things you can do for someone who has had a seizure is to make sure, when they regain consciousness, that there are clean, dry clothes available for them.
If this is the first time the person has had a fit, they should consult a doctor. But if you are helping someone who has had fits before and is under treatment, there is no need to summon an ambulance or send the person home. Once the seizure is over and they have rested for a while the best thing for them to do is to carry on quite normally and resume whatever they were doing when the fit occurred.
WHEN A SEIZURE IS AN EMERGENCY
Most fits last for only a minute or two. If the convulsions continue for more than five minutes, or if another fit begins immediately the first has finished, summon an ambulance immediately. Prolonged convulsions, called status epilepticus, are dangerous. You should call an ambulance, too, if the person does not regain consciousness within a few minutes.
What you should do
Make sure that the person’s airway is clear and they are able to breathe. Put them on their side in the recovery position if you can.
Gently wipe away any obstructing saliva or froth from their mouth.
If possible, stay with the person and ask somebody else to call an ambulance immediately. They should say that the person is in status epilepticus.
At the same time as letting the ambulance service know, ring your own doctor in case they can reach you more rapidly than the ambulance.
If the person has been prescribed rectal Valium suppositories (stesolid), give them one of these. If the seizures have not decreased in ten minutes, it would be reasonable to give a second.
Probably the seizures will have stopped by the time the ambulance arrives. However, if they have not, the patient must be given an intravenous injection to stop the seizures. It is therefore important to make sure that the doctor is on his way, as well as the ambulance.
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Archive for Epilepsy
Revolving disco lights are a notorious seizure trigger. But not everyone has the kind of epilepsy that is provoked by flickering lights. Those few people who do are said to have photosensitive epilepsy (PSE). In these people, watching television, flickering lights or even moving through shadows in bright sunlight may all trigger off a seizure. The rate of flicker seems to make a difference: 16—25 flashes per second is the rate most likely to precipitate a seizure. A rate of less than five flashes per second rarely induces seizures. The flickering must also be in the central part of your visual field to induce seizures; flickering that you see only out of the corner of your eye has little convulsant effect. However, going to the cinema very rarely provokes fits. About a third of people with photosensitive epilepsy are sensitive to pattern, especially chequerboard pattern.
Photosensitive epilepsy is mostly a disorder of children and adolescents. Although two per cent of people of all ages with seizures have PSE, in the age range 7—19 years the proportion rises to ten per cent. About one in four people lose their photosensitivity, usually before the age of 30.
Although television is the commonest trigger for seizures in people who have PSE, the fact that someone has a fit whilst watching TV does not necessarily mean that they have photosensitive epilepsy. In most Western countries people now watch so much television that inevitably some epilepsy sufferers will have a fit while sitting in front of the TV. Moreover, drowsiness is even more likely to induce fits than flickering lights, and a lot of TV-watching takes place in the evening, when people are drowsy anyway (or have TV-induced drowsiness). A diagnosis of photosensitive epilepsy can only be made from an EEG taken while the person is being stimulated by flashing lights.
Sodium valproate is the most successful drug for photosensitive epilepsy. However, it may not even be necessary for you to take anticonvulsant medication if you take these simple precautions to reduce your chances of having a seizure.
Always watch TV from a distance of at least six feet (two metres).
Watch a colour TV if possible, rather than a black and white one.
You are less likely to get a seizure watching TV if the room is well lit. Put a small, lighted table lamp on top of the TV set.
Use a remote control panel to change channels; do not go close to the set to adjust it or to switch channels.
Avoid discos or any other situation in which you are likely to meet rapidly flashing lights or flickering patterns.
If you find yourself in such a situation, cover ONE eye with a hand. Do this if you have to go near a TV set too. Do not close both your eyes to protect against flicker; this only seems to accentuate the effect and make you more likely to have a fit.
Wear polarized sun glasses when you are out of doors on sunny days. They help to remove flickering reflections, especially beside the sea.
VDUs
In general VDUs cause no problems, because they do not have the same characteristics as TV sets. In very simple technical terms, most VDU monitors change the picture 70 times a second (70Hz), which is outside the photosensitive range of most people who have PSE, while in a standard TV monitor the picture changes only 25 times a second, which is much more likely to cause seizures.
If fits occur it is usually because the person is sensitive to pattern, rather than to flicker, or because a TV screen is being used as a monitor, with the person sitting closer to it than normal.
However, some of my patients have reported having seizures about two or three hours after a long VDU session. There is no real medical explanation for this, but if you notice such an association yourself, it is probably sensible to avoid using a VDU or to use it less frequently or for shorter periods.
CHILDREN AND VIDEO GAMES
Video games are unlikely to induce seizures. The monitors in games arcades have a picture change rate of 70 times a second, and hand-held video games have a liquid crystal display which does not flash in the same way as a VDU. Neither of these is likely to induce photosensitive seizures.
Seizures have sometimes occurred in children who have been playing video games, but in nearly every case it is because a TV screen was used as the monitor, or because the child was sensitive to pattern. Occasionally a specific game is found to trigger seizures; one American manufacturer devised a game which involved ‘bad guys’ with flashing plates on their chests and backs, and ray guns which were pointed towards the viewer and flashed. Unfortunately, an early trial of the game induced a seizure in a child who was watching it. Further research discovered that the flashes fell well within the sensitivity range of most people with PSE, and the game was withdrawn.
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These include hypnosis, aromatherapy, bio-feedback, and acupuncture. The success of these techniques, for which there is little or no scientific evidence of effectiveness, is variable and limited. However, patients may find them of value in giving a sense of control over their bodies and their lives. A new procedure, long-term stimulation of the vagus nerve is at present being evaluated.
General principles-The treatment of epilepsy extends far beyond the prescription of
anti-epileptic medication. It is, of course, important to correctly identify the type of epilepsy and to prescribe the most appropriate anti-epileptic drug to obtain the best possible control of seizures without side-effects. However, for many patients and their families, social and psychological factors far outweigh the problem of preventing or controlling the seizures. Help may best be given through a multi-disciplinary approach, preferably within a specialist clinic with advice from a number of different specialists, including nurses, psychologists, and psychiatrists. Many patients get practical help and support from voluntary associations such as the British Epilepsy Association, and patients should be informed of their address and telephone number.
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