Recognition and Care of Individuals with Seizures

TYPES OF SEIZURES

The kind of seizure an older person may have depends on where the electrical disturbance takes place and how much of the brain is affected. It's possible to have just one type of seizure, or more than one type.

Generalized seizures happen when waves of electrical activity swamp the whole brain at once. These may produce convulsions (tonic clonic or grand mal seizures); sudden falls (atonic seizures); massive muscle jerks (myoclonic seizures); or momentary blackouts (absence seizures).

Tonic clonic seizures,

Which many people call convulsions, are the ones most people think of when they hear the word "epilepsy."

Tonic clonic seizures often start with a cry, caused by air being suddenly forced out of the lungs. The person slumps in his seat or falls to the ground, unconscious. The body stiffens briefly and then begins to jerk.

The tongue may be bitten. A frothy saliva may appear around the mouth. Breathing may be very shallow and even stop for a few moments.

Sometimes the skin turns a bluish color because breathing may be briefly interrupted, and the blood doesn't get as much oxygen as usual.

After a minute or two the jerking movements slow down and the seizure ends naturally. Bladder or bowel control may be lost as the body relaxes after the seizure. Consciousness will then slowly return.

Partial seizures,

happen when a smaller area of the brain is affected.

Partial seizures in the elderly may produce uncontrolled shaking, alter emotions, or change the way things look, smell, feel, taste or sound to the person having the seizure. When people have these experiences, yet stay fully conscious, the episodes are called simple partial seizures.

But there's nothing simple about them to an older person going through this experience. When familiar surroundings suddenly look different, when people hear voices and nobody's there, when they see images -- perhaps of a loved one who's passed on, or an object that suddenly appears where it's not supposed to be -- it can be terrifying.

Episodes of this kind are caused by electrical disturbances in the part of the brain that controls senses such as sight (causing visual disturbances), or hearing (producing the illusion of voices or sounds) or even memory (creating perhaps an image of the past or blocking recognition of familiar places).

However, elderly people may not talk about these episodes, even to their doctors, because they're afraid they're losing their minds. They're not, of course. These are seizures, not symptoms of mental illness.

And the doctor should be told about them because these seizures may require a medicine that's different from what he or she might otherwise prescribe.

Complex partial seizures

 are experienced in a different way. They affect consciousness while they're happening, and people can't remember them afterwards.

Complex partial seizures typically produce a kind of confused, dreamlike state. A senior citizen with complex partial seizures may stare, make chewing movements with the mouth, pick at clothing, mumble, do the same actions repeatedly.

He or she won't be able to talk to other people while the seizure is going on but may respond to simple requests made in a calm, friendly voice.

Complex partial seizures are particularly common in older people with epilepsy, but they occur at any age.

Sometimes people wander during these episodes. In rare cases they may become very agitated, make flailing movements with their arms, try to undress, try to run, scream, or cower in fear.

Although it's always possible for seizures to change, people usually develop a pattern of things they do, and these are likely to occur in the same order each time.

Sometimes partial seizures spread to involve the whole brain, causing a convulsion or a fall. When this happens as a regular part of a person's seizure pattern, the special feeling produced by the partial seizure acts as a warning. Sometimes it gives people enough time to get to a safe place before they lose consciousness. The warning feeling is often called an aura.

Symptoms of Seizures

Simple Partial Seizures

• Jamais vu (familiar things suddenly seem unfamiliar)
• Trembling that moves up one side of the body
• Déjà vu (unfamiliar things seem familiar)
• Out of body experiences
• Sudden shifts in mood
• Unexplained anger or fear
• Disturbed speech

Complex Partial Seizures

• Lip smacking
• Swallowing
• Picking at clothes
• Wandering
• Lack of response to others
• Repeated phrases
• Senseless, clumsy movements
• Lost time
• Disrobing
• Being briefly unaware of danger or pain

Generalized Seizures

• Brief staring
• Sudden muscle contractions
• Sudden falls
• Convulsions

Handling Convulsions in an Older Person

• Ease the person having the seizure into a reclining position on the floor or flat surface.
• Put something soft and flat under the head.
• Turn him or her gently on to one side to prevent choking and keep the airway clear.
• If the person having the seizure is seated, turn gently to one side so any fluids drain away from the mouth.
• Don't try to force anything into the mouth. Seizures do not cause people to swallow their tongues.
• Don't try to give fluids or medicine until the seizure is completely over and the person is fully alert again.
• Don't try to restrain the jerking movements. Muscles contract with force during seizures. Applying restraint could cause tears in the muscle or even break a bone, especially in elderly people whose bones may be fragile.

Responding to Confusion in an Older Person

Confusion may occur during a complex partial seizure or during the recovery period after other types of seizures.

In either case, the same basic rules apply:

• Remove anything from the area that might cause injury or could be a hazard to someone who is temporarily unaware of where he is or what he's doing.
• Don't try to restrain an older person who is wandering and confused during a complex partial seizure. If danger threatens, guide gently away.
• People may be quite agitated during these episodes. Trying to restrain them, or grabbing hold, is likely to make the agitation worse and may trigger an aggressive response.
• Be reassuring, comforting and calm as awareness returns. If confusion persists, get a medical evaluation.

Warning Signals

Most seizures, even in elderly people with other health problems, end naturally without any special treatment. Although emergency medical assistance should be obtained when someone has a first seizure, subsequent seizures usually do not require special treatment.

However, it is always possible for more serious problems to develop. Here are a few ways to spot them:

• Watch the time. If the convulsive shaking and jerking of a tonic clonic seizure lasts longer than five minutes, or starts up again shortly afterwards, call an ambulance or follow specific instructions from the doctor on in-home care. Non-stop seizures, which doctors call status epilepticus, are quite dangerous for elderly people. Prompt medical care is needed.
• Check for secondary injuries. Seniors who have seizures may break bones, so special care should be taken to find out if there's any unusual pain following a seizure. Headaches are quite common, but a severe headache after a seizure in someone who doesn't usually have them should be checked out.
• Call for help if breathing is labored following the seizure, if there is chest pain, or unusual pain of any kind, or if consciousness does not return after a few minutes.
• Be aware that periods of confusion lasting more than one hour associated with seizures may signal that something is seriously wrong.

If an older person with a seizure disorder who does not have a mental impairment seems to slip in and out of a confused or agitated state with few intervals of normal awareness, you may be seeing another kind of continuous seizure activity. This, too, should be evaluated at a hospital.

Special Circumstances

If you are living with an older person with seizures who has other medical problems, check with the doctor about how he or she wants you to respond when a seizure happens.

Find out whether the doctor wants to be notified every time or just in certain circumstances.

Ask whether or when you should call an ambulance; and if there are any special warning signals that you should be on the lookout for.

General First Aid for All Seizure Types

The first line of response when a person has a seizure is to provide general care and comfort and keep the person safe. The information here relates to all types of seizures. What to do in specific situations or for different seizure types is listed in the following pages. Remember that for the majority of seizures, basic seizure first aid is all that may be needed.

First Aid for Specific Seizure Types

• Focal Aware (simple partial) Seizures
• Focal Impaired Awareness (complex partial) Seizures
• Absence Seizures
• Atonic and Tonic Seizures
• Tonic-Clonic Seizures

Always Stay with the Person Until the Seizure Is Over

• Seizures can be unpredictable and it’s hard to tell how long they may last or what will occur during them. Some may start with minor symptoms but lead to a loss of consciousness or fall. Other seizures may be brief and end in seconds.
• Injury can occur during or after a seizure, requiring help from other people.

Pay Attention to the Length of the Seizure

• Look at your watch and time the seizure – from beginning to the end of the active seizure.
• Time how long it takes for the person to recover and return to their usual activity.
• If the active seizure lasts longer than the person’s typical events, call for help.
• Know when to give 'as needed' or rescue treatments, if prescribed, and when to call for emergency help.

Stay Calm, Most Seizures Only Last a Few Minutes

• A person’s response to seizures can affect how other people act. If the first person remains calm, it will help others stay calm too.
• Talk calmly and reassuringly to the person during and after the seizure – it will help as they recover from the seizure.

Prevent Injury by Moving Nearby Objects Out of the Way

• Remove sharp objects.
• If you can’t move surrounding objects or a person is wandering or confused, help steer them clear of dangerous situations, for example away from traffic, train or subway platforms, heights, or sharp objects.

Make the Person as Comfortable as Possible

• Help them sit down in a safe place.
• If they are at risk of falling, call for help and lay them down on the floor.
• Support the person’s head to prevent it from hitting the floor.

Keep Onlookers Away

• Once the situation is under control, encourage people to step back and give the person some room. Waking up to a crowd can be embarrassing and confusing for a person after a seizure.
• Ask someone to stay nearby in case further help is needed.

Do Not Forcibly Hold the Person Down

• Trying to stop movements or forcibly holding a person down doesn’t stop a seizure. Restraining a person can lead to injuries and make the person more confused, agitated or aggressive. People don’t fight on purpose during a seizure. Yet if they are restrained when they are confused, they may respond aggressively.
• If a person tries to walk around, let them walk in a safe, enclosed area if possible.

Do Not Put Anything in the Person's Mouth!

• Jaw and face muscles may tighten during a seizure, causing the person to bite down. If this happens when something is in the mouth, the person may break and swallow the object or break their teeth!
• Don’t worry - a person can’t swallow their tongue during a seizure.

Make Sure Their Breathing is Okay

• If the person is lying down, turn them on their side, with their mouth pointing to the ground. This prevents saliva from blocking their airway and helps the person breathe more easily.
• During a convulsive or tonic-clonic seizure, it may look like the person has stopped breathing. This happens when the chest muscles tighten during the tonic phase of a seizure. As this part of a seizure ends, the muscles will relax, and breathing will resume normally.
• Rescue breathing or CPR is generally not needed during these seizure-induced changes in a person’s breathing.

Do not Give Water, Pills or Food by Mouth Unless the Person is Fully Alert

• If a person is not fully awake or aware of what is going on, they might not swallow correctly. Food, liquid or pills could go into the lungs instead of the stomach if they try to drink or eat at this time.
• If a person appears to be choking, turn them on their side and call for help. If they are not able to cough and clear their air passages on their own or are having breathing difficulties, call 911 immediately.

Call for Emergency Medical Help

• A seizure lasts 5 minutes or longer.
• One seizure occurs right after another without the person regaining consciousness or coming to between seizures.
• Seizures occur closer together than usual for that person.
• Breathing becomes difficult or the person appears to be choking.
• The seizure occurs in water.
• Injury may have occurred.
• The person asks for medical help.

Be Sensitive and Supportive, and Ask Others to Do the Same

• Seizures can be frightening for the person having one, as well as for others. People may feel embarrassed or confused about what happened. Keep this in mind as the person wakes up.
• Reassure the person that they are safe.
• Once they are alert and able to communicate, tell them what happened in very simple terms.
• Offer to stay with the person until they are ready to go back to normal activity or call someone to stay with them.