First aid and epilepsy: how to recognise a seizure and help a patient

By Cristiano Antonino On Jul 13, 2022

Epilepsy is a clinical manifestation characterised by sudden phenomena with generalised seizures due to an abnormal electrical discharge that is prolonged, affecting groups of nerve cells in both the cerebral cortex and the trunk

Since, as doctors say, a good 5 per cent of people during their lifetime may have an epileptic seizure, without being epileptic, it is easy to understand even from this data alone how the single or sporadic seizure can often be related to other pathologies or injuries affecting the nervous system or as a result of certain external stimuli that cause the phenomenon to appear.

How to recognise an epileptic seizure

In epilepsy during a ‘big bad’ seizure, the patient stiffens up in the first phase, notwithstanding the fact that when he has already had previous seizures he usually feels the onset of another epileptic phenomenon, which also causes him to assume positions that avoid the occurrence of injuries caused by unconscious movements or falls.

The seizure continues with the loss of vigilance on the part of the seizure victim who falls to the ground, often after a scream, losing consciousness and shaking in characteristic violent rhythmic movements; during this phase it is easy to witness the cyanotic state of the patient who may even reach true dyspnoic crises accompanied also by involuntary loss of urine and, more rarely, faeces.

Another characteristic, during the crisis, is to witness the loss of drool from the mouth, sometimes mixed with blood, due to the laceration that the patient has caused to his tongue during unconscious movements by biting it.

The next phase is that of awakening, with gradual recovery of vigilance, which, however, is usually preceded by a state of confusion if not, indeed, by actual falling asleep followed by slow awakening.

In the ‘little evil’ seizure, on the other hand, while experiencing the same symptoms as in the ‘big evil’ just seen, the patient loses vigilance for a shorter period of time, sometimes even a handful of seconds, where the seizure is characterised by a succession of shocks spread throughout the body but also of short duration.

Recognising epilepsy in children and infants

Infantile epilepsies usually manifest themselves around 3 to 9 months of a child’s life where there are real muscle spasms.

Reaching a diagnosis in the absence of adequate diagnostic techniques is almost impossible, not least because any eventual study must be conducted on the basis of the exclusion of any existing or previous pathologies.

We may see sporadic epileptic attacks, which have nothing to do, also because of their atypicality in relation to the patient’s age, usually however occur in children, due to an intestinal parasitosis.

We are talking about rare forms, and moreover it is difficult for the presence of intestinal parasites not to be ascertained before a seizure occurs. However, if one witnesses epileptic-like manifestations in the absence of other causes, it may be useful not to exclude the presence of possible intestinal parasites which, if in conspicuous numbers, may secrete toxins that act on the brain and generate seizures.

Finally, beware of febrile convulsions: these forms have nothing in common with normal epilepsies, but the symptoms are often partly similar and could be mistaken by relatives, impressed by the violent and sudden attacks that children experience, for true epileptic seizures.

These manifestations, however, are transient and almost always related to febrile states whose temperature rises above 38 degrees centigrade and which affect a conspicuous number of young patients.

These are reversible manifestations that should, however, be referred to a neurologist, perhaps on the advice of the paediatrician, who will institute ad hoc treatment, it being understood that these manifestations generally regress, until they disappear, after the age of ten, even in conjunction with febrile episodes in which there is a high temperature.

Treatment of epilepsy

If one is not faced with severe epileptic seizures, which in rare cases could have an inauspicious outcome for the patient, the phenomenon can almost always be coped with by the caregiver, even if he or she is not a doctor.

There are manoeuvres, for example, that can be performed with a certain ease if one manages to remain calm and if, above all, one enters into the logic that the epileptic is not a dangerous person, the only harm he is capable of doing is, unintentionally, against himself.

It is precisely for this reason that, during a seizure, the caregiver of an epilepsy patient must put in place all the necessary precautions to prevent the patient from injuring himself, for example, by falling or moving violently and disorderly; this means, if possible, placing the patient on a soft surface, even when he shakes his head, he must ensure that he does not hit it violently, sometimes seriously injuring himself. In addition, if the situation permits, the patient should be prevented from cutting his tongue with his teeth.

To avoid this, a folded cloth handkerchief should be placed under the dental arches to cushion the blows inflicted by the teeth on the tongue, while ensuring that the manoeuvre does not cause biting injuries to the rescuer.

The patient must be restrained by limiting unconscious movements, but this must be done firmly but also delicately, trying to be elastic and, if necessary, supporting sudden movements but dampening their intensity.

Excessive restraint of the gestures, precisely because they are violent and sudden, can cause fractures and injuries to the patient, who must never be pinned under the rescuer’s weight, which is dangerous because it ends up aggravating the situation due to the fact that the patient who is forced in this way may end up not breathing properly and go into cerebral hypoxia, which certainly worsens the crisis.

If anything, the patient’s rib cage can be gently compressed if he or she is unable to exhale the necessary amount of air after a long inhalation.

This should also be done gently to avoid rib fractures.

Never administer drugs by mouth during a crisis, as this risks suffocating the patient who is completely unable to exert any swallowing control.

Generally, the crisis evolves after a variable period of time, depending on the type of epilepsy suffered by the patient, when he wakes up the patient will be confused and prostrate, try to reassure him without frightening him and before making him drink, as he is likely to ask you for water due to the enormous effort made, make sure that he is awake to the point that he is able to swallow without any problems, otherwise wait until he wakes up completely.

It is always a good idea, however, to have a doctor present who will administer the appropriate medication, and in some cases, even hospitalisation is recommended, especially if it is the first attack.

Never administer medication ‘haphazardly’: wait for the doctor to decide whether the patient needs medication.

What to tell the doctor or rescuer?

If you know the patient’s medical history, report everything in full detail to the doctor or first-aider, including the medication you know about and that the person is taking; it is not certain that the patient will be able to cooperate effectively immediately after a seizure.

Those suffering from epileptic seizures, on the other hand, must be warned that any medication, even the most trivial, taken for other causes must be submitted to a doctor’s opinion, as it may affect the treatment being given.

Likewise, any other manifestations or doubts should be clarified with the doctor and the specialist treating the patient, who should be informed as to whether or not it is possible to drive, given the limits imposed by law for epilepsy patients.

Epilepsy therapy

It is useless to catalogue here the drugs used to treat epilepsy and to counteract possible attacks: as mentioned earlier, they are strictly a medical matter and no one, without first consulting a doctor, should venture to administer treatment on their own initiative ‘at random’.

Suffice it to recall here that, at present, recourse to special pharmaceutical classes keeps the patient at bay from subsequent attacks and ensures him or her a normal quality of life, as long as one does not alter the doctor’s prescriptions oneself.

In fact, it often happens that the patient, when there has not been a crisis for a long time, stops taking his or her medication: this should never be done unless the doctor says so.

European Resuscitation Council (ERC), The 2021 Guidelines: BLS – Basic Life Support

Pre-Hospital Seizure Management In Paediatric Patients: Guidelines Using GRADE Methodology / PDF

New Epilepsy Warning Device Could Save Thousands Of Lives

Understanding Seizures And Epilepsy