Download CDE #36484 Seizures

1
2
1 I llustration of a brain showing epileptic seizure
activity, front view. Electroencephalogram
(EEG) tracings show abnormal waveforms
emanating from the temporal lobe (blue-green)
of the brain. (Phototake via AP Images)
2 Science Photo Library/AP Images
Facts for Telecommunicators
By Roderick Jackson
CDE #36484
A
ccounts of seizures and epilepsy date
back thousands of years and, at that
time, were often viewed as a spiritual condition to be treated and dealt
with through religious practice. Hippocrates wrote one of the first medical
accounts of seizures and epilepsy, On the
Sacred Disease. He dispelled the idea
that epilepsy was a form of supernatural
condition, instead suggesting that the
phenomenon was a naturalistic event
caused in the brain.
There are nearly 3 million people in
the U.S. who are diagnosed with epilepsy,
and there are 150,000 new cases annually
in the U.S. alone. Seizures affect all races,
genders, ethnicities and socioeconomic
backgrounds. Many famous leaders, artists, scientists and intellectuals have experienced seizures or were diagnosed with
epilepsy. Statistics show that 10% of the
U.S. population will experience a firsttime seizure in their lifetime. So, about 1
in 100 people in the U.S. may experience
a first-time unprovoked seizure.
Seizures and epilepsy
are two of the least
understood chronic
medical conditions.
Epilepsy is the fourth
most common neurological disorder in
the U.S., after migraine,
stroke and Alzheimer’s
disease. Epilepsy is a medical condition that produces seizures and
affects various mental and physical body
functions. In the medical community, it is
also known as seizure disorder. The medical field also uses the Latin word “ictus,”
which is sometimes used to describe the
seizure itself. More commonly, telecommunicators may hear the form “ictal,”
which refers to the time when the seizure
occurs. The terms pre-ictal and post-ictal
refer to the period immediately before and
after the seizure occurs.
What Is a Seizure?
According to the Epilepsy Foundation, a
seizure is “a massive disruption of electrical
communication between the neurons in
the brain leading to the temporary release
of excessive energy in a synchronized
form.” Simply stated, a seizure is an
abnormal spasm or convulsion during
which the brain has excessive electrical
activity that may change a person’s
sensation, awareness or behavior.
Also known as an epileptic event,
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seizures are a defined characteristic of
epilepsy. Symptoms include temporary
confusion, staring spells, uncontrollable
jerking movements (especially of the arms
and legs), loss of consciousness or awareness, and even psychic symptoms in which
the patient knows when they are about to
experience a seizure.
A seizure can have many different
forms and symptoms, depending on
where in the brain it originates and where
it spreads. Although there are numerous
types of seizure, not all are characterized
by convulsions.
Types of Seizures
The symptoms of a seizure depend on the
type of seizure the patient is experiencing.
There are two main categories of seizures:
1) focal seizures, sometimes called partial
or localized, and 2) generalized seizures.
When a focal seizure occurs, abnormal
activity is limited to only one area of the
brain. A common symptom is twitching in
one part of the body or limbs, which usually subsides after a few minutes. There
are two types of focal seizure: simple and
dyscognitive. With simple focal seizures,
there is no loss of consciousness, but the
patient’s emotions or perceptions of sight,
sound, feeling or taste may be altered. This
type of seizure can result in involuntary
jerking of the arms or legs, accompanied
by dizziness or a tingling sensation. Dyscognitive focal seizures alter the person’s
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consciousness
or
awareness for a period
of time. The patient may
experience involuntary movements, such as hand rubbing, lip
smacking, fumbling hand movements or
walking in circles.
In contrast to focal seizures, which are
localized to one area of the brain, generalized seizures occur when there is abnormal activity in both hemispheres of the
brain. There are six types of generalized
seizure:
1. Absence, or petit mal, seizure. Symptoms include staring spells accompanied
by a momentary loss of consciousness and
subtle body movements.
2. Tonic seizure. This type of seizure
causes stiffening in the muscles in the
back, arms and legs. Falling is a specific
danger to be mindful of.
3. Clonic seizure. Clonic seizures are
marked by sudden jerking motions on
both sides of the body, particularly affecting the neck, face and arms.
4. Myoclonic seizure. This is a brief jerk
or twitch that occurs suddenly in the arms,
legs or sometimes the entire body.
5. Atonic, or drop, seizure. This type of
seizure causes the patient to lose muscle
control, typically in a single part of the
body such as the jaw and neck. Injury
from falling is a common side effect.
6. Tonic-clonic, or grand mal, seizure.
The patient first enters the tonic phase
with stiffening in the entire body, followed
by the clonic phase, in which the body
spasms uncontrollably. Loss of bodily fluids and biting of the tongue are two indicators of a tonic-clonic seizure.
When a seizure is prolonged or occurs
in a series, then the person is at a higher
risk of status epilepticus, a continuous
state of seizure activity that puts the
patient at a higher risk of brain damage.
What Is Epilepsy?
The Mayo Clinic defines epilepsy as a
central nervous system disorder in
which nerve cell activity in the brain is
disturbed. This causes a seizure, during
which abnormal behavior, symptoms and
sensations including loss of consciousness
can occur. When a person experiences an
unprovoked seizure for the first time, it
does not necessarily mean that person has
epilepsy. A person must experience two
or more unprovoked seizures before they
will be considered for a possible epilepsy
diagnosis. When seizures continue to
occur with no known cause, or because
of an underlying condition that cannot
be corrected, this is a sign of epilepsy.
Seizures and epilepsy differ from each
other, as seizures are symptoms of epilepsy
and epilepsy is the underlying disorder
that produces sudden electrical energy
that disrupts normal brain functions.
Epilepsy may be traced to numerous
factors such as genetics, head trauma such
as that caused by automobile accidents or
other traumatic injuries, infectious diseases
such as meningitis, prenatal disorders and
developmental disorders including autism.
Other factors such as brain tumors,
encephalitis or lead poisoning may also
be to blame. There are several risk factors
that could increase a person’s chance of
being diagnosed with epilepsy: age, your
family history, head injuries, strokes, brain
infections and childhood seizures.
Diagnosis & Treatment
Diagnosing this medical condition is a
multi-step process during which it is crucial
for the patient to receive appropriate
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treatment. When someone experiences a
seizure, the physician will take a complete
medical history, review the symptoms
caused by the seizure, discuss any current
medications and then conduct a series of
tests including a neurological exam. The
cost of diagnosing and treating seizures
and epilepsy exceeds $17 billion annually.
During the examination process, the
physician determines whether the patient
has a personal or family history of seizures,
and whether the seizure could have been
caused by a short-term problem such as a
fever or infection that can be easily treated.
Knowing the symptoms of the seizure
and what occurred just before the seizure
began will help the doctor determine if it
was caused by an underlying or continuing
problem with the way the brain’s electrical
system works. The doctor also needs to
know if the seizure was an isolated episode
that could have been caused by head
trauma, alcohol withdrawal or drug abuse.
Under the guidance of a physician, the
decision to treat seizures and epilepsy is
individualized and the risks of treatment
are weighed against the risks of seizures
so that appropriate decisions are made.
Several tests are performed in order to
confirm the medical diagnosis and begin
the course of treatment. The most frequently used diagnostic tool is the electroencephalogram (EEG). During this test,
electrodes are placed on the head while
the physician monitors a video display.
The EEG can be conducted either while
the patient is awake or asleep to record
any possible seizure activity. This helps
determine and confirm what type of seizure is occurring and rule out any other
possible medical conditions.
In addition, physicians may order a
neurological exam to test behavior, motor
abilities and mental function, which could
determine the type of seizure. Blood tests
can provide crucial information relating to
signs of infection and any genetic conditions. Other brain imaging and testing
methods used to help detect and reveal
abnormalities are computerized tomography (CT) scans, which use X-rays and cross
sectional images. This can help reveal
brain abnormalities such as tumors that
may be causing seizure activity. Magnetic
resonance imaging (MRI) may be used to
detect brain lesions and/or abnormalities,
and positron emission tomography (PET)
PUBLIC SAFETY COMMUNICATIONS 45
4 Illustration of epilepsy, showing the brain, midsagittal
section, with the pathways and foci of epileptic activity and
neurons firing electrical impulses. (Phototake via AP Images)
Seizures: Myths & Truths
3
4
There is never a good time to worry
if your radio will work.
3 Epileptic tracing of temporal lobe of the human
brain. (Phototake via AP Images)
scans use a small amount of low-dose
radioactive material injected in the veins to
help visualize the active areas of the brain.
Once a diagnosis is made, medications
and drug therapy are prescribed to treat
the medical condition. Finding the appropriate medicine and dosage is a complex
process. The factors to be considered are
based on the frequency of seizures, the
patient’s age and other factors such as
medical history and other medications
prescribed. Although medication can be
prescribed to help stop seizures, there
are other methods of treatment to be
considered. Some physicians use a therapy known as vagus nerve stimulation, in
which a device is implanted just beneath
the skin to assist in sending bursts of electrical energy through the vagus nerve to
the brain.
Common Myths
About Seizures
Myth: Seizure/epilepsy is a mental illness
Fact: Epilepsy is not a form of mental
illness and does not cause mental illness.
This is a physical disorder or condition that
disrupts the brain’s electrical activity.
Myth: You should put something in a
person’s mouth to stop them from swallowing their tongue during a seizure
Fact: When seizing, the tongue is
relaxed and if the person is lying on their
back, the tongue could fall to the back
of the throat, blocking the airway. Forcing something inside the person’s mouth
could harm their teeth or jaw.
Myth: Seizures can be stopped by
restraining or holding the person down
Fact: Never restrain a person during a
seizure as this may cause injury. Move any
dangerous objects away from the patient.
Attempting to restrain the person will not
stop or slow the seizure and is likely to agitate or harm them. The person will not be
able to respond or recognize anyone until
the seizure is over.
Myth: You will never get well once you
have epilepsy.
Fact: When taking medications and
other forms of treatment, people with the
disorder are able to live without seizures.
Myth: Seizures/epilepsy cannot be
controlled.
Fact: The majority of people diagnosed
can be successfully treated with the proper
medications. Another option is the vagus
nerve stimulator.
Myth: People cannot die from seizures.
Fact: Tragically, death can and sometimes does occur during seizures due to
automobile accidents, drowning, suffocation and falls.
Myth: Epilepsy is rare.
Fact: Epilepsy is the most common
neurological condition in the world today
and does not discriminate from any age,
race, socioeconomic or ethnic background.
Myth: People with epilepsy are physically limited in what they can do.
Fact: In most cases, the condition is not
a barrier to physical achievement. Some
individuals are severely affected and could
be limited in what they can do.
Myth: With today’s medication and
technology, seizures and epilepsy are
largely a solved problem.
Fact: Seizures and epilepsy is a chronic
medical problem that can be successfully
treated, but treatment does not work for
everyone and more research is needed.
Myth: You cannot have more than one
type of seizure.
Fact: It is possible to have more than
one type of seizure. This largely depends
on which areas of the brain are misfiring.
Summary
Seizures and epilepsy are brain disorders
caused by bursts of abnormal electrical
activity in brain cells. During the last
200 years, we have seen great strides
in understanding seizures and epilepsy.
During the latter half of the 19th century,
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English neurologists clarified the root of
the condition and identified the mystery
of how abnormal electrical bursts
caused seizures and altered a person’s
consciousness and behavior.
In 1929, a great milestone was reached
when Hans Berger, a German neurologist
invented a method of recording electrical
activity of the brain which is known today
as the EEG. There have been many new
drugs discovered since the 1940’s which
have had great success in treating seizures
and epilepsy. Research for new and better
ways to cope with and hopefully prevent
the disorder continues today.
Doctors treat seizures and epilepsy primarily with seizure-preventing medicines
and even though they are not a cure, the
seizure activity is controlled in the majority of people diagnosed. The goal is to
continue to research viable treatments in
the hope of finding a cure to seizures and
epilepsy. People diagnosed with epilepsy
struggle to overcome self-esteem issues
that accompany this condition and public
education is needed and necessary to eliminate any misconceptions. With the appropriate diagnosis and treatment, patients
can still live productive lives. ∥PSC∥
RODERICK JACKSON, NREMT, RPL is currently
an operations manager (Fire/EMS) at Houston
Emergency Center in Houston, Texas. He has
worked in public safety since 1995 and holds
certifications as an EMD and CTO instructor.
Jackson is also an adjunct instructor for APCO.
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Seizures: Myths & Truths
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1. People often die from having seizures.
a.True
b.False
2. Seizures always cause the person to lose consciousness.
a.True
b.False
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4. You should restrain someone who is having a seizure.
a.True
b.False
5. Epilepsy is a form of mental illness.
a.True
b.False
6. A generalized tonic-clonic seizure is typically characterized by
a. Full consciousness
b.Jerking of one part of the body
c.Abnormal sensory experiences including sounds, smells,
feelings and visual distortions
d.Possible feelings of fear or insecurity
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1. Study the CDE article in this issue.
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10.Seizures and epilepsy affect
a. Primarily African-American people
b.Primarily poor people living in unhealthy environments
c. Mostly women
d.All races, genders, ethnicities and backgrounds
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9. What is epilepsy?
a.A peripheral nervous system disorder of the ganglia
outside the brain
b.A circulatory system disorder of the blood that causes
seizures
c.A Musculoskeletal system disorder of the muscles and
nerves that causes seizures
d.A central nervous system disorder of the nerve cells in
the brain that is disturbed by bursts of electrical activity,
causing seizures
2.Answer the test questions online or
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7. What is a seizure?
a.An abnormal spasm or convulsion in the brain that
affects mental and physical body functions
b.Synchronized energy that is released by the brain
c. Spiritual cleansing for the brain
d.A form of supernatural condition
8. How many people are diagnosed with epilepsy in the U.S.?
a.500,000
b.200,000
c. 3 million
d.5 million
3. Epilepsy can affect anyone, at any age.
a.True
b.False
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