Seizures can be unpredictable and scary. Neelima Thakur, MD has joined the Tufts Medical Center team as an epileptologist. Her focus is in diagnosis, monitoring, and management of epilepsy. Dr. Thakur shares how to recognize and help a person suffering from a seizure.
What is epilepsy?
Epilepsy is a neurological disorder presenting with recurrent unprovoked seizures. It is important to know that epilepsy and seizures are not the same. Epilepsy is defined as a disease characterized by an enduring predisposition to generate unprovoked seizures. A seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous electrical activity in the brain.
According to the International League Against Epilepsy, “a person is considered to have epilepsy if they meet any of the following conditions:
Have had at least two unprovoked (or reflex) seizures occurring more than 24 hours apart.
- One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
- Diagnosis of an epilepsy syndrome
• Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last five years.”
How common is it?
Epilepsy is the fourth most common neurological condition, according to the Epilepsy Foundation. It affects more than 65 million people worldwide and around 5 million people in United States. Epilepsy onset is more common in children and elderly, although it can occur at any age. The lifetime likelihood of experiencing at least one epileptic seizure is about 9 percent and the likelihood of receiving a diagnosis of epilepsy is almost 3 percent.
What causes epilepsy?
The most common causes of epilepsy are idiopathic (no clear known cause), family history or genetics, structural abnormalities, stroke, hypoxic injuries, traumatic brain injury, tumors, brain infections and inflammation and dementia.
Are treatments available?
Yes. Anti-epileptic drugs are usually the most common initial method of treatment. Dietary therapies can be considered in certain epilepsy patients with intractable seizures. These include the ketogenic diet, modified Atkins diet, hypoglycemic diet, and other. Surgical treatments should be considered if more than two antiepileptic drugs do not work for a patient.
Surgical resection of the epileptogenic focus is an option if the epileptogenic focus is localizable and is in a safe area of the brain for a resection. Alternative surgical options are available for epilepsy patients who are not candidates for an epilepsy surgical resection but may be candidates for surgical implantation of devices which includes responsive neuro stimulation, deep brain stimulation, and vagus nerve stimulation
What should a bystander do or not do when someone is having a seizure?
Seizures are of different types. One of the most common or violent appearing seizure is the generalized tonic clonic, which is also called the Grand mal seizure. During this type of seizure, the patient loses awareness of his or her surroundings, may scream, fall, have recurrent jerking movements of the body, or rolling of the eyes. This may be associated with frothing out of mouth, protrusion of tongue, clenching of the teeth and bleeding out of the mouth due to a tongue bite.
In this situation, a bystander can help by doing the following:
- Ease the person to the floor or to an area where the person is not around anything hard or sharp to cause injury. Loosen ties or anything around the neck that may make it hard to breathe.
- Turn the person gently onto one side. This will help the person breathe.
- Do not try to hold the person to stop the violent jerks
- Do not try to put your fingers or hand in the mouth of the person who is actively having a seizure.
- Do not try to give CPR (mouth to mouth breathing) on a patient who is actively having a seizure.
- Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.
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