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Epilepsy Association of Western Australia (Inc.)

 Annual General Meeting Thursday October 30^th 2008 @ 6.00pm

17th Annual Epilepsy Seminar

Annual Audit 2008

 www.epilepsy.org.au

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Her son Romeo has Epilepsy

Seizure First Aid

What to do when someone has a seizure depends on the kind of seizure they are having . . .

The general rule for all seizures is to remain calm. Note the time the seizure starts and how long it lasts and protect [rather than restrain] the person from injury. Roll the person onto their side [coma position] if they have fallen and establish supportive communication as the seizure ends. Check for injuries and stay with the person until they are sufficiently recovered to take charge again.

 

Generalised Seizures

Generalised Seizures are seizures that involve the whole brain or spread to involve the whole brain after starting in one part of the brain.





 

Absence seizures

Absence seizures often appear as a blank stare or blinking, and are often mistaken for daydreaming or inattentive behaviour. Lasting less than 15 seconds, they often occur in clusters and may occur many times a day. The person may or may not hear you, but will not respond until the seizure is finished.



 

Atonic Seizures

Atonic seizures occur when muscle tone is lost temporarily causing the body to collapse or fall quickly to the ground. Depending on how the person falls, these seizures can be particularly difficult and cause a range of injuries. Protective headwear can become necessary.

 

 

Myoclonic Seizures

Myoclonic?seizures occur as brief involuntary jerking movements, often following poor sleep, a nap or tiredness. They are too often mistaken for clumsiness as children move into early adolescence.


 

Partial seizures

Partial seizures start in one part of the brain. They can affect many different functions depending where in the brain they occur, the nature of the underlying injury, lesion, tumour or other cause, and if they generalise [ie spread to involve the whole brain].

 

Simple Partial Seizures

Simple partial seizures may involve stiffening or jerking of limbs. They can cause unusual auditory, visual or olfactory sensations, but the person remains aware of the world about them. Afterwards the person may be sleepy and limbs might be temporarily weakened. They may be the only seizures that a person with epilepsy will experience and yet given that their effects are often mild, many young people with simple partial seizures may be undiagnosed.

Complex Partial Seizures

These can begin with a sudden strange feeling or an abrupt sensation of nausea. They may involve a blank stare, a chewing action, repetitive movements, wandering about aimlessly, pulling at clothing and possible mumbling. The child may struggle and be frightened. These seizures usually last somewhere between 30 seconds and three minutes. Afterwards the person may be confused and unable to recall the seizure. This may be misinterpreted as misbehaviour in children.




 

Wheel Chair First Aid For Seizures

• Confined in a wheelchair
   
• Seated on a bus, train or tram
   
• Strapped in a pram or stroller

Stay Calm, Stop and Observe.
 

• Don't try to stop the seizure.
   
• Don't put anything in the person's mouth.
   
• Don't try to remove them from their position

- in most cases the seat provides some support.

 

During a seizure
 

• Protect the person by preventing them from falling if there is no seat belt.
   
• Make sure the wheelchair or the stroller is secure.
   
• Protect the person by supporting their head. Something soft under the head will help if there is no moulded head-rest.
   
• Check whether you need to move any hard objects that might hurt arms and legs in particular.
   
• Sometimes they may need to be taken out of the chair at the end of the seizure if the airway is blocked.

Consciousness usually returns within a few minutes.

Reassure the person and tell them what has happened.

People with epilepsy can experience several different kinds of seizures. These all involve sudden, unexpected, altered levels of consciousness and may produce uncharacteristic behaviour for a brief period. Some are simple and brief and may just involve short, staring spells. Others are more dramatic and can involve stiffening of the body, jerking of limbs, making strange sounds, lip smacking or an unusual kind of chewing motion, pulling at clothing, even undressing, wandering around quite aimlessly, being in a state of clearly altered consciousness or even unconsciousness. Sometimes seizures have all the same appearances as someone who has had an adverse reaction to alcohol or drugs.

If you think someone may be having any kind of epileptic seizure, always
 

• Stay calm,
   
• Protect [rather than restrain] the person,
   
• Remain with them and
   
• Reassure them as they come out of it.

Dialling 000 - Emergency

- When dialling 000 these are the general questions you will be asked ? be prepared.
- What is the exact location of the emergency?
- What is your contact phone number?
- What is the problem?
- What exactly happened?
- How many people are hurt?
- What is the age of the person needing the ambulance?
- Is the person conscious?
- Is the person breathing?
- NO to the last two questions results in the immediate dispatch of the maximum ambulance response.
- YES leads to a maximum of eight extra questions.

Epilepsy questions callers will be asked after dialling 000 and stating there is an epilepsy emergency:

- Has the person had more than one fit now?
- If female, is she pregnant? [age 12-50]
- Did the person hit their head before the fit?
- Is the person diabetic?
- Does the person have a history of heart problems?
- Is the person known to have epilepsy? or Has the person ever had a fit before?
- Has the jerking [twitching] stopped yet? [You go and check. I'll stay on the line]
- Is the person breathing now?

To assist the ambulance service:
- If you can, avoid third party calls - whoever is with the person has the most current, accurate information.
- Answer each question calmly, accurately.
- Provide accurate location details - the nearest intersection is helpful.
- Have someone wait outside.
- Ring back on 000 if the person's condition changes.

When an ambulance is called in an emergency situation for epilepsy

Seizures are responsible for a range of emergencies resulting from accidents, burns and even serious depression. One of the most common emergencies in epilepsy is called status epilepticus, which is the name used for lengthy, uncontrolled seizures ? seizures that seem to just keep going without letting up. Most people will not have to worry about this but whenever and wherever it does occur it needs to be dealt with as efficiently as possible.

- they will ask the same questions as an emergency operator will ask [see above].
- they will ask for the rectal diazepam kit prepared for the person experiencing the lengthy, uncontrolled convulsion
- they will ask for the letter of authorisation from the treating doctor. [This letter should be current - no older than 3 months - with specific instructions about the drugs, dosages and emergency procedures. If there is no kit or recent letter of authorisation, the general ambulance officers will transport the person immediately to hospital.]


If the MICA [Mobile Intensive Care Ambulance] officers are called, they often carry diazepam and are able to administer diazepam rectally or intravenously.

Parents, carers, educators and the community are all advised to be prepared for an emergency. Individual emergency action should be prepared for all people whose epilepsy is difficult to control. If there is a history of status epilepticus, you should discuss with your doctor your best options. Your epilepsy association counsellor may also be able to offer some very practical advice.

If you are a carer you can quite easily administer rectal diazepam via a small tube with a flexible nozzle which can be bought on prescription at some Australian pharmacies. It comes with instructions, but basically you lubricate the nozzle with a small amount of the liquid in the tube and slip the nozzle it into the persons rectum, squeeze the tube and deliver the diazepam solution. It's not as difficult as it might sound but is nonetheless something you might like to discuss with a counsellor from your local epilepsy association. Some epilepsy associations run courses for carers in handling epilepsy emergencies, as do some hospitals. A number of state government training departments also run such courses though Epilepsy Australia has serious reservations about a number of these.

Quite apart from being confident that you can administer it, there are several ways it can be administered. The most common way is not in a prepared tube, but with a small kit comprising flexible tubing, a syringe and ampoules of diazepam usually obtained through a hospital pharmacy. This kit must be assembled every time the need arises. Your doctor may recommend that you use this small kit as it is easier to obtain. The small, prepared tube is currently not stocked by most pharmacies and while it is available from some hospitals, others will only provide the kit. Your local epilepsy counsellor will be able to tell you how to obtain this product where you live, if your doctor is unsure. There are also pharmacies that will send the tubes to anywhere within Australia. Your doctor should also provide a letter of authorisation for an ambulance officer to administer rectal diazepam if appropriate.

Diazepam is not licensed for specific rectal use in Australia, even though it is frequently, and quite legally, used in this way. There are clearly a number of unresolved and controversial issues regarding the use of rectal diazepam. Epilepsy Australia believes that it is highly unsatisfactory that many people are not informed regarding this treatment. It certainly has its dangers in that some people may react badly to it. It is therefore wise to call an ambulance and have them administer it the first time. In the unlikely, but possible, event where the person receiving the rectal diazepam suffers respiratory depression or some other adverse reaction, it's better to have the facilities of an ambulance at hand. The trouble is that ambulances do not get to many parts of Australia in time to deal with this kind of emergency. In such cases it is useful, and we would say essential, for you to be able to intervene.

Midazolam is another drug that can help stop unremitting seizures and is increasingly used by ambulance services. It can be administered nasally and through the linings of the mouth - again considerably easier than it sounds. This is becoming a preferred way of dealing with status epilepticus for a number of people as it is less invasive personally, and for some people, more effective. Once again, though unlikely, it can cause unwanted reactions.

The possibility of adverse reactions to efforts to stop episodes of status epilepticus leads some people to argue that the best course of action is to simply call an ambulance and get the person to a hospital. Sometimes the seizures will start up again and there are more effective measures that can be taken in a hospital environment to deal with them - such as an intravenous injection of appropriate antiepileptic medications. The availability of ambulances and the time they take to make a response in the area where the person is having the emergency, are both important issues to consider. Another issue is the number of times status epilepticus occurs.

A lot of people do not like to be carted off to hospital - and then have to find their way back home on discharge - just because they have had a prolonged seizure, particularly if it happens often and if they know they respond well to rectal diazepam or to midazolam. Being able to safely administer a product that will bring seizures to an end with minimum fuss is the option most people would go for. It's not all cut and dried and your doctor or the doctor of the person for whom you are a carer, will do their best to find a solution to best suit your needs.

If you are the person who has these kinds of seizures then it is something you should discuss in terms of your own feelings about having someone possibly placing medication in your rectum. You might not in fact have someone around you who knows what to do - and you certainly can't do it yourself in this situation. An emergency bracelet or wallet/purse information card can provide valuable emergency information. A quick telephone call to the person you have nominated to be called in an emergency will ensure that the situation can be dealt with very promptly.