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Review

. 2002 Jan;34(2):186-95.

[Article in

Spanish]

A Legido 
¹

Affiliations

Affiliation

• ¹ Departamento de Pediatría, Sección de Neurología, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania, PA 19134-1095, USA. [email protected]

• PMID:

  11988916

Free article

Review

[Article in

Spanish]

A Legido.

Rev Neurol.

2002 Jan.

Free article

. 2002 Jan;34(2):186-95.

Author

A Legido 
¹

Affiliation

• ¹ Departamento de Pediatría, Sección de Neurología, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania, PA 19134-1095, USA. [email protected]

• PMID:

  11988916

Abstract

Objective:

To review the preventive and prophylactic aspects of epilepsy.

Development:

The description of the prevention of the causes of epilepsy includes the measures to prevent epilepsy and epileptic seizures. The concept of antiepileptogenesis is discussed according to the available information about the role that both the classic and new antiepileptic drugs (AEDs) play in this process. Neuroprotection is discussed in the context of the mechanisms of action of the AEDs and of the mechanisms of neuronal lesion produced by the causes of epilepsy or by the seizures themselves. Among the new therapeutic modalities the current knowledge about the vagus nerve stimulator and the surgical treatment is summarized. The potential future therapeutic modalities include alternative medicine, pharmacologic treatment of the epileptogenic focus, genetic treatment and vaccination.

Conclusions:

The first step in preventing epilepsy is to avoid the causes or the risk factors. Some classic AEDs have demonstrated to be effective in the prophylaxis of provoked seizures (acute, symptomatic) but not of unprovoked seizures (epileptic). The best knowledge of the pathogenesis and the molecular and biological basis of epileptogenesis secondary to lesional causes, suggest that antioxidant and neuroprotective agents, including the new AEDs, may prevent epilepsy. There is a need to design studies with the goal of demonstrating their antiepileptogenic and/or neuroprotective activity at different ages in life. New and future therapeutic modalities may offer additional preventive options.

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Seizures – treatments, symptoms, causes and prevention

If someone is having a seizure, prevent them from injuring themselves and stay with them until the seizure has finished. Call an ambulance if the seizure lasts for more than 5 minutes, if the person is unresponsive for more than 5 minutes afterwards, or a second seizure quickly follows the first.

What is a seizure?

Seizures are caused by rapid and uncoordinated electrical firing in the brain. This can cause temporary abnormalities in behaviours, movements (such as alternating stiffening and jerking of the arms and legs), sensations or a loss of consciousness or altered consciousness level.

When should I call an ambulance?

Call triple zero (000) if:

• the seizure continues for more than 5 minutes or a second seizure quickly follows the first
• the person remains unresponsive for more than 5 minutes after a seizure stops
• the person has been injured
• the person has diabetes or is pregnant
• you know, or believe it to be the person’s first seizure
• there is food, vomit or fluid in the mouth

How to help someone having a seizure?

Don’t try to restrain the person or stop the jerking. The main thing is to prevent them from injuring themselves. Don’t move the person unless they are in danger. Put something soft under their head, remove any sharp or unstable objects from the area and stay with them.

There is no danger they will swallow their tongue. Don’t put anything in their mouth and make sure there is no fluid or vomit that could choke them.

Time the seizure and keep an eye on their breathing.

Talk to them calmly to reassure them, until they regain consciousness.

When the seizure stops, put them on their side in the recovery position. If they have vomited or have food or fluid in their mouth put them in the recovery position immediately.

If they fall asleep after the seizure don’t disturb them, but keep monitoring their breathing.

Don’t let them have anything to eat or drink until the seizure has completely stopped. If possible, someone should go home with them.

What are the symptoms of a seizure?

Seizures can cause changes in movement, sensation, awareness, thought or behaviour, depending on which part of the brain the seizure affects. Some seizures involve only part of the brain — others involve the whole brain.

Before a seizure you may have an ‘aura’ — a feeling that forewarns a seizure is coming. An aura may involve odd smells, feelings of deja-vu (where you feel you have been here before), tingling, vision disturbances, or fear or joy. This aura is actually the first part of a seizure.

During the seizure, the symptoms experienced depend on the type of seizure. A person may be alert during the seizure, and able to remember it afterwards, or may not remember it at all.

Symptoms of seizures include:

• loss of consciousness during the seizure, or between several seizures
• becoming unresponsive
• in an absence seizure, the person stops concentrating on their activity and stares off into space, becoming unresponsive until the seizure abruptly ends
• becoming vague, disorientated or confused
• numbness or tingling sensations
• excess saliva coming from mouth
• increased heart rate
• hallucinations
• impaired thinking
• eye blinking or eyes rolling upwards

Motor (movement) symptoms can include:

• stiffening movements (known as the tonic phase) — this may cause a person to fall
• jerking movements (clonic phase)
• alternate stiffening and jerking (known as tonic-clonic)
• floppiness and loss of muscle tone (known as atonic) — this may also cause a person to fall
• tremor or shaking
• sudden nod of the head
• strange postures
• repetitive movements, such as lip smacking or chewing

Most seizures last for less than 2 or 3 minutes and will stop on their own, without any treatment.

Febrile seizures in children may last for a few minutes or even go on for an hour, with the child usually losing consciousness. They may appear red or blue in the face and their muscles may jerk or stiffen. These seizures are not harmful to the child.

CHECK YOUR SYMPTOMS — Use the collapse and fainting Symptom Checker and find out if you need to seek medical help.

What happens after a seizure?

After a seizure has ended, there is a recovery phase (known as the post-ictal phase) before a person returns to their normal state. During this phase a person may be confused, tired or exhausted, sore or thirsty. They may feel weak, sick or anxious, be injured, have lost control of their bladder or bowel, or have a headache.

A person may or may not remember the seizure. It may take hours or days to get back to normal.

What types of seizures are there?

Seizures are classified depending on which part of the brain the seizure starts in, whether a person is aware during the seizure or not, and whether there is movement.

Seizures are classified into 3 major groups:

• focal onset
• generalised onset
• unknown onset

Focal onset seizures start in one small region of the brain (the focus) and may spread to other brain areas. They used to be known as partial seizures. A person may be fully aware of what’s happening (focal aware) or their awareness may be affected (focal impaired awareness).

Generalised onset seizures affect both sides of the brain from the start. This may cause a person to lose consciousness. The seizures may be:

• generalised motor seizures — where the person may make stiffening and jerking movements, known as tonic-clonic seizures (previously called grand mal), or have other muscular effects
• generalised non-motor seizures — where the person has changes in awareness, may stare or have repeated movements like lip-smacking or pulling at clothes

Unknown onset seizures are those that haven’t been diagnosed as either focal or generalised in onset because it’s not clear where the seizure started in the brain. This may be because a person was asleep or alone when the seizure started.

Febrile seizures (also known as febrile convulsions) are seizures brought on by fever in young children. They do not cause any long-lasting effects.

What causes seizures?

Seizures can be caused by:

• epilepsy
• head injury
• brain infection
• brain tumours or other medical problems, including stroke
• birth defects
• some prescription medicines

For some people who have seizures, there will be some things that are likely to trigger a seizure. Common seizure triggers include:

• illicit drugs
• excessive alcohol or alcohol withdrawal
• high or extremely low blood sugar
• flashing lights
• lack of sleep
• extreme stress
• high fever (febrile seizures)

Sometimes, no cause or trigger for a seizure will be found.

How are seizures treated?

Most people who have a seizure don’t go on to have any more, but a person with epilepsy has a tendency to have recurrent spontaneous seizures.

See a doctor if you or your child has a seizure for the first time, if there are several seizures, or if the seizures happen more often than usual.

Medication

People diagnosed with epilepsy will normally need medication to control their seizures. These medications are called antiepileptic drugs, and for up to 70 per cent of people their seizures will be controlled with this medication.

Make sure you follow your doctor’s instructions and let them know if you have any side effects from the medication. Do not stop taking the medication suddenly, as this may itself cause seizures. If one antiepileptic drug doesn’t work for you, there are others you can try until you find the best one for you.

Ketogenic diet

For children whose seizures do not respond to medication, a special diet called the ketogenic diet may help with some types of seizures. Your doctor or specialist will be able to advise whether this is suitable for your child.

Surgery

Surgery to remove the brain tissue that is the focus of seizures may be considered for seizures that are resistant to other treatments, and that always happen in the same location of the brain.

Vagus nerve stimulation

Vagus nerve stimulation involves implanting a device like a pacemaker into the chest. The device sends out weak electrical signals to the brain via the vagus nerve. It can be used for epilepsy that doesn’t respond to medication and that can’t be treated with surgery.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

Seizures and safety

By law, a person who has had a seizure must not drive until advised it is safe to do so by their doctor. Adults and children with epilepsy should have regular reviews with their GP or specialist.

Some people with diagnosed medical conditions like epilepsy, wear special pieces of jewellery or identification (for example MedicAlert) that show that they will need special medical care in an emergency.

Special smartwatches and monitors are also available that can detect seizures and send alerts to family members or carers.

People who have seizures should take precautions when swimming, driving or bathing.

Can seizures be prevented?

Some people who have seizures may get warning signs, such as a change in body temperature, visual problems or a strange taste in their mouth for example. If these ‘auras’ occur, try to get to a safe place or position if possible.

Sometimes, other people can tell if someone they know is about to have a seizure. They may look different, their pupils may change size or they may act out of character. Again, if this happens, try to guide the person to a safe location.

Some people can prevent seizures by avoiding their triggers such as:

• flashing or flickering lights
• lack of sleep
• stress
• alcohol
• missing seizure medication doses

As mentioned, medication is effective at treating seizures in 60-70 per cent of people.

Important: Anyone taking prescribed medicines for seizures should always take the correct dosage and make sure they do not miss a dose.

Learn more here about the development and quality assurance of healthdirect content.

Epilepsy safety | OGBUZ “Polyclinic No. 7”

Benefit for a patient suffering from epilepsy.

Epilepsy is a dangerous disease, but it is not a sentence. If you correctly follow the recommendations, the likelihood of epileptic seizures can be minimized. We invite you to read the recommendations.

Epilepsy Day (March 26 – World Epilepsy Day) has its own color – purple. It is believed that it is the purple color that has a beneficial effect on the nervous system, reduces anxiety, phobias and fears. On this day, all participants pin purple ribbons or wear purple pieces of clothing to express their support for people with epilepsy.

Epilepsy is one of the most common diseases of the nervous system, occurring in 0.5-1% of the population in developed countries. This means that about 50 million people worldwide have epilepsy. But only 25% of them receive adequate medical treatment. At the same time, epilepsy is one of the few chronic diseases in which a stable remission is possible: people study, work, create families and give birth to healthy children, lead a normal full life. Modern drugs allow in 70% of cases to completely free a person from seizures, they are effective and low-toxic, do not affect the psyche and mood. Epilepsy is often combined with other diseases and pathological conditions – chromosomal syndromes, hereditary metabolic diseases, cerebral palsy. The frequency of epilepsy in patients with cerebral palsy is 19-33%

Epilepsy is a chronic brain disease characterized by repeated, spontaneous (unprovoked) seizures in the form of impaired motor, sensory, autonomic, mental or mental functions resulting from excessive discharges of nerve cells in the cerebral cortex. Thus, epilepsy is called recurrent spontaneous seizures, a single seizure, as a rule, is not considered as epilepsy.

Helping the sick during an attack.

If the patient anticipates an attack (for example, an attack begins with some unusual conditions and sensations called “aura”), he must take the necessary safety measures: lie down on the bed or on the ground, away from traumatic objects, weaken tie (for men). The child should be placed on a flat bed or floor, and tight clothing should be loosened or loosened, especially at the throat, to clear the airway. Outside the home, the child must be moved to a safe place (away from water, traffic, sharp objects and corners), put something soft under his head (for example, a folded jacket, jacket). It is necessary to protect the patient from injuries, especially head injuries.

If a seizure occurs suddenly and the patient does not anticipate it, he cannot protect himself from injury, and precautions must be taken after the seizure has begun. During an attack, the patient must not be carried, except in cases where he may be in danger, for example, on the roadway, near the fire, on the stairs or in the water.

In case of increased salivation and vomiting, the patient should be laid on his side so that he does not choke. This should be done gently, without using force.

Do not try to hold the patient by restricting his movements. Also, do not try to open the patient’s mouth, even if biting the tongue has occurred: this can lead to injury to the teeth, oral mucosa and tongue. Remember that when the head is positioned on its side, the retraction of the tongue never occurs and recommendations for unclenching the jaws of pulling out and even fixing the tongue are not justified and harmful. Such a dangerous complication of an attack as retraction of the tongue, leading to asphyxia and death, occurs only if the head is positioned face up with the head thrown back. In no case do not allow this position of the head!

It is necessary to wait for the attack to end, being near the patient and carefully observing his condition, in order to correctly and fully describe the manifestations of the attack to the doctor.

It is very important to note the time when the attack began, since the duration of the attack or series of attacks, approaching 30 minutes, means that the patient is entering a life-threatening condition – status epilepticus – a dangerous condition that requires urgent hospitalization and intensive care.

After an attack, the patient falls asleep. In this case, it is not necessary to disturb him in order to allow the nerve cells exhausted from the attack to recover. It is necessary to stay close to the patient and wait until the post-attack period ends and consciousness is fully restored.

During an attack, one should not try to restrain and limit the patient’s convulsive movements by using force. Also, you can not unclench the jaws compressed by cramps with your own hands or with a hard object. You can not water the patient with water, do artificial respiration. It is also not recommended to try to wake the patient after an attack by shaking him, tapping him, letting him sniff pungent odors, or using any other methods.

Focal seizures are usually less dramatic. You should not try to restrain and limit the patient’s actions if they pose a threat to the patient or people around, since violent restriction can increase arousal and confusion and provoke aggression.

Most seizures end on their own and last for a short time (several seconds or minutes). Seizures usually spontaneously stop after 1-3 minutes, and therefore usually the patient does not need the help of a doctor. However, if the duration of the attack exceeds 5 minutes, it is necessary to call a doctor, intramuscular or intravenous administration of the drug is required to stop the attack.

Safety rules for patients with epilepsy.

Patients with epilepsy should try to lead a normal life, avoiding excessive unjustified restrictions. However, it is necessary to comply with a number of security measures, especially while maintaining seizures with loss of consciousness.

The patient should not be without insurance at a height, at the edge of the platform of railway stations, near fire and near water!

Household safety rules.

Following a few simple rules will help keep your home safe in the event of an attack. The recommendations below will be especially relevant for children with epilepsy, but many of these safety precautions are useful for adults as well.

All sources of fire must be properly covered and heaters must be removed to a safe place.

If occasional sudden (without aura) seizures occur, plastic rounded plates can be placed on the corners of furniture.

If possible, doors, especially bathrooms and toilets, should open outwards so that a fallen child does not block the door. Latches and locks from the inside are also undesirable.

Take a bath at a shallow water level and always be accompanied by an adult. The water should not be very hot. The shower must be fixed high and securely.

Bathing and fishing alone are forbidden, as drowning is the main cause of death in seizures.

Sometimes the patient is advised to wear special protective equipment, helmets.

Provoking factors for seizures.

Attacks usually occur without antecedent factors (spontaneously, accidentally) and are completely unpredictable. However, in some patients, seizures are triggered by certain situations (eg, flickering lights, sleep restriction, stressful situations, strong feelings of fear or anger, certain medications or alcohol, hyperventilation). If factors that provoke the occurrence of seizures are identified, they should be avoided, this will lead to a decrease in the frequency of seizures.

Who should I tell about the illness?

Patients are usually advised to talk about their illness to colleagues at work, teachers at school, especially with poorly controlled seizures, so that timely help can be provided in case of an attack.

It is advisable to carry a special card, bracelet or medallion with information about the disease.

Information about the disease is often required when applying for a job and it is not recommended to hide it.

Memo for patients and relatives of patients with epilepsy

An example of the most complete recommendations of a neurologist

Causes of epilepsy in children and prevention of epileptic seizures

In many countries, epilepsy imposes significant restrictions on the individual and social opportunities of children with this diagnosis. They experience difficulties in daily communication with others, which often leads them to social isolation and psychological problems, and in the future they will not be able to engage in certain activities, and even just drive a car.

A special role among the causes of epilepsy is played by the intrauterine development of the child, hereditary and genetic factors.

Of course, epilepsy in children cannot go unnoticed, but with timely diagnosis and treatment of the disease, the child will be able to develop normally and lead a full life just like his peers. An example of this is the fact that in Israel, people with well-controlled epilepsy can freely drive a car, engage in social work and any other activity according to their personal preferences. This is possible primarily due to the diagnosis of the disease even during the prenatal development of the child and an integrated approach to the treatment of epilepsy in children.

Prenatal development of a child, hereditary and genetic factors play a special role among the causes of epilepsy. In order to prevent serious consequences or at least correct the development of the disease, it is important to diagnose epilepsy even during pregnancy – by the middle of the term, an ultrasound examination already allows you to study the structure of the brain of the embryo and its pathology. If changes that can lead to the development of epilepsy persist in the last trimester of pregnancy, ultrasound examination should be confirmed by MRI of the fetal brain.

See also

Mental norm and pathology

As a rule, the development of epilepsy in children is due to organic disorders in the cerebral cortex, the so-called “cortex”. They may be associated with a lack of substances that take part in the construction of the central nervous system during fetal development. Timely diagnostics will help to track this process and take the necessary measures. However, not only a deficiency, but also an excess of certain substances and enzymes in the body of a newborn can cause epilepsy at an early age. For the same reason, jumps in the level of sugar or insulin in the blood can provoke an epileptic seizure in a completely healthy person.

In case of metabolic disorders, substances and toxins can accumulate in the child’s body, which he is not able to remove in a natural way for a healthy person. As a rule, metabolic disorders in children are associated with the breakdown of sugar, fats and carbohydrates, therefore, when drug treatment of epilepsy does not have the desired effect, the patient is transferred to a special diet that excludes potentially dangerous organic compounds in food.

A clear example of the role of the endocrine system and organic metabolism in the development of epilepsy in children is the long-standing Remedia baby food scandal in Israel, when a whole batch of milk formulas that did not contain vitamin B arrived on the shelves. deaths and dozens of disabilities associated with the development of the central nervous system, and lawsuits from parents continue to come to this day.

Forms and symptoms of epilepsy in children

There are many forms of development of epilepsy and degrees of severity of the disease, which, by and large, can be divided into 2 categories: general epilepsy and partial. It is very simple to distinguish one from the other: if during a convulsive attack the child loses consciousness even for a fraction of a second, epilepsy is considered general. It is impossible to say which of these two evils is the lesser, because both are caused by serious organic pathologies of the central nervous system – the difference is only in their localization. But it can definitely be argued that any kind of general epilepsy is accompanied by changes in the mind of the child, which ultimately cannot but affect his personal development.

Successful treatment of physiological problems associated with childhood epilepsy does not preclude psychological work with the child.

Children with epilepsy have cognitive and behavioral problems – memory disorders, attention disorders, learning and developmental difficulties. Experts find it difficult to say what they are caused in the first place: the course of the disease itself or the effect of drugs against epilepsy. However, it is impossible not to treat childhood epilepsy at all: each attack destroys part of the neurons in the cerebral cortex – this means that over time the child will not only stop developing, but, on the contrary, will regress in its development. Failure to treat epilepsy can lead to a state of encephalopathy, when the child stops responding to external stimuli, including his family and friends.

Psychological support for children with epilepsy

Successful treatment of physiological problems associated with childhood epilepsy does not preclude psychological work with the child. After all, the disease not only affects his body, but also negatively affects the development of communication skills, relationships in the family and in the social environment of the child, which is extremely important for psychological health and development. Often these problems are caused by the fear of parents: after all, even if the child is “balanced” with medication (that is, taking medications allows for a long time to prevent and contain epilepsy attacks), it is never possible to say exactly at what moment an attack will occur. This can happen when bathing, when a child crosses the road, in a dream, and in many other unpredictable and dangerous situations.

See also

Myths about diagnosing mental illness

Therefore, children with epilepsy are under the vigilant control of their parents and are very limited in communication: they cannot freely communicate with their peers, they cannot go on vacation to relatives or summer camp, they cannot play sports. Of course, in such a situation, social communications that are important for personal development at an early age are disrupted. Therefore, the course of treatment of epilepsy in children should include psychological work with the child and his parents. Outside the limitations of parental care, a child with epilepsy is largely able to learn, communicate, and develop normally as a person.

Seizure prevention

Prevention of epileptic seizures is of great importance in this development. An epileptic seizure can only be prevented with medication. However, you can protect yourself by avoiding factors that provoke attacks, or at least prepare for them.