Diagnosis and management of seizure

The most feared disease, seizure (or epilepsy), can spark at any time and the sufferer can fall and suffer any time. No one can predict the attack because of external health. Seizure/epilepsy is very difficult to diagnose since there is no single certain test to ascertain it. Also, even though the doctor will evaluate seizure/epilepsy with quite a lot of tests and investigations, nothing could pinpoint the cause for the complaint unless otherwise there is focal structural abnormality.

Anyhow, detailed case taking, incidences, patient and family member’s narration (about the family history, suffering and personality, behaviour and habit of person especially related to anxiety, tension, smoking, drinking and drugging, etc.), lab investigations, etc. can shape the plan and compulsion for the treatment.

Also, as the sufferer is not aware of the suffering or way of suffering, family members have the sole responsibility to note the nature and course of seizure (i.e. how it began and how it looks like, etc.) to tell the doctor, to treat accordingly. They should analyse the sufferer in the following way: 

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• How seizure gets started

• How many minutes it lasted 

• Whether the sufferer lost conscious from the beginning or not

• Which part or side of the body suffers or suffers more?

• Is there any trigger or not?

• How about the time, food, incidences, emotions, reactions, activity of the sufferer just before the suffering?

• How many minutes the sufferer takes to regain consciousness

• Whether the sufferer had suffered incontinence of urine or stool during seizure?

During examination, doctors analyse the sufferer for brain dysfunctions with weakness, coordination of movement(s), reflexes, spasticity, alteration in sensations and functions, etc. 

Diagnostic techniques – The common tests followed to frame seizure disorders are:

• Routine blood tests and urine tests (to rule out any infection, anaemia, low or high sugar levels, metabolic disorders, poisoning, hormonal imbalance, etc.)

• X-ray skull (in AP view and lateral view) / CT / MRI scan (to identify any bleeding spots / clots / brain tumours / cysts)

• Electroencephalography (EEG) – to find out abnormal brain functions. Here brain functions are graphed through the current measured through electrodes placed on the scalp. The waves and spikes produced can indicate the place of abnormal foci in brain or flickering or spark. In seizure case, it may show abnormality in waves / spikes till 24 hours of the suffering and in epilepsy, unusual waves can be even read when the sufferer is normal and not having any seizures. Most often, EEG readings happen to remain normal (in seizure and epilepsy cases) confusing diagnosis.

• Behaviourial (personality, mood swings, emotional changes, etc.) and neurological analysis (with muscle control, coordination, movements, reflexes)

Prevention – Since the cause remains unknown, no known preventive measures have been made out as of now. Anyway, for seizures - getting enough sleep, eating a proper nutritious diet and abstaining from alcohol and drugs, caring head against any injury reduces the chance of seizures or epilepsy. Also one needs to monitor stress sleep, diet, medications and stimulants for preventing as well as managing seizure. 

Be 

• Open minded and share your feelings or fears

• Active and do physical exercises regularly

• Regular with medications

Do’s 

• Physical as well as mental exercises (reading, thinking, solving puzzles / problems) 

• Wear helmet while involved in risk factors 

• Proceed for treatment as early as possible in case of any complaints

Avoid

• Racing against time

• Circumstances which favour anxiety and tension

• Overloading brain / mind anticipating trouble

• Addictives – alcohol / coffee, smoking and drugs

• Unnecessary medicines

Precautions

• Don’t have any fear about the disease (mostly it is not life-threatening) - learn well about the disease

• Good sleep is first and foremost good medicine. Have good sleep at least seven hours a day

• Avoid triggers, especially tension, over exertion, dehydration, lowered sugar level, highly fluctuating lights and bass sounds, etc., to avoid attacks

• Treat fever at the early stage itself and if necessary take sponge bath to reduce or control temperature

• Get medicines from qualified doctors stating everything, i.e. complaints suffered before / during / after seizure

• Take medicines regularly and never miss doses

• Don’t drink, drive and swim alone

• Be aware of the drug’s adverse effects and cope up with that

• Avoid pregnancy unless otherwise medicine doses have been altered or reduced under the supervision of physician – since most commonly anti-epileptic drugs cause congenital anomalies or birth defects 

• Pre-natal and post-natal care should be given in the right way under the supervision of physician and gynaecologists.

Management 

Caring for persons during seizure

• Protect the sufferer from any injury by supporting and cushioning during fall or fainting or violent jerks of seizure

• Try to remove objects / furniture away from the sufferer during jerks or suffering period 

• Do not try to stop or hold the sufferer as you cannot stop it or make it off all of a sudden - allow the seizure to run its natural course.

• Do not give anything (iron rod or keys or any thing) in the hand to seizure patients (even though their activity looks like they are trying to grab or hold something) - It will also injure supporter (or you) or sufferer himself. So, don’t provide anything. 

• Do not give anything through the mouth – even water or medicines as they cannot swallow at that time. 

• Also, avoid putting any objects in the mouth to avoid tongue biting – This type of activity can cause choking or can also break teeth 

• Try to extend the head (stretching backwards) so that breathing will be easier for the sufferer

• Roll over the suffer to lie sidewards so that frothy saliva can drool out (avoiding choking / avoiding entering into lungs causing bronchitis or pneumonia)
  If possible, loosen their dress and keep the area aerated. Don’t crowd around the sufferer

• Hospitalise if sufferer suffers eh seizure violently and continuously or when the person has not regained consciousness in a short span of time. Hospitalisation can clear airways, provide oxygen, intravenous fluids and medicines to comfort the sufferer at the earliest.

Caring for persons after seizure

• Give reassurance with hope for future

• Make them get investigated all the way and make them proceed to proper treatment

• Help them keep regular with medicines / food / habits

Complications – In case of seizure disorders, complications reflect in all facets (education, employment, quality of life, etc.) i.e., by the disease itself, due to progress of disease, by psychological upset or by medicines, etc.

First and foremost

• Getting injured due to fainting / fall / seizure

• Mental agony about the disease, life-time medicines, cure, fate, etc.

• Feeling disabled to drive / high-skilled task (where attention is more precious or life is in danger) in spite of having all the parts in good condition or functions make one more worried and depressed

• Bronchitis or pneumonia due to ingestion of saliva 

• Side-effects of regular life time anti-epileptic medicines, i.e., 

• Dullness and poor concentration 

• Children cannot cope with study as before

• Miscarriages during pregnancy

• Can cause birth defects or congenital anomalies like cleft palate, autism, holes in heart

• Impotency and low sperm count

• Kidney and liver can suffer damage

Finally

• Lack of treatment / care can lead one to emergency situation i.e., violent continuous seizure (Status epilepticus) / death

Treatment point of view of seizure / epilepsy disorders

(To be continued)