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Table of Contents Introduction .....................................................................................................................1 About this Training .........................................................................................................1 What is a Seizure? ..........................................................................................................2 Typical Causes for Seizures ............................................................................3 What is Epilepsy? ...........................................................................................................4 Causes of Epilepsy ..........................................................................................4 Danger of Prolonged Seizure ..........................................................................5 Epilepsy and Seizure Triggers .........................................................................5 Epilepsy and Seizures: Types ..........................................................................6 Generalized Seizures ......................................................................................6 Partial Seizures................................................................................................7 Special Cautions ..............................................................................................8 After a Seizure ................................................................................................................9 The Postictal Phase ........................................................................................................9 Treating Seizures .........................................................................................................10 Treatment Do’s .............................................................................................10 Treatment Don’ts ..........................................................................................11 Treatment Guidelines ...................................................................................12 PreHospital Treatment: Convulsive Seizure in Progress ....................................................................12 Patient No Longer Convulsing ..................................................................... 15 Complex Partial Seizure ............................................................................... 17 Epilepsy and Seizures: Patient Experiencing Seizure with VNS Implant .............18 Epilepsy and Seizures: Is Ambulance and Hospital Transport Needed? .............19 Epilepsy and Seizures: Antiepileptic Drugs ............................................................. 20 PreHospital Treatment: Convulsive Seizure of Unknown Origin ........................................................21 Convulsive Seizure due to CNS Injury ......................................................... 21 Active Seizure Has Ceased .......................................................................... 23 Convulsive Seizure due to Metabolic Disorder ...........................................23 Active Seizure Has Ceased .......................................................................... 25 Seizure in Progress Due to Infection ...........................................................25 Once Active Seizure Has Ceased .................................................................25 Using SAMPLE to take a seizure history .................................................................. 26 Glossary of Terms ........................................................................................................28 Frequently Asked Questions ......................................................................................30 control. Where differences arise, it is hoped that EMS responders will raise Introduction the issues with their leadership to see if modifications in local practice would As EMS personnel, naturally, you are enhance patient care and outcomes. often the first responders when someone is having a seizure. The Epilepsy Foundation recognizes how important that EMS response can be to the health and safety of an Seizure – a sudden, brief estimated three million Americans disruption of the normal neuron subject to seizures caused by epilepsy. functioning in the brain. Beyond that number, there are likely millions more who may experience one or more seizure episodes as a result of Normal nerve cells, or neurons, in the trauma or other acute or chronic brain fire billions of electrical signals to illness. each other by means of tiny bursts of energy. They start and then stop, over Given the prevalence and critical and over again. Think of these bursts nature of these events, the Epilepsy as flashes of energy. Foundation has prepared this manual to provide information and training A seizure is a sudden, brief disruption crucial to an effective EMS response to of the normal functioning of neurons in seizures. The recommendations from the brain. The disruption in the the Epilepsy Foundation outlined in neurological environment causes this training are built on solid some nerve cells to fire without experience. However, the Foundation stopping and spread to involve other also recognizes that the availability of nerve cells. When this happens, a kind EMS responders, their training, of electrical pulse sweeps through the authority for their practice, and their brain and typically causes the affected utilization of medications and person to experience a variety of treatments varies from location to behaviors such as staring, falling, location. Therefore, this information repetitive motions, disorientation, or to should be regarded as guidelines. experience the massive muscular contractions generally known as With this in mind, suggested response convulsions. and treatments guidelines are divided into two categories: All Responders/BLS Response About this Training (Basic Life Support) ALS Response (Advanced Life When an individual has a convulsive Support) seizure – that is, an alteration of brain function producing loss of EMS responders should follow local consciousness and muscle regulations, practice and/or medical contractions affecting the whole body 1 – often the first impulse on the part of the public is to call 911 for an emergency medical services (EMS) What is a Seizure? response. This training describes a variety of seizures associated with epilepsy, seizures with other potential causes, appropriate EMS response on Seizure – a sudden, brief scene, and issues to be considered disruption of the normal neuron when determining whether or not functioning in the brain. further medical care is warranted. In general, the goals are to: Normal nerve cells, or neurons, in the brain fire billions of electrical signals to Strengthen the knowledge of each other by means of tiny bursts of Emergency Medical Services energy. They start and then stop, over (EMS) responders in the and over again. Think of these bursts recognition, causes, as flashes of energy. A seizure is a appropriate response and sudden, brief disruption of the normal management of generalized functioning of neurons in the brain. and partial seizures and status epilepticus. As mentioned earlier, the disruption in Enhance the ability of EMS the neurological environment causes responders’ ability to respond some nerve cells to fire without effectively to individuals stopping and spread to involve other experiencing a seizure, with an nerve cells. When this happens, a kind emphasis on epileptic seizures. of electrical pulse sweeps through the Help the EMS responders’ brain and typically causes the affected make informed decisions person to experience a variety of regarding the proper response behaviors such as staring, falling, to seizures with respect to the repetitive motions, disorientation, or to need for additional care and experience the massive muscular ambulance transport contractions generally known as convulsions. By the end of this training, you will be able to: A seizure that involves the entire brain Define what a seizure is and list is called a generalized seizure. This various causes type of seizure generally results in Describe the basics of epilepsy, convulsions and other clearly a variety of seizures associated observable behaviors. But not all with epilepsy and other seizures are dramatic. potential causes Differentiate between the types More limited disruptions of brain of seizures function produce less dramatic Outline appropriate EMS changes in movement or behavior, responses and treatment depending on what part or how much options for those experiencing a of the brain is affected. These are seizure better known as partial seizures 2 because only part of the brain is After a seizure, recovery may occur affected. We’ll talk more about