Guidebook on Seizures: Causes and What To Do

Guidebook on Seizures: Causes and What To Do Self instructional module is one of the educational material that helps individualized learning. It is important to go through the module in schematic way. Take your own to read this material slowly and carefully in the place/room provide for you in the hospital premises. In case if you have any doubt regarding the content make a note and clarify with the investigator. Try to answer the question given at the end when you find any leisure time. Compare your answer with the key answer provided. SELF INSTRUCTIONAL MODULE ON PROMOTION OF SAFETY MEASURES ON MANAGEMENT OF SEIZURE INTRODUCTION: This is a self explanatory booklet on promotion of safety measures for patients with seizure and primary care givers of the patients. Some of the valuable information is given in this Self Instructional Module (SIM) for you; which will be very useful and informative for you in your practical life. CHAPTER 1 NEURONS AND FUNCTIONS OF BRAIN NEURONS: We are amazingly efficient and blessed with the nervous system in our body. Nervous System consists of vast number of cells called Neurons. Neurons transfer messages from one to another to take information in form of our senses and control our thoughts and activities. To send a message, the neurons want a messenger. We called that messenger as Chemical Messenger. The chemical messenger travels to the next neuron and transfer the information. If the amount of chemical messenger is enough, the neurons will receive the message in the form of Electrical charges. Changes that takes place in these electrical charges producing a electrical wave which is called Firing. Once a neuron fires ; it sends the information along to all the other neurons it is in contact with. During transmission of messages; there are some chemical transmitters which will freeze the neuron to prevent the brain from having much more activity to handle. There are also some unfreeze messengers which will help to pass the messages to all other neurons. So the passing of message from one neuron to another is a combined action of freeze and unfreeze messengers of the nervous system. HOW SEIZURE HAPPENS If there is not enough freeze messengers a seizure can happen. A seizure happens when too many informations are going around the brain at once, all at the same time. BRAIN Brain is one of the most important part of our body. Without brain there is no meaning for our life. The brain cells (neurons) helps us to carry out many actions and thoughts throughout our life. Any alteration in the brain happens means, the whole body function will be altered. Important parts of a Brain The important parts of a brain are a) Cerebrum b) Midbrain c) Pons d) Medulla Oblongata e) Cerebellum Functions of brain Brain helps in the mental activities which involve memory, intelligence, sense of responsibility , thinking, reasoning , moral sense and learning. Sensory perception of pain, temperature , touch , sight , hearing , taste and smell. Helps in fine control of skeletal muscle movements and function. Helps in fine control of complex movements and learned co-ordinated activities. Helps to sense appetite, thirst, pleasure, fear, sleeping and waking cycles. Controls the rate and rhythm of heart. Controls the blood pressure. Helps in initiating respiration and it also controls the rate and depth of respiration. Helps in maintaining posture and balance. Helps in language process. SUMMARY This chapter deals with Neurons in nervous system, its functions, how seizure happens, Brain and its function. The co-ordinated function and balance between the neurons and the brain helps us to live in this beautiful world. Exercise no. 1 A vast number of cells present in nervous system is called ______ The messenger that passes message from one neuron to another is____ Neurons receiving the message in the form of____ Too many messages going around the brain at the same time will leads to __ _____ helps in mental activities like memory, intelligence, thinking, reasoning and learning. CHAPTER- II SEIZURE Introduction Seizure is a disorder that affects the nervous system of our body. When too many information are going to the brain at once all at the same time, seizure will occur. Can seizure be cured? Seizure cannot be cured in the real sense of the term. Seizure is a disease like diabetes mellitus, hypertension and asthma. But seizure can be completely controlled by following some of the safety measures. Facts and Myths about seizure. Facts. Seizure can occur at any time in life and for any people. The leading cause of seizure in adults is head injury caused by auto mobile accidents. The leading cause of seizure for those above 65 years is stroke. People with seizure are not violent or crazy. People with seizure are not mentally ill. Seizure is not a curse. Seizure is not be a barrier to success in life. Myths A person with seizure cant be go for Education. A person with Seizure cant get Job. A person with seizure cant get marry. Seizures are thought to be caused by possession by demons. Seizure is a curse. Meaning of seizure: A seizure is a sudden disruption of nerve cells of brains normal electrical activity, that can cause a loss of consciousness and make the body to jerk. It cause a change in behaviour characterized by changes in sensory perception (sense of feeling) or motor activity. Causes of seizure: High fever Brain infections (Meningitis, tetanus, malaria) The triggering factors like Lack of sleep and stress. High level of sugar and sodium in blood. Low level of sugar, calcium and magnesium. Kidney or Liver failure. Alcohol abuse. Insufficient oxygen supply to brain Cigarette smoking. Congenital abnormalities Increased blood pressure. Reaction to some medication. How Seizure Occur We have seen in chapter 1, that there are clusters of nerve cells in the brain called neurons. A persons thoughts, feelings and actions are produced by electro chemical impulses that the neurons generate. When too many information are going to the brain ,the information are getting mixed up. Thus during a seizure, the neurons send mixed up information to our body, so the body does things that you dont want it to. Anything the brain or body can do it can do due to seizure. Usually the neurons send signals around 80 times a second. During seizure, neurons may fire as many as 500 times a second. Types of seizure: Seizures are mainly classified into Generalized seizure Partial seizure Generalized seizure start in the whole brain at a time, it includes; Absence seizure Tonic- clonic seizure Atonic seizure Partial seizures start in a small portion of the brain and stay there. They are of two types Complex partial seizure in which conscious is changed or lost. Simple partial where the person is conscious for the whole thing. Aural stage of seizure: Partial seizures can have the capacity to spread to whole brain, causing generalized seizure. In this case, Partial seizure is then called an aure, because it is a warning that a bigger seizure is coming. It is characterized by odd smell, taste, simple convulsions and visual disturbances. Signs and Symptoms of Seizure: The symptoms of a seizure depend upon the area of the brain affected. If small areas are affected aural stage symptoms will be there and if large portions of brain are affected, then the person will have Jerk and muscle spasm Altered or loss of consciousness Loss of bowel or bladder control Confusion Speech arrest Motionless stare Exessive salivation Anxiety, weakness, irritability, dizziness, changes in appetite. Light-headedness Tongue or cheek biting Cyanosis Unexpected falls with physical injury Complications Severe injury Status epileptics : It is a state of continuous seizure activity or a condition in which seizures reoccur in rapid succession without return to consciousness between seizures. Diagnosis of seizure Taking an Encephalogram Magnetic Resonance Imaging Computed Tomography Blood analysis These are the main methods to diagnose a seizure. These tests will reveal the abnormality which leads to seizure. These will give clear cut images of your brain and its nerve cells. Summary This chapter deals with the Facts and Myths about seizure, Meaning of Seizure, Causes, How seizure occurs, types, Signs and symptoms, Complications and Diagnosis of a Seizure. Seizures are caused mainly due to abnormal electrical activity of the brain nerve cells. EXERCISE NO: 2 Try to answer the following questions. _____ gives as information (warning) that a bigger seizure is coming. ____is the result of abnormal electrical activity of brain nerve cells. ____is a complication of seizure , which causes repeated reoccurrence of seizures without consciousness between seizures. ____type of seizure affects a small portion of brain ___is the leading cause of seizure in people above 65 years old. CHAPTER III SAFETY MEASURES ON MANAGEMENT OF SEIZURE This section is going to deal with the safety measures that the safety measures that the patient and the primary care giver have to follow before, during and after a seizure attack. Section- 1 Promotion of safety measures on management of seizure- To the Patients with Seizures. The main areas that section -1 deals with Instruction regarding drug treatment of seizure Instruction regarding Employment and Driving Instruction regarding marriage and pregnancy Instruction regarding recreational activities Instruction regarding relaxation techniques Instruction regarding dietary pattern 1) Instruction regarding drug treatment of seizure Things to be kept in mind while taking anti-epileptic drugs The aim of taking antiepileptic drugs is to obtain adequate control of fits Your brain need a constant maintenance of antiepileptic drugs to control seizures, so you have to take medications regularly Dont withdrawal the medication until prescription of the doctor If you have no fits for 4 to 5 years after withdrawal of drug, reoccurrence of seizure will become extremely small. Dont stop antiepileptic drugs when you are taking other medications for other diseases. If you vomit within an hour after taking anti-epileptic drug, take an extra dose of same medication after some time. If you forget to take a dose of drug taken an extra tablet within same 24hours period. Dont drink alcohol when you are under anti epileptic drug treatment. Mothers having seizure can safely breast feed their babies while taking anti-epileptic drugs, if any problem arises, they should consult their treating doctor. Some anti-epileptic drug have a side effect of causing gingivitis in mouth, so you should keep the mouth clean and tidy. 2) Instruction regarding Employment and Driving. If you are well and completely controlled without any disabilities from seizure, then you can work in any job which is not disturbing. The jobs not recommended for a persons with seizure are defence services, working with unguarded machinery, fire services, Railway engine driver. Persons whose fits are not controlled should not drive any vehicle. Persons with seizure should wear helmet and seat belt while travelling. Persons with seizure should wear Medical alert Tag which should contain your name, age, diagnosis, address and phone number of nearest relative. 3) Instruction regarding Marriage and Pregnancy. Persons with seizure can marry, if seizure is in good control. The spouse of the person should be aware of the situation. Poor controlled seizure patients cant marry, as it will cause problems. The anti-epileptic drugs must be continued in the same dosage during entire pregnancy. Treatment with one drug is preferred during pregnancy. Antenatal Mothers on seizure treatment should attend regular antenatal visits. 4) Instruction regarding recreational activities If you are in good seizure control, you can participate in non strenuous activities. Avoid athletic activities like fast running jumping etc. Swimming can do under supervision. Remember to carry sufficient medicine while travelling and take them at scheduled time. Flying in aeroplane is also safe ,but you should inform to the staffs in advance. While watching T.V and working in computer Sit or stand as far from screen as possible. Do not watch T.V if you are tired or need sleep. Watch T.V in a well lighted room. Avoid excessive play and work in computer, it will weakened the brain function. If you continues to have any discomfort (tingling, numbness, stiffness etc..) see a doctor immediately. Instruction regarding relaxation techniques to reduce stress Relaxation allows the body to heal from within. Sit in a comfortable position: Place your hands in a resting state on your lap Close your eyes. Take a deep breath. Relieve the breath slowly. Do this for 10 to 30 mintues in a day. Instruction regarding dietary pattern Drink plenty of water. Flesh foods like chicken and mutton are good. Rice, Nuts, Eggs, can also eat. Diet should not ignored in any circumstances. SECTION 2 Promotion of safety measures on management of seizure among primary care givers of patients with seizure. The main areas this section deals with: Care of patients during seizure. Care of patient after seizure. Prevention of seizure related injury. Instruction regarding care of patients during seizure Dont try to restrain the person Remove objects that could cause injury. Loosen tight clothing. Turn the head or whole body to the side to drain saliva from mouth. Nothing to be inserted between the mouth during seizure. Do not attempt to give CPR during seizure. If the person turns blue or stop breathing CPR can be performed after seizure. If the seizure continues for more than 5 minutes or if not responding, seek medical help. Stay near to the patient and speak kindly. Instruction regarding care of patient after seizure Treat if there is any injury. Record all details like When seizure started How long it lasted. What body parts were affected Any specific symptoms like confusion, head ache, fever, vomiting. How the person behave before and after the seizure. Allow the patient for a sound sleep. Do not offer anything (food or water) until the patient is fully alert and awake. Do not disturb while the patient is sleeping. After waking, check whether the patient is oriented or not. When to seek emergency help When the patient have, Inability to walk or stand Fever Guidelines for primary care givers of a seizure patient Be conscious about the signs symptoms of aural stage of seizure Place the patient on a flat surface during seizure Provide a clam environment Stay near the patient Remove the all the materials which harm the patient Never try to move the patient during seizure If the patient is having high fever take necessary action immediately A medical alert card should always with the patient when he goes out which should have the following information name, address, phone number, diagnosis Check whether patient get adequate sleep Check whether patient takes drugs regularly Avoid the social stigma Stressful events with seizure patients has to do it in a careful manner. Prepare the patient psychologically both for success and failure in any attempt. Summary This chapter deals with the promotion of safety measures on management of seizure. This chapter includes 2 sections. Section -I deals with the safety measures for patients with seizure and section II deals with the safety measures for the primary care giver to undertaken during a seizure. Exercise III Try to answer the following questions Restrain the patient during seizure True b) False Put any hard object in to the mouth during seizure to avoid tongue biting. True b) False Relaxation techniques can reduce stress True b) False If the patient loss breathing during seizure, start CPR True b) False Keep the patient in supine position during seizure. True b) False KEY ANSWERS Exercise No -1 Neurons Chemical messenger Electrical charges Seizures Brain Exercise No-2 Aural stage Seizure Status Epilepticus Partial seizure Stroke Exercise No-3 False False True False False CONCLUSION From this booklet (SIM),it is clearly understood that on the whole, the future of persons with seizure is definitely bright and those affected can certainly look forward to a much better quality of life. In order to attain this, you should promote the safety measure that you have read and follow it with out fail.