ALGORITHM FOR PROVIDING FIRST AID FOR AN ATTACK OF EPILEPSY

Epilepsy (falling disease) is a fairly common pathology of the nervous system, the main manifestation of which is an epileptic seizure. An epileptic attack can be quite frightening and is characterized by loss of consciousness, the onset of seizures and, in some isolated cases, foam at the mouth. Sometimes it may take on a reddish tint.

To provide first aid, you do not need to have specific medical knowledge or skills. In most cases, the seizure goes away on its own; it is not necessary to call an ambulance. As a rule, a person who knows about his problems carries a note with the numbers of his relatives, friends, and information about himself, which may be useful to those who happen to be close to him.

However, people who want to help the victim should carefully perform first aid procedures, since the wrong procedure can cause serious harm to the patient.

People suffering from epilepsy should be regularly examined by a doctor, as the correct prescription of medications and constant monitoring of the disease reduce the risk of epileptic seizures. The Yusupov Hospital provides medical services from the best neurologists and epileptologists in the capital, who will select individual treatment for each patient.

Epilepsy and epileptic seizures are of completely different types and can manifest themselves in different ways. However, despite the variety, the attack always occurs suddenly. There are some signs by which you can determine an impending seizure, but this is not always possible. It is important for the person providing assistance to maintain inner calm and confidently carry out all necessary actions, since a person’s life is at stake.

Signs of an epileptic seizure

The mechanics of the occurrence of epilepsy has not been precisely clarified at the moment, but it is known that seizures begin against the background of intense stimulation of areas of the cerebral cortex due to increased electrical activity of nerve endings.

Signs of an attack, as a rule, vary from person to person, but there is a certain set of symptoms that helps determine the stage of the attack and immediately proceed to first aid procedures. Such crises cause great pain and stress to the patient, so after the seizure the victim must be handled very carefully.

Signs of an epileptic seizure include:

• sudden loss of balance, falling to the ground;
• loss of consciousness;
• nausea, vomiting;
• heavy breathing;
• muscle hypertonicity;
• inseparable loud shouting;
• a sharp increase in blood pressure;
• blood from the nose;
• involuntary throwing of the head back;
• “glass eyes”;
• increased salivation, sometimes with foam;
• loss of sense of reality of the surrounding world;
• disruption of the thinking process, misunderstanding of words or shouts of strangers;
• involuntary bowel movements or urination;
• local convulsions or convulsions of the whole body;
• numbness of the limbs;
• pupils stop responding to light;
• bluishness or redness of the face and other skin;
• very rapid pulse or its strong decrease;
• convulsions.

It is quite difficult to prevent an attack, but by certain indicators you can understand its approach and take the patient to a safe place.

Expert opinion

Author: Olga Vladimirovna Boyko Neurologist, Doctor of Medical Sciences
Doctors consider epilepsy one of the most dangerous neurological pathologies. This is because a seizure can occur at any time. This increases the risk of injury. Therefore, epilepsy requires timely diagnosis and treatment. The disease occupies a leading place in the structure of disability. According to statistics, 30% of patients are disabled people of group 1 or 2. In order to reduce the risk of injury during an epileptic attack, doctors have developed special first aid recommendations. Anyone can familiarize themselves with them.

Doctors at the Yusupov Hospital diagnose and treat various forms of epilepsy. Modern European CT, MRI and EEG equipment are used for examination. This medical equipment allows you to quickly determine the localization of the pathological focus. The quality of treatment depends on the accuracy of the research. An individual therapeutic plan is drawn up by experienced neurologists and epileptologists. If you follow medical recommendations for the treatment and prevention of epileptic seizures, 60-70% of patients at the Yusupov Hospital achieve long-term remission.

Diagnostics

Neurologists diagnose and treat epilepsy. Some of them specifically expand their qualifications in this area, which allows them to act even more effectively.

Examination of a patient with suspected epilepsy includes the following methods:

• collection of complaints and medical history: the doctor asks the patient in detail about the symptoms that bother him, finds out the time and circumstances of their occurrence; a characteristic sign of epilepsy is the appearance of seizures against the background of sharp sounds, bright or flashing lights, etc.; special attention is paid to heredity, past injuries and diseases, the patient’s lifestyle and bad habits;
• neurological examination: the doctor evaluates muscle strength, skin sensitivity, severity and symmetrical reflexes;
• EEG (electroencephalography): a procedure for recording the electrical activity of the brain, allowing one to see the characteristic activity of an epileptogenic focus; if necessary, the doctor may try to provoke overexcitation using flashes of light or rhythmic sounds;
• MRI of the brain: makes it possible to identify pathological areas and formations: tumors, fissures, ischemic areas, consequences of a stroke, etc.;
• angiography of the vessels of the head: injection of a contrast agent into the blood followed by radiography; allows you to see areas of vasoconstriction and deterioration of blood flow;
• Ultrasound of the brain (Echo-encephalogram): used in children of the first year of life whose fontanel has not yet closed; visualizes tumors and other space-occupying formations, fluid accumulation, etc.;
• rheoencephalography: measurement of electrical resistance of head tissue, which can be used to diagnose blood flow disorders;
• general examinations: general blood and urine tests, blood biochemistry, tests for infections, ECG, etc. for a comprehensive assessment of the patient’s condition;
• consultations with specialized specialists: neurosurgeon, toxicologist, narcologist, psychiatrist, etc. (prescribed depending on the suspected cause of the attacks).

The list of studies may vary depending on the patient’s age, type of attack, presence of chronic pathologies and other factors.

Causes of occurrence and development

There are no immediate causes that can cause an epileptic seizure, but there are a number of risk factors that, under certain circumstances, can trigger an epileptic seizure. Risk factors can be either congenital or acquired.

Hereditary predisposition involves the special functioning of neurons and their tendency to spontaneous excitation. This feature can be passed on from generation to generation, but does not always manifest itself. Epilepsy with a hereditary predisposition can develop in the case of acquired provoking factors, namely:

• with cerebral hemorrhage or other cerebrovascular accidents;
• after traumatic brain injury;
• as a result of prolonged alcoholism, use of narcotic and psychotropic drugs, severe stress;
• with meningitis, encephalitis;
• for birth injuries;
• with a brain abscess or stroke;
• in the presence of aneurysms, cysts or adhesions in the brain.

Factors influencing the occurrence of an epileptic seizure are:

• poor sleep patterns;
• drinking alcohol, caffeine, taking any amount of drugs, antidepressants not prescribed by a doctor;
• refusal to take medications or undergo therapy;
• smoking;
• stress;
• changes in hormonal levels due to certain diseases;
• menstruation in women.

It is very important to understand: if an attack has begun, in no case should you give the patient any medications, especially those that are not prescribed by the attending physician. In such a situation, the process has already started, and any pills can only do harm. An attack, if it lasts no more than three minutes, should simply be controlled and not try to bring the person to his senses. However, if the attack lasts longer, it is important to call a medical team.

Doctors at the Yusupov Hospital work around the clock, so in case of complications after epileptic syndrome, you should immediately consult a doctor to avoid disastrous consequences. We will help our patients get out of any difficult situation.

How can you help a patient with epilepsy?

Strictly monitor the correct intake of medications, even if this requires resorting to pedagogical pressure. Sometimes a special box with medications for the day or week helps.

The condition must be carefully recorded, i.e. keep a diary recording attacks, in which they note the time and duration of attacks, their nature, the situation with which they may be associated (high body temperature, insufficient sleep), side effects of medications.

Regularly visit the doctor and follow all his prescriptions.

Maintain a proper sleep schedule.

Provoking factors

Often, epileptic seizures occur from various “triggers” - situations that provoke an attack. This could be a bright flashing picture, a sequence of sharp sounds. There are cases where overly bright cartoon screensavers caused a negative reaction in children. The danger comes from flashing, rapidly changing images that overload sensitive systems.

If the attack is caused by just such a factor, then it is better to get rid of it at the first opportunity: turn off the TV, turn down the volume. After the attack ends, ensure that you stay in a quiet room with dim lighting. If you do not get rid of the triggers, they can provoke a series of repeated attacks, which will not be easy for the body to survive.

Reasons for the formation of an attack

Pathological activity of the brain of a patient with epilepsy is a process that can “start” for a variety of reasons.

The most common factors in the development of an epileptic attack:

• photostimulation (exposure to sharply flickering light);
• stress;
• lack of sleep;
• taking certain types of medications;
• deep intense emotions: sharp fear, fear, anger, and others;
• alcohol consumption;
• frequent and deep breathing (hyperventilation);
• electrical influence, for example, electrophoresis;
• acupuncture and massage;
• use of psychostimulants.

How to spot an impending seizure

It is impossible to prevent an epileptic seizure, but you can warn others about it in advance or ask for help if you suffer from epilepsy and feel an attack coming.

First comes the tonic phase, its manifestations are convulsions, loss of control over the situation, increased salivation, etc. As a rule, due to hypertonicity of the muscles, the legs remain straight, and the arms involuntarily bend at the elbows. Breathing becomes difficult and may stop for several seconds at regular intervals. Asphyxia causes the skin to turn blue, especially the lips.

The tonic phase lasts about 30-45 seconds, after which the clonic phase begins. The clonic period is characterized by alternating muscle tension and relaxation - convulsions and convulsive states. During this period, the person twitches randomly, bends in unnatural positions, but does not come to his senses. The patient may spontaneously bite his lips or tongue, which causes blood to appear in the saliva. During the period of complete muscle relaxation, the internal sphincters also weaken, which can cause bowel or bladder emptying.

A few minutes before the onset of epileptic syndrome, the patient may suffer from restlessness, increased anxiety, and may experience hallucinations of various types. There are several types of pre-epileptic conditions, so-called auras:

• speech aura – disturbance of sensory or motor functions;
• mental aura - a sudden, unconditional feeling of sadness, melancholy, increased anxiety, panic attacks, or vice versa, a sharp surge of energy and joy;
• vegetative aura – dysfunction of the executive organs: blood vessels, secretion glands and muscles;
• sensitive aura - distortions in the sensations of external stimuli, a feeling of extreme cold or heat, a disturbance in the sensation of one’s body;
• sensory aura - changes in auditory, olfactory and visual sensations.

It is important not to panic if you notice similar symptoms in yourself or someone nearby. You should calmly warn others about this and secure your location by removing all dangerous piercing or cutting objects, and also move to a safe place where you can lie down.

The round-the-clock reception of doctors at the Yusupov Hospital will protect patients in the clinic from complications after an epileptic seizure. We pay close attention to each of our visitors, guaranteeing high-quality treatment results.

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Types and symptoms

Epilepsy is multifaceted and multifaceted; its symptoms are not limited to seizures. The most common classification is depending on the severity of attacks and their main manifestations.

Aura (harbingers)

Many epileptic seizures begin with an aura. This is the name given to a complex of specific sensations that occurs shortly before a seizure. Manifestations of an aura can be completely different: paresthesia (pathological sensations), a specific taste in the mouth, auditory, visual or olfactory hallucinations, etc. Before the appearance of an aura, a person often begins to experience causeless anxiety and internal tension.

Partial (focal) seizures

These conditions occur when a small area of ​​the brain is involved in pathological overexcitation.

Simple partial seizures are characterized by preserved consciousness and last only 1-2 minutes. Depending on the location of the pathological focus, a person feels:

• sudden change of mood for no apparent reason;
• small twitching in a certain part of the body;
• feeling of déjà vu;
• hallucinations: lights before the eyes, strange sounds, etc.;
• paresthesia: a feeling of tingling or crawling in any part of the body;
• difficulty pronouncing or understanding words;
• nausea;
• change in heart rate, etc.

Complex attacks are characterized by more severe symptoms and often affect consciousness and thinking. Human can:

• lose consciousness for 1-2 minutes;
• there is no point in looking into emptiness;
• scream, cry, laugh for no apparent reason;
• constantly repeat any words or actions (chewing, walking in a circle, etc.).

Typically, during a complex seizure and for some time after it, the patient remains disoriented for some time.

Generalized seizures

Generalized seizures are one of the classic signs of epilepsy that almost everyone has heard of. They occur if the epileptogenic focus has spread to the entire brain. There are several forms of seizures.

• Tonic convulsions. The muscles of most of the body (especially the back and limbs) simultaneously contract (come to tone), remain in this state for 10-20 seconds and then relax. Such attacks often occur during sleep and are not accompanied by loss of consciousness.
• Clonic convulsions. Rarely occur in isolation from other types of attacks. Manifested by rhythmic rapid contraction and relaxation of muscles. The movement cannot be stopped or delayed.
• Tonic-clonic seizures. This type of attack is called grand mal, which means “great illness” in French. The attack is divided into several phases: precursors (aura);
• tonic convulsions (20-60 seconds): the muscles become very tense, the person screams and falls; at this time his breathing stops, his face becomes bluish, and his body arches;
• clonic convulsions (2-5 minutes): the muscles of the body begin to contract rhythmically, the person thrashes on the floor, foam is released from the mouth, often mixed with blood due to a bitten tongue;
• relaxation: convulsions stop, muscles relax, involuntary urination or defecation often occurs; consciousness is absent for 15-30 minutes.

After the end of a generalized seizure, a person remains for 1-2 days feeling overwhelmed, problems with coordination of movements and fine motor skills. They are associated with cerebral hypoxia.

• Atonic attacks. They are characterized by short-term muscle relaxation, accompanied by loss of consciousness and falling. The attack lasts literally 10-15 seconds, but after it ends the patient does not remember anything.
• Myoclonic seizures. They manifest themselves as rapid twitching of the muscles of individual parts of the body, usually the arms or legs. The seizure is not accompanied by loss of consciousness.
• Absence seizures. The second name for attacks is petit mal (minor illness). This symptom of epilepsy occurs more often in children than in adults and is characterized by a short-term loss of consciousness. The patient freezes in place, looks into emptiness, does not perceive speech addressed to him and does not react to it. The condition is often accompanied by involuntary blinking of the eyes, small movements of the hands or jaws. The duration of the attack is 10-20 seconds.

Pediatric epilepsy

Childhood epilepsy has many masks. In newborns, it can be manifested by periodic muscle contractions that do not resemble seizures, frequent tilting of the head back, poor sleep and general restlessness. Older children may suffer from classic seizures and absence seizures. Partial seizures most often occur:

• severe headaches, nausea, vomiting;
• short periods of speech disorder (the child cannot utter a single word);
• nightmares followed by screams and hysterics;
• sleepwalking, etc.

These symptoms are not always a sign of epilepsy, but they should serve as a reason for an urgent visit to the doctor and a full examination.

First aid algorithm

First aid for an epileptic seizure is extremely important, since incorrect actions can not only not help the victim, but also worsen the situation. If someone nearby begins to show symptoms of an impending seizure, you should prepare:

• find out whether the person has had epileptic seizures before;
• If a person has epilepsy, he must immediately take the pills prescribed by the doctor to block the seizure. At the same time, people nearby should not give the patient tablets of unknown origin;
• secure your location, move to a safe, uninhabited place;
• if the situation occurs indoors, it is necessary to open windows or doors to ensure the flow of fresh air;
• the patient's head should be placed on one side to avoid choking on saliva or vomit;
• provide the patient with a fall on a soft surface, place an additional soft object under the head so that the head is higher than the body;
• remove all potentially traumatic objects;
• remove belts, necklaces, hats and all things that can squeeze, cause discomfort and make breathing difficult.

What to do if an epileptic seizure has already begun?

To begin with, it is worth remembering that panic and loss of self-control are factors due to which help during an epileptic seizure may be incorrect. You need to calm down, take a breath and begin to perform the following algorithm of actions:

• record the time of onset of the attack;
• if possible, place the patient with a rolled up soft cloth or any non-hard object between the jaws to avoid biting the lips or tongue;
• record the time of the end of the attack, this will help in the future when making a diagnosis.

It is important to stay close by until the symptoms go away completely. If there is no direct threat to life and health, then it is better not to actively interfere with the course of events. Excessive activity from those who want to help can often harm further well-being.

There are a number of erroneous actions that can cause significant harm to the victim.

Why does a seizure occur?

According to scientists, an epileptic seizure begins due to abnormal activity of nerve cells in the brain. A powerful electrical discharge occurs, which becomes a trigger. The patient suddenly begins to have strong and uncontrollable convulsions.

In historical sources, epilepsy is called a “falling disease” because the patient falls off his feet. Historians claim that many celebrities of past centuries suffered from similar attacks, such as Napoleon and Julius Caesar. The disease usually develops in childhood and adolescence. Over time, the interval between attacks and the nature of the seizures may change noticeably.

What not to do

Doctors talk about several actions that should never be taken if you want to help.

Firstly, under no circumstances should you leave a person alone. During the tonic phase of seizures, the patient may stop breathing due to spasm of the airways. During the clonic phase, hitting your head on something.

Secondly, it is strictly contraindicated to try to restrain a person who is convulsing. The muscles are overstrained due to contractions, and excessive pressure on the limbs or spine will not lead to anything good, but will only increase the risk of damage to the muscle fibers or joints when it comes to the limbs.

Thirdly, there is a well-established stereotype that an epileptic needs to insert something between his teeth. Usually a spoon or keys are mentioned as a suitable item. But the facial muscles are no less tense than others, so an attempt to unclench the jaws can damage the teeth and result in a fracture of the lower jaw. This measure is also fraught with injury for those who want to provide first aid: the jaws are clenched with such force that the epileptic can bite off the finger with which they want to open his mouth.

The risk that an epileptic will bite off his own tongue is a harmful lie. This is a muscle like all the others. When she is in a state of hypertonicity, the likelihood of biting or sticking her tongue tends to zero.

Fourthly, it is very important not to give any medications to an epileptic, even if some medications are found in the patient’s pockets or bag. When under stress, it is easy to miscalculate the dosage, including that of a specially prescribed drug. You can also allow a situation in which the pill ends up in the wrong throat. If the medicine does harm, the person who wants to help will face criminal liability, even if he acted with the best intentions.

At the end of the attack, especially if none have been observed before, the patient should be taken to the clinic for further examination. Qualified doctors at the Yusupov Hospital are ready to provide assistance at any time of the day. Our doctors treat each patient responsibly and attentively, carry out all manipulations and examinations based on individual indicators.

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What to do after an attack

After an epileptic seizure, the patient needs peace and rest, since during an attack the body depletes resources and needs to be replenished. Before the ambulance arrives, provide the victim with complete comfort and psychological support. Try to rid him of all irritants and remain calm.

An ambulance should be called only if the seizure lasts more than 3 minutes, or if it recurs. Professional help is also necessary if during an attack the patient injures himself, is injured or suffocates. After an epileptic attack, the following steps should be taken:

• put the patient on his side and let him rest for a few minutes;
• if the attack happened in a crowded place, ask everyone to move away to ensure psychological comfort for the victim;
• if a person involuntarily empties his bowels or bladder, try to clean the area and remove dirty clothes;
• notify the patient’s relatives or loved ones about what happened, especially if he is a minor or an elderly person;
• do not leave the patient for at least another 15-20 minutes, since normalization of the condition does not occur immediately. Transport the victim home if he wishes.

It is important to understand that even the correct implementation of first aid cannot guarantee the absence of the risk of developing side complications. Immediately after an epileptic seizure, the patient should be admitted to the neurology clinic of the Yusupov Hospital, where the best neurologists in the capital will determine the diagnosis and prescribe concomitant treatment. Examinations in the hospital are carried out using modern European equipment, which allows you to obtain the most accurate results. Our medical staff is ready to provide first aid in emergency situations throughout the day.

When to call an ambulance

To provide first aid for epilepsy, it is not always necessary to involve doctors. As a rule, attacks are fleeting. There are cases when compassionate citizens called the ambulance crew, but by the time they arrived they had already left the scene on their own.

In addition, for some, such situations happen several times a day. With such options, it is enough to know the basic principles of providing assistance, and if everything proceeds without complications, you can cope on your own.

In some situations, the help of medical specialists is vital for a patient with epilepsy.

The attack happened for the first time in my life

You cannot be sure how the body will react if it has not experienced such overexertion before. It is quite possible that epilepsy is manifesting itself right now (this can happen at any age). However, there is a danger that a seizure is a sign of some disease, the exacerbation of which requires the intervention of appropriately qualified specialists.

The victim is a child or elderly

The bodies of children and the elderly are most vulnerable to critical changes in health. Even if everything goes as normal, only doctors will be able to give an accurate conclusion regarding the condition of the body and further health risks.

Cramps in a pregnant woman

A neurological disease can be fatal to a child in the womb. If a woman is late in pregnancy, there is a risk of premature onset of labor.

There is a possibility of injury

During seizures, the patient may hit his head on a sharp corner or be injured during a fall. Even if it just seems to you that there is a risk of traumatic brain injury or any other injury, it is better to call specialists and keep the patient in place until the doctors arrive.

The patient remains unconscious for more than 10 minutes

It is important to check the patient’s clarity of consciousness after an attack, to find out whether he remembers his name or home address. If he does not regain consciousness on his own, there is no need to “help” him: hit him on the cheeks or splash water. It is also forbidden to try to bring people to their senses using such means as ammonia: any strong odors can provoke a second attack, which, compared to the one just suffered, can cause significant harm to health.

Epilepsy always carries the risk of irreversible changes in brain structures. If a person breathes but does not regain consciousness for more than ten minutes, it is important to organize professional medical assistance as soon as possible.

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Treatment

At the Neurology Clinic of the Yusupov Hospital, clients can count on several treatment methods. In particular, we are talking about drug therapy and neurosurgical technologies. By skillfully combining these techniques, doctors achieve a significant improvement in the condition of their patients and provide them with the most comfortable life possible with this pathology.

It should be understood that epilepsy is not a death sentence; people with this disease can live a normal life, limiting themselves to virtually nothing. To do this, you need to regularly undergo the necessary examinations, see your doctor and take prescribed medications. Doctors at the Yusupov Hospital take care of their patients, regularly ordering examinations and prescribing medications only based on the individual indicators of each patient.

How is epilepsy treated?

Epileptic seizures are treated with medications. Doctors select a specific set of remedies for each specific case. Patients are usually prescribed medications of different effect groups:

• anticonvulsants
• antiepileptic drugs
• neuroleptics
• corticosteroids
• antibiotics
• anti-inflammatory and dehydrating medications

The dosage and duration of treatment is determined by the attending doctor. With improvement, the number of drugs used is reduced.