Seizure Treatment: Hospital Protocols And Procedures

Seizures are abnormal electrical activity in the brain, causing changes in awareness, behaviour, senses and muscle control. They can affect anyone at any age and can be caused by a variety of factors, from underlying medical conditions to injuries or illnesses. Treatment for seizures in a hospital setting will vary depending on the type, severity and cause of the seizure. This may include treating any underlying conditions, such as a stroke or low blood sugar, as well as the administration of anti-seizure medications. If medications are ineffective, other treatment options include special diets, medical devices or surgery.

Recognising the signs of a seizure

Before a seizure occurs, some people may experience an "aura", which is more common with complex focal seizures. Auras can involve feelings of deja vu, fear, euphoria, or visual, hearing, or smell abnormalities. These sensations can serve as warning signs that a seizure is about to occur. However, not everyone experiences auras, and many seizures can come on suddenly without any early signs.

During a seizure, a person may exhibit several recognisable symptoms. They may fall down if they lose muscle tone or consciousness. They might shake, jerk, or twitch, and their eyelids may also twitch. They may become unaware of their surroundings and seem confused. In some cases, their lips may turn blue, indicating breathing difficulties. It is important to note that not all seizures are the same, and the symptoms can vary depending on the individual and the type of seizure.

After a seizure, the person may be sleepy, confused, or disoriented. They may have trouble breathing or waking up fully. It is important to help them sit in a safe place to recover and offer comfort and reassurance once they are alert. Offer to call a friend or loved one to help them get home safely.

It is crucial to stay calm and keep the person safe during and after a seizure. Remove any objects nearby that could cause injury, and ease them to the ground if they are falling. Turn them gently onto their side, with their mouth pointing downwards, to keep their airway clear. Loosen any tight clothing around their neck, and remove eyeglasses if they are wearing any. Timing the seizure is also important, as prolonged seizures (lasting more than five minutes) require immediate medical attention.

First aid and safety

Seizures are caused by abnormal electrical activity in the brain, resulting in changes in awareness, muscle control, behaviour, and senses. They can affect anyone at any age and can be triggered by various factors, including underlying medical conditions, injuries, or illnesses. Recognising the signs of a seizure is crucial to providing effective first aid and ensuring the person's safety.

If you encounter someone experiencing a seizure, it is essential to remain calm and stay with the person. Remove any objects nearby that could cause injury and check for a medical bracelet, which may provide information about their condition, medications, and emergency contacts. Do not hold the person down or restrict their movements, as this could cause injury to you or them. Avoid placing anything in their mouth, as it may hurt their teeth or jaw, and refrain from giving mouth-to-mouth breaths during the seizure.

Ease the person to the ground if they appear to be falling. Gently turn them onto their side with their mouth pointing downwards to prevent saliva or vomit from blocking their airway. Place something soft and flat, like a jacket, under their head, and remove their eyeglasses. Loosen any tight clothing around their neck that could obstruct their breathing. Time the seizure; if it lasts more than 5 minutes, seek immediate medical attention by calling for emergency assistance.

After the seizure has ended, help the person to a safe place to recover. Keep them company until they regain alertness, and provide comfort and reassurance by explaining what happened. Offer to contact a friend or loved one to ensure they return home safely. If the person is injured, has difficulty breathing or waking up, or experiences a seizure in water, seek immediate medical attention.

It is important to note that people with epilepsy may require ongoing treatment to manage their seizures. Treatment options include anti-seizure medications, special diets, medical devices, and surgery. Up to 70% of people with epilepsy can effectively manage their condition with medications. However, if medications prove ineffective, other treatment options may be considered, such as epilepsy surgery or vagus nerve stimulation.

Tests and diagnosis

Seizures are caused by abnormal electrical signals firing in the brain, resulting in changes in awareness and muscle control, as well as symptoms affecting behaviour and senses. They can vary in appearance and can affect anyone at any age.

• Blood tests can help identify underlying medical conditions, such as low blood sugar, or other potential triggers.
• Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) scans can detect physical abnormalities in the brain, such as tumours, infections, or blood vessel issues.
• Electroencephalography (EEG) measures electrical activity in the brain, helping to identify abnormal patterns associated with seizures.
• Genetic tests may be conducted to identify any genetic factors contributing to seizures.
• Positron Emission Tomography (PET) scans can help visualise metabolic activity in the brain, aiding in the localisation of seizure foci.
• Spinal tap (lumbar puncture) involves extracting a small amount of cerebrospinal fluid to test for infections or other abnormalities.
• Neuroimaging techniques, such as MRI or functional MRI (fMRI), can help identify structural abnormalities or areas of abnormal brain function associated with seizures.
• Neuropsychological testing may be used to assess cognitive functions, including memory, language, and problem-solving, to determine the impact of seizures on brain function.
• Video-EEG monitoring involves continuous video recording and EEG monitoring to capture seizure activity, helping to characterise seizure types and localize seizure foci.
• Intracranial EEG (icEEG) involves placing electrodes directly on the exposed brain to record electrical activity. This invasive procedure is typically reserved for cases where non-invasive methods are insufficient for diagnosis or surgical planning.

Once a comprehensive evaluation is completed, healthcare providers can develop an appropriate treatment plan, which may include medications, dietary interventions, medical devices, or surgery.

Treatment options

First Aid

First aid is crucial during a seizure to ensure the person's safety and comfort. This includes keeping the person away from harm, easing them to the ground if they are falling, and turning them gently onto their side to maintain a clear airway. Removing eyeglasses, loosening tight clothing around the neck, and placing something soft under their head are also recommended. It is also important to stay calm, time the seizure, and call for emergency assistance if it lasts more than five minutes.

Medication

Anti-seizure medications are a common treatment option, with the U.S. Food and Drug Administration (FDA) approving more than 20 such medications. These medications can control seizures in about 60-70% of people with epilepsy. Treatment is individualized, and healthcare providers may try different medications, doses, or combinations to find the most effective approach. However, it is important to note that some anti-seizure medications are linked to birth defects, so pregnant women or those planning to become pregnant should discuss this with their healthcare provider.

Special Diets

Special diets are often recommended in conjunction with anti-seizure medications or as an alternative treatment option. The ketogenic diet and the modified Atkins diet, which are high in fat, moderate in protein, and low in carbohydrates, are commonly suggested. Low glycemic index diets may also help reduce seizures. Diets are typically recommended for children when medication is not effective or surgery is not an option.

Surgery

Surgery for seizures involves removing abnormal brain tissue, cutting fiber bundles connecting brain areas, or implanting neuromodulation devices. Surgery is usually considered when multiple anti-seizure medication trials have failed to control the seizures. It is a safe and effective treatment option, especially when seizures originate from a specific area of the brain. However, patients typically continue taking medications after surgery.

Vagus Nerve Stimulation

This treatment involves implanting a small device in the chest wall, similar to a pacemaker. The device sends electrical signals to the brain through the vagus nerve, reducing the number and severity of seizures. This approach is considered when seizures do not respond to medications and cannot be treated with surgery.

Surgery

During epilepsy surgery, a neurosurgeon treats the area of brain tissue where seizures occur. They may remove, disconnect, or destroy the tissue or implant a device. The skull bone is then secured with titanium clips, and the skin is closed and bandaged. The surgery can take several hours, and patients may need to stay in intensive care for a day and in the hospital for three to five days for open surgery.

One surgical option is laser ablation, which has a lower risk of side effects and quicker recovery time than resection. Laser ablation has a "seizure freedom" rate of about 60%, compared to 70-75% for resection. Neurostimulation, or neuromodulation, is a third option where devices are implanted in the body to control seizures. This is considered when a clear focal point for the seizures cannot be identified.

Robotic surgery through 2-millimeter holes is another technique that shortens hospital stays and increases precision. Patients undergoing epilepsy surgery have an extensive support network of brain specialists, including surgeons, anesthesiologists, neurologists, neuropsychologists, and more. While the prospect of brain surgery can spark anxiety, doctors emphasize that it is a safe procedure with immense benefits.

Frequently asked questions