4-4. TREATMENT OF SEIZURE DISORDERS

a. General Principles. Included are the following:

(1) Encourage the person to lead a normal life with social activities.

(2) Recommend moderate exercise with proper safeguards; for example, swimming and horseback riding.

(3) Automobile driving after one year has passed since the last seizure.

(4) No alcoholic beverages.

(5) The individual's family should use their common sense and guard against overprotecting him and being overly sympathetic. The family should suggest that the person enter vocational rehabilitation and join a local interest group such as the Epilepsy Foundation of America. They should encourage the person to take his medication regularly and to carry an identification card stating that he is an epileptic.

b. Initial Aid to a Seizure Patient. Although seizures are rarely life-threatening, good management techniques can help the patient. Follow these guidelines:

(1) Prevent the person from injuring himself. To keep him from biting his tongue or the inside of his mouth, place a tongue depressor, handkerchief, or padded gag between his teeth.

CAUTION: DO NOT cram anything in the person's mouth, and be careful with your fingers.

(2) DO NOT restrain the person

(3) DO NOT leave the person alone.

(4) Loosen his clothing, especially clothing around his neck, and place a pillow under his head.

(5) Turn his head to the side after the seizure activity. This will allow mucus to flow out of his mouth.

(6) DO NOT give him drugs during the attack except for treatment of status epilepticus. Drugs could delay the completion of the attack.

(7) Be careful not to overreact or overtreat the person.

(8) If necessary, arrange for the person to be hospitalized.

c. Recording and Reporting Seizures. Follow this procedure:

(1) Record personal observations of the patient. Be accurate in your description of details.

(2) Record circumstances preceding the attack. Record what the patient told you and what he did. Also, record statements of what he did from witnesses.

(3) Record exact sequence of seizure symptoms. Be sure to include:

(a) Where on the body did the seizure start?

(b) Was the seizure local or generalized?

(c) How long did the seizure last? Include the total time and the time of each phase of the seizure.

(d) List symptoms that were noticed during the seizure; for example, incontinence, cyanosis, pupil changes, etc.

(4) Laboratory findings. An electroencephalogram (EEG) is the most important test in the study of epilepsy. Drugs, photic stimulation, sleep, and hyperventilation may be of diagnostic value. Include skull x-rays, CSF studies, GTTs, CT scan of the head, cerebral angiograms, and brain stems.

(5) Drug therapy principles. No single drug is effective for all types of seizures. The person may require several drugs. Begin treatment with the smallest effective dose and increase the dosage until the seizures are controlled or until the person experiences side effects from the drugs. Monitor the person's blood level of anticonvulsants. For some reason, children often need and tolerate much larger doses of medication than their age and weight would indicate. Never withdraw anticonvulsant drugs suddenly. Continue medications for at least five seizure-free years. Alcoholics experiencing seizures are not helped by anticonvulsant drugs or are of little value.

(6) Medications for specific types of seizures.

(a) Grand mal-focal--psychomotor seizures. The drug of choice for control of frequent seizures is Dilantin^R (phenytoin sodium). Watch for side effects. Possible side effects include gum hypertrophy, nervousness, rash, ataxia, drowsiness, and nystagmus (involuntary rapid movements of the eyeball). When this medication is given intravenously, monitor the person's blood pressure every five minutes. Another drug which can be given is phenobarbital.

(b) Status epilepticus. Give one of the following drugs slowly:

1 Valium^R (diazepam).

2 Dilantin^R (phenytoin sodium).

3 Phenobarbital sodium.

4 Amytal^R (amobarbital sodium).

5 Intractable cases may require general anesthesia.