Convulsions, epilepsy
Eva Klabusayová
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Learning objectives
̶ Student knows the types of convulsions and epileptic seizures.
̶ Student knows how to provide safety for the patient during epileptic seizure and how to
proceed after the end of the seizure.
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Convulsions
̶ Involuntary skeletal muscle contraction
̶ Bending of body, body stiffening
̶ Twitching of limbs, jerking movements
̶ Flutter of the eyes, blank staring
̶ The patient doesn’t communicate, possible loss of consciousness
̶ Irregular breathing, respiratory arrest
̶ Foaming at the mouth
̶ Biting of tongue, lips, cheeks
̶ Loss of muscle tone of sphincters – urination, fecal incontinence
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Etiology of convulsions
̶ Sudden rise of body temperature (e.g. febrile convulsions in children)
̶ Neurological disorders - epilepsy
̶ Metabolic disorders (e.g. hypoglycemia)
̶ Intracranial expansive processes, stroke, intracranial bleeding
̶ Eclampsia
̶ Intoxication
̶ Infectious diseases
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Epilepsy
̶ Neurological disorders characterized by recurrent epileptic seizures
̶ Disorder of electrical activity of the brain - disturbed balance between inhibition (GABA) and
excitation (glutamate) neurotransmissions
causes: often unknown, brain injury, genetic, metabolic disorder etc.
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Epilepsy - types of seizures
Partial (focal)
̶ Initiation in focal part of the brain, symptoms corresponds with the location of epileptogenic
region
̶ Some patients develops “auras” - “warnings”, seizure limited to particular area of the brain
(a “rising” feeling in the stomach, a feeling of numbness or tingling, halutinations…)
̶ If seizure continues to spread, partial complex seizure develops - automatic unpurposeful
movements (licking, chewing), incomprehensible speech
̶ After seizure possible anxiety, aggressiveness, amnesia
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Epilepsy - types of seizures
Generalized seizures
̶ Epileptic activity of brain cortex or hempisphere
̶ Scream, fall, growling, salivation
̶ Violent muscle contractions of the limbs
̶ Quick, random spasms
̶ After seizure usually loss of consciousness
̶ Absence seizures
̶ sudden lapses of consciousness, staring into space
̶ typically in children
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What endangers the patient?
̶ Injury caused by fall
̶ Injury caused by surrounding objects
̶ Airway obstruction
̶ Sudden cardiorespiratory arrest
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First aid during the seizure
̶ Communicate with the patient (if conscious) as well as with the other persons present
̶ Lay the patient on the floor
̶ Put something under the patient's head, lose tight clothes around neck
̶ Move harmful or sharp objects
̶ Do not restrain convulsions, spasms or automatisms
̶ Wait for the end of seizure
̶ Measure the length of the seizure
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First aid after the seizure
Patient with decreased level of consciousness
̶ Follow algorithm SSS ABC!
̶ Open and clear the mouth, open the airway
̶ Turn the patient on the side
̶ Wait for return of consciousness
Patient is conscious
̶ In case of post-paroxysmal disorientation calm the patient down
̶ Check if there are injuries (head, tongue, spine)
̶ Obtain anamnesis
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First aid - medicaments
̶ In children (with anamnesis of febrile convulsions, epilepsy)
Diazepam 0,5 mg/kg body weight orally (tablets)
Diazepam rectal solution, rectal suppository
̶ 5 mg per rectum in children up to 15 kg
̶ 10 mg per rectum in children above 15 kg
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First aid - what NOT to do!
̶ Do not use physical power!
̶ Do not restrain movement (convulsions and automatisms)
̶ Do not try to pull out patient’s tongue
̶ Do not put any objects in patient’s mouth
̶ Do not use jaw maneuvers during the seizure
̶ Do not give water or food to the patient
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When to call ambulance?
̶ Repeated seizures (cumulation of seizures)
̶ Status epilepticus
̶ First seizure
̶ Injury of the patient
̶ Diabetic
̶ Pregnant woman
̶ Patient does not return consciousness after 5-10 minutes
̶ Patient does not return to his/her usual state, disorientation persists
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When NOT to call ambulance?
̶ Patient on medication with known epilepsy
̶ Return of consciousness
̶ Disorientation does not persist
̶ There is no injury
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Learning outcomes
̶ Student is able to decide when it is necessary to call an ambulance.
̶ Student knows how to ensure patient safety during an epileptic seizure.
̶ Student is able to describe how to proceed after the seizure.
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Resources
Czech league against epilepsy: http://www.clpe.cz/Epistandardy_2017_web.pdf
Czech Red Cross: https://www.cervenykriz.eu/cz/standardy/standardy-prvni-pomoci-2017.pdf
https://www.epilepsy.com/sites/core/files/atoms/files/SFA%20Flier_HQ_8.5x11_PDF.pdf
https://reference.medscape.com
https://www.youtube.com/watch?v=jJWfHHqfSbk
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Resources - pictures
https://radiopaedia.org/cases/early-and-late-subacute-intracerebral-haemorrhage-on-mri-and-ct
https://cz.depositphotos.com/88798832/stock-illustration-man-got-fever-high-temperature.html
https://www.desitin.cz/pro-pacientyvpois/diazepam-desitinr-rectal-tube/
https://cs.iliveok.com/health/cipky-z-hemoroidu_112579i15828.html
https://www.kissclipart.com/ambulance-png-clipart-ambulance-clip-art-tsst4z/
Simulation Centre, Faculty of Medicine, Masaryk University
2020