First aid for an attack

An epileptic seizure can look quite frightening, but in reality it does not require urgent medical attention.  

Usually, after the end of the attack, the person quickly recovers, but until everything stops, he really needs your support. We will tell you exactly how to help people suffering from epilepsy. 

How to behave during an attack:

1. If any unusual conditions (“aura”) appear before the attack, then the patient should be placed on a flat bed or floor, unbuttoned clothes (loosen the collar, untie the tie), especially at the throat.
2. Relieve pressure on the neck that can make breathing difficult.
3. Outside the home, the patient must be moved to a safe place (away from water, traffic, sharp objects and corners). Remove all objects that could be dangerous (glass, sharp and hot objects). 
4. You can put a soft object under your head (rolled jacket, bag, bag).
5. If a seizure attack occurs suddenly and the patient does not anticipate it, he himself cannot protect himself from injury, and precautions should be taken after the onset of the attack.
6. During an attack, the patient should not be carried, except in those cases when he may be in danger, for example, on the roadway, near a fire, on stairs or in the water.
7. With increased salivation and vomiting, the patient must be placed on his side so that he does not choke. This should be done gently, without using force!
8. Try to keep the patient in a lateral position until the attack stops.
9. Do not try to hold the patient by limiting his movement.

Also, you do not need to try to open the patient’s mouth, even if the tongue is bitten: this can lead to injury to the teeth, oral mucosa, upper and lower jaws and the tongue itself. Tongue biting occurs at the very beginning of an attack. If the patient has bitten his tongue or cheek, then the injury has already occurred. Further attempts to open the mouth to avoid injury to the oral mucosa are futile and dangerous. Moreover, the resulting bleeding can lead to red staining of saliva (foam). 

• In no case do not allow the head to be thrown back! But it is often in this position that the patient’s head is located when relatives try to open his jaw.
• No need to do artificial heart massage and artificial respiration.
• Do not feed, do not put pills in the mouth, do not give water until the patient is fully awake.
• Stay close until the patient has fully recovered.
• It is necessary to wait for the seizure to end, being close to the patient and carefully observing his condition in order to correctly and fully describe the manifestations of the seizure to the doctor.
• Record the time of the onset of the attack so you know how long it will take.   

It is very important to note the time when the seizure began, since the duration of the seizure or a series of seizures approaching 30 minutes means that the patient is entering a life-threatening condition – status epilepticus.

After an attack, the patient may feel weak, exhausted, and may fall asleep immediately or a few minutes after the attack. In this case, you do not need to disturb him in order to give an opportunity to recover. 

It is necessary to stay close to the patient and wait until the period of post – attack confusion of consciousness (if it develops) ends and consciousness is fully restored.   

It happens that after an attack, the patient develops psychomotor agitation, while along with inappropriate behavior, aggressive actions towards others can be noted.

It is important to remain calm and self-controlled, to reasonably balance between moderate physical restraint of the patient in his manifestations, but at the same time try to provoke him to counteraction as little as possible.

The described methods of assistance relate to generalized seizures.

Focal seizures are usually less dramatic.

You should not try to restrain and limit the actions of the patient; however, if they pose a threat to the patient or people around him, you should carefully try to restrict his movement, since violent restriction can increase agitation and confusion and provoke aggression.

What not to do during an attack:

• Hold the quivering limbs with force. This can lead to fractures and dislocations with excessive force.
• To unclench the jaws clenched by spasm with force or hard objects. This should not be done even with a bite of the tongue, even if it has begun to bleed!
• Water the patient with water.
• Give water and tablets to drink during an attack.
• Give artificial respiration or heart massage.

After an attack, try to wake the patient up by shaking him, tapping him, letting him smell pungent odors, or using any other means.

Urgent care is optional:

• if the patient is diagnosed with epilepsy while:
• the patient reported that seizures had been previously observed and his state of health is close to normal, he is calm and answers questions correctly
• the epileptic seizure lasted no longer than 5 minutes
• the patient was not injured during the attack

When to call an ambulance?

• if the attack has occurred with a pregnant woman;
• if the attack occurred with a child or an elderly person;
• if the attack lasted more than 5 minutes;
• if during an attack the patient is injured;
• if after an attack the patient does not regain consciousness for more than 10 minutes;
• if this attack is the first;
• if there is evidence of diabetes mellitus, infection, poisoning, high body temperature;
• if an epileptic seizure occurs in water;
• the next seizure occurred immediately after the previous one (serial seizures);
• regaining consciousness after an attack is slow, confusion is noted;
• if the patient has a breathing disorder.

Most seizures end on their own and last for a short time (a few seconds or minutes). In these cases (except for the first-ever episode) there is no need to call a doctor, carry out special treatment or hospitalization of the patient.

However, a prolonged seizure poses a threat to the development of status epilepticus and can be dangerous for the patient. In these cases, intramuscular or intravenous drugs are required to stop the attack.

Generalized seizures usually stop spontaneously after 1-3 minutes, and therefore usually the patient does not need the help of a doctor. However, if the duration of the attack exceeds 5 minutes, special measures are required to stop the attack. As a rule, in these cases, intramuscular or intravenous administration of drugs leads to the termination of the attack.

Some drugs used to relieve an attack are also available in dosage forms for rectal administration (microclysters in rectal tubes, as well as suppositories). These forms are easy to use, and the patient’s parents or relatives can independently administer the drug without calling a doctor or waiting for an ambulance to arrive.

With prolonged seizures, or seizures following one after another without regaining consciousness, there is a threat of developing status epilepticus, and the patient should be hospitalized in the intensive care unit.

Focal seizures also require medical attention only for prolonged seizures.

How can you help a patient with epilepsy treatment?

Strictly monitor the correct intake of medicines, even if this requires resorting to pedagogical pressure. Sometimes a special box helps, where medicines are laid out for a day or a week.

The state must be carefully recorded, i.e. keep a diary with a record of seizures, in which they note the time and duration of seizures, their nature, the situation with which they may be associated (increased body temperature, insufficient sleep), side effects of drugs.

Regular visits to the doctor and the fulfillment of all his appointments.

Stick to proper sleep patterns.

Patient memo

Seizure

• Protect my head.
• Do not restrain my movements, only if I am not in danger.
• Don’t put anything in my mouth, especially your fingers.
• When the attack is over, talk to me, lay me on my side so that I can breathe easier.
• Make sure that I can completely rest and calm down after the attack ends.
• Please note that it is usually not necessary to call the nursing staff, unless the seizure lasts longer for me than usual, or if seizures with seizures occur one after the other.

If you have a seizure without seizures

• Do not restrain my movements, only if I am not in danger.
• Calm me down and be with me during the confusion that may follow after a seizure.
• Stay with me until I am fully awake and able to speak to you.