History UsefulNotes / Epilepsy

In reality, epilepsy is much more variable. For starters, only a minority[[note]]anywhere from 3-5%[[/note]] of those with epilepsy have seizures triggered by flashing lights or any other environmental input, and it is known as Photosensitive Epilepsy. And for that matter it can be smells and sounds that trigger the seizure - since they too affect the brain. Usually seizures occur at random purely due to internal workings of the brain, simple as that.

In reality, epilepsy is much more variable. For starters, only a minority of those with epilepsy have seizures triggered by flashing lights or any other environmental input, and it is known as Photosensitive Epilepsy. And for that matter it can be smells and sounds that trigger the seizure - since they too affect the brain. Usually seizures occur at random purely due to internal workings of the brain, simple as that.

[[note]] ''Status epilepticus'' refers to when a person either has a single continuous seizure lasting more than 5 minutes, or has multiple separate seizures in a 5 minute window without returning to a normal state of consciousness inbetween. This is a ''very bad thing'', as it can lead to severe brain damage or death, hence the greater desire for intervention. [[/note]]


). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect.

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect.

One in 26 Americans have epilepsy, so you almost certainly know someone with this disorder whether you know it or not. ''[[ParanoiaFuel You]]'' may even have it ''without knowing it'' until your first seizure event. This is one of the reasons that the inaccurate portrayal of ConvulsiveSeizures and inaccurate [[WorstAid seizure first aid]] is so dangerous. More people die in the United States from epilepsy than breast cancer. Additionally, even people who don't have epilepsy can have seizures for all sorts of reasons - the most common being head injury, high fever, brain infections like meningitis, drug abuse, electric shock, eclampsia, or abnormal levels of glucose of sodium or glucose. 90% of people with seizure disorders live in the developing world.

As can be seen with trope names such as EpilepticFlashingLights and EpilepticTrees, the Hollywood depiction of epilepsy tends for the dramatic -- and innaccurate: Flashing lights cause immediate loss of consciousness and seizures with intense muscle convulsions.

The idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. Epilepsy medication takes several hours to kick in anyway. If ''you're'' the one who's accidentally overdosed and you're on your own, you probably have about 20 minutes max to call an ambulance to your location before the effects of the overdose set in - but don't panic. It really is almost impossible to overdose on epilepsy medication, even if you're ''trying''. But it's still pretty scary as the effects of an overdose are usually highly exacerbated effects of the regular dose's side effects, as well as potentially causing more seizures and vomiting. A frequent effect is entering a comatose state, although some epileptics describe being fully aware during it. However all these effects are ''temporary,'' even if hospitalisation is needed, usually lasting only as long as a regular dose.

The idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. Epilepsy medication takes several hours to kick in anyway. However it really is almost impossible to overdose on epilepsy medication, even if you're ''trying''. Side effects of an overdose include more seizures, indescribable neural pain, and temporary paralysis, vomiting and loss of bladder control. It's scary - to say the least. Epileptics have described the waking experience ranging from "a singularity of pain in my brain", to "I couldn't even move my eyeballs", to "I spent 12 hours convincing myself that I was still alive." However all these effects are temporary, and last only as long as the dose, which is usually 12 hours, so don't panic.

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. While it is almost impossible to fatally overdose on the medication used to treat epilepsy (no, really), not only will the medication take several hours to kick in, but side effects of extra doses range from more seizures to indescribable neural pain to full-body paralysis, and ultimately last until the medication wears off, which can be up to 12 hours.

Use of alcohol, cocaine/amphetamines/related drugs, or PCP (or alternately GoingColdTurkey from alcohol or from the benzodiazipines such as Xanax or Klonopin or Valium) can precipitate a seizure even in someone without epilepsy, make medications less effective in diagnosed epileptics, and/or lead to a "worse" form of seizure (e.g. a normally "petit mal" person has a temporal lobe seizure or ConvulsiveSeizures.) Stress is exaggerated as a factor but young children whose brains are still developing have been known to have their first seizures after life-changing events like an unexpected death in the family or a parent's divorce.

Anyone who has a brain may have a seizure. Animals can have seizures. In most cases the exact cause is unknown, and although most people learn to detect the signs of onset, some never seem to pinpoint the signals. Sometimes the reason for not pinpointing signals is as simple as seizures being pretty distracting. Or they just might not get the signs of onset.

!!Usually the seizure will end natrually with no intervention. The epileptic can wake up within seconds, or remain unconscious for a few minutes. After that...

* If they have injured themselves, they might not even notice. This ranges from mere bruises, to cuts from fingernails digging in, to trying to walk on broken bones. Try and keep them from worsening their injuries while you phone an ambulance.

** They may want to sleep. This is not a problem, although again, you should use their contact details to get them home first.
** They may have wet themselves. This is not uncommon, so don't worry about it.

* This is a person's first seizure.

* Be friendly and reassuring as consciousness returns. Do not yell at the person, but tell them they may have had a seizure. Ask if this is their first seizure.

* Someone experiencing combativeness as a result of a seizure state, barring their doing something immediately dangerous to others like using a firearm, ''must be left alone'' and watched from a safe distance -- further aggressiveness or restraint toward him or her will ''only'' worsen the situation, and the presence of anyone that may be triggering anger needs to be removed to a different location. Leaving the person alone and deprived of negative stimuli will allow the episode to end sooner, and the person to either regain conscious control or become unconscious.

In reality, epilepsy is much more variable. For starters, only a minority of those with epilepsy have seizures triggered by flashing lights or any other environmental input, and it is known as Photosensitive Epilepsy. Usually seizures occur at random purely due to internal workings of the brain, simple as that.

Second, there are many types of seizure and a wide variety in seizure frequency. Some people just "blank out" for a few seconds without anyone else even realizing he or she had just been through a seizure. Involuntary muscle movements in seizures have a great deal of variance. Muscle spasms in a seizure might be limited to slight shakiness in one hand. It might also not be simply random spasms, but instead for instance repeatedly lowering and raising an arm. The most dramatic seizures with a person falling down on the ground and thrashing around are only one of the types, and the people who have this kind every twenty minutes are in the most extreme minority.

There is also ''temporal lobe'' epilepsy, where seizures can present as dissociative episodes and/or hallucinations/seeing visions/ HearingVoices or music or sound, and which is notorious both for misdiagnosis (as a dissociative disorder such as fugue, Borderline Personality Disorder, or Multiple Personality Disorder due to dissociation, as schizoaffective or schizophrenic due to hallucinations/visions/voices/music/sounds), creating compulsive artistic behavior specifically around writing/painting/drawing/composing music/all of the above, and for violence (as the seizures are far less dramatic/obvious, and yet someone in one is just as unresponsive to commands -- including those from authorities or law enforcement or parents or whomever -- as someone having a grand mal seizure -- yet their behavior is often misread as threatening or willfully disobedient, and you can see where that can go with AbusiveParents or with police, for example) [[note]] A fairly good way to determine if you are possibly misdiagnosed and should see a neurologist rather than/along with a psychiatrist is the absence of the ''other'' symptoms of the non-epileptic condition. For example, if you have "trippy" auditory or visual hallucinations/perceptual disturbances but you ''don't'' have paranoid ideation or the "negative symptoms" of schizophrenia/schizoaffective disorder, you may actually have temporal lobe epilepsy and a neurologist consultation would be a very good idea.[[/note]]

Anyone who has a brain may have a seizure. Animals can have seizures. In most cases the exact cause is unknown, and although most people learn to detect the signs of onset, some never seem to pinpoint the signals.

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines -- meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. While it is almost impossible to fatally overdose on the medication used to treat epilepsy (no, really), not only will the medication take several hours to kick in, but side effects of extra doses range from more seizures to indescribable neural pain to full-body paralysis, and ultimately last until the medication wears off, which can be up to 12 hours.

One in 26 Americans have epilepsy, so you almost certainly know someone with this disorder whether you know it or not. ''[[ParanoiaFuel You]]'' may even have it ''without knowing it'' until your first seizure event. This is one of the reasons that the inaccurate portrayal of ConvulsiveSeizures and inaccurate [[WorstAid seizure first aid]] is so dangerous. More people die in the United States from epilepsy than breast cancer. Additionally, even people who don't have epilepsy can have seizures for all sorts of reasons- the most common being head injury, high fever, brain infections like meningitis, drug abuse, electric shock, eclampsia, or abnormal levels of glucose of sodium or glucose. 90% of people with seizure disorders live in the developing world.

First aid for epilepsy is not too difficult. The goal is to keep the person safe until the seizure stops naturally by itself. Holding someone down or restraining a person who is having a seizure is dangerous and can lead to combative behaviors. It is known for them to get parts of their body trapped in furniture while becoming so tense that they cannot be moved, in which case, you will simply have to wait. Someone having a seizure cannot swallow their tongue, although they may bite it. Never, ever put any foreign object in their mouth, since they may choke, break their teeth, and in the case of your fingers, it has been known for them to bite down ''to the bone.'' Some people with epilepsy have medications that can be taken in the aftermath of a seizure to prevent further incidents (like Ativan) or devices like a [[http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns vagus nerve simulator]].

* Keep other people from panicing or performing WorstAid, of course.

* Time the seizure with a watch or phone -- if it lasts over five minutes or if it's their first seizure, you should call an ambulance and they'll want to know how long it's been going on for.

* Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped. Even then, only do it if you know CPR; don't try to be a hero.

* Check to see if a person is wearing any kind of medical alert information (bracelet) to see if there are specific instructions.

** This isn't always easy. Some epileptics may try to continue with what they were doing before the seizure started, although they will still be confused. Others have been quoted repeatedly asking "Are you sure?" Remember that they have zero awareness from the very moment their brain entered the seizure to the moment they awoke, and just keep explaining until they get it.

** Most epileptics carry some contact details. If they can't give you a number or destination or if they tell you this is their first seizure, or if they are injured, offer to call an ambulance. Again, you may have to ask repeatedly.

!! You should call an ambulance if:

* Be friendly and reassuring as consciousness returns. Do not yell at the person, but tell them they may have had a seizure.

** The person is not known to have epilepsy (e.g. does not have epilepsy listed on a medical ID necklace/bracelet or In Case of Emergency (ICE) information on their cell phone).

As can be seen with trope names such as EpilepticFlashingLights and EpilepticTrees, the Hollywood depiction of epilepsy tends for the dramatic - and innaccurate: Flashing lights cause immediate loss of consciousness and seizures with intense muscle convulsions.

There is also ''temporal lobe'' epilepsy, where seizures can present as dissociative episodes and/or hallucinations/seeing visions/ HearingVoices or music or sound, and which is notorious both for misdiagnosis (as a dissociative disorder such as fugue, Borderline Personality Disorder, or Multiple Personality Disorder due to dissociation, as schizoaffective or schizophrenic due to hallucinations/visions/voices/music/sounds), creating compulsive artistic behavior specifically around writing/painting/drawing/composing music/all of the above, and for violence (as the seizures are far less dramatic/obvious, and yet someone in one is just as unresponsive to commands - including those from authorities or law enforcement or parents or whomever - as someone having a grand mal seizure - yet their behavior is often misread as threatening or willfully disobedient, and you can see where that can go with AbusiveParents or with police, for example) [[note]] A fairly good way to determine if you are possibly misdiagnosed and should see a neurologist rather than/along with a psychiatrist is the absence of the ''other'' symptoms of the non-epileptic condition. For example, if you have "trippy" auditory or visual hallucinations/perceptual disturbances but you ''don't'' have paranoid ideation or the "negative symptoms" of schizophrenia/schizoaffective disorder, you may actually have temporal lobe epilepsy and a neurologist consultation would be a very good idea.[[/note]]

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. While it is almost impossible to fatally overdose on the medication used to treat epilepsy (no, really), not only will the medication take several hours to kick in, but side effects of extra doses range from more seizures to indescribable neural pain to full-body paralysis, and ultimately last until the medication wears off, which can be up to 12 hours.

* Time the seizure with a watch or phone - if it lasts over five minutes or if it's their first seizure, you should call an ambulance and they'll want to know how long it's been going on for.

* Cushion their head with something soft - a cushion, a blanket, your jacket - but don't try to restrict their head or neck.

** Catatonia means the person is absolutely immobile and "frozen" and "silent" yet can hear/see/feel but is unable to respond to outside stimuli - imagine "AndIMustScream" in temporary form, or if the "petrify" effect in video games were real.

** The "acid trip" effect in temporal lobe epilepsy is when these symptoms combine, to form an experience that contains at least two of the above symptoms along with hallucinations - which produces an effect that is both to the sufferer and observer sometimes near-indistinguishable from a mushroom or LSD trip. These experiences have been described much the same as said drug trips have - as everything from blissful and ecstatic with almost religious overtones to the highest caliber of purely terrifying NightmareFuel.

* Non-generalized tonic-clonic seizures involve convulsions/numbness, but only of some locations (e.g. an arm or leg goes numb or shakes, one side of the body twitches, one side of the face twitches...) - the entire body does not fall and the person may be blacked out OR have some degree of awareness. These can easily be confused with strokes (and often happen as a result of strokes, brain tumors, traumatic brain injury, or other brain damage as well as epilepsy.)

* On the other hand, if the person is reaching out (even in a dissociated manner, such as speaking but to everyone/no one in particular or actively trying to engage a conversation), be there for them. Someone who is not ''entirely'' dissociated may find speaking to others and being "grounded" by anything from physical touch (of course, only if permitted - ASK FIRST) to conversation to doing a familiar activity to just being reassured that their experience will soon pass and is not going to harm them very helpful, and someone who is dissociated entirely may well go on "autopilot" speaking or writing or doing something else harmless as opposed to doing so in fear and lashing out.

* Someone experiencing combativeness as a result of a seizure state, barring their doing something immediately dangerous to others like using a firearm, ''must be left alone'' and watched from a safe distance - further aggressiveness or restraint toward him or her will ''only'' worsen the situation, and the presence of anyone that may be triggering anger needs to be removed to a different location. Leaving the person alone and deprived of negative stimuli will allow the episode to end sooner, and the person to either regain conscious control or become unconscious.

** The episode lasts longer then 5 minutes, UNLESS the person's events tend to do so - milder temporal lobe events often last longer than grand mal.

** The person is intoxicated on alcohol or other recreational drugs at the same time as having the event and said intoxication precipitated it - as there can be more or worse until the person's brain chemistry is balanced again

** The person's consciousness is markedly lessened - e.g. they are semiconscious rather than just tired

Use of alcohol, cocaine/amphetamines/related drugs, or PCP (or alternately GoingColdTurkey from alcohol or from the benzodiazipines such as Xanax or Klonopin or Valium) can precipitate a seizure even in someone without epilepsy, make medications less effective in diagnosed epileptics, and/or lead to a "worse" form of seizure (e.g. a normally "petit mal" person has a temporal lobe seizure or ConvulsiveSeizures.)

* Keep calm and reassure other people who may be nearby.
* Don't hold the person down or try to stop his movements.
* Time the seizure with your watch or phone.
* Clear the area around the person of anything which may hurt them or fall on them.
* Loosen ties or anything around the neck that may make breathing difficult.
* Put something flat and soft, like a folded jacket, blanket, or towel, under the head.
* Turn him or her gently onto one side. This will help keep the airway clear. Do not try to force the mouth open with any hard implement or with fingers.
* Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
* Stay with the person until the seizure ends naturally.
* When the person regains consciousness, they will be in a [[https://en.wikipedia.org/wiki/Postictal_state postictal]] state, and will probably be tired and confused. They may even try to continue with whatever they were doing before the seizure. Tell them they've had a seizure - you may have to do so repeatedly since epileptics have been quoted repeatedly asking, "Are you sure?"
* If a person injures themselves during a seizure, they probably won't even be aware of it at this point. Epileptics have been known to try and walk with broken bones; if they are injured, try to keep them from worsening any injuries.
** On the converse side of things, now is a great time to snap any broken nails back into place.
* Offer to call a taxi, friend, or relative, to help the person get home. Since they are not fully aware of their surroundings, it is wise to ask repeatedly.

* The person is not known to have epilepsy (e.g. does not have epilepsy listed on a medical ID necklace/bracelet/card or In Case of Emergency (ICE) information on their cell phone).

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. It takes several hours for the extra dose to register in the brain anyway, and the results tend to include more seizures, indescribable neural pains and full-body-paralysis for hours longer than the seizure would have lasted.

* When the person regains consciousness, they will be in a [[https://en.wikipedia.org/wiki/Postictal_state postictal]] state, and despite being conscious will probably be confused. They may even try to continue with whatever they were doing before the seizure. Tell them they've had a seizure - you may have to do so repeatedly since epileptics have been quoted asking, "Are you sure?"

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. It takes several hours for the extra dose to register in the brain anyway, the results are always frightening and usually indescribably painful, and last for hours longer than the seizure itself would.

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone an extra dose of "their meds" to stop a seizure in progress is WorstAid. It takes several hours for the extra dose to register in the brain anyway, the results are always frightening and usually indescribably painful, lasting for hours longer than the seizure itself would.

Stopping a seizure state in progress is something that can ''only'' be done in a hospital, and due to the risk of death doing so involves (the only way to do it involves high dose benzodiazipines - meaning that even if you've stopped the seizure, the person's central nervous system is highly depressed) it is almost only done in cases where the seizures themselves carry a risk of being fatal (e.g. ''status epilepticus''). Anticonvulsant and/or cannabinoid treatment can prevent/reduce seizures if initiated, tolerated, and properly maintained, but takes anywhere from 48 hours to two weeks to take full effect, so the idea that one can just give someone "their meds" to stop a seizure in progress is WorstAid.