General First Aid

Do I call 911?


Normally seizures do not require 911. However, if any of the above is true then call. This is the person’s first time having a seizure. After the seizure, the person is having trouble walking or breathing. The first seizure leads to another seizure shortly after. The person becomes injured during the seizure. The seizure takes place in water. The person having the seizure has a health condition like diabetes.




What steps can I take if someone is having a seizure?


Make sure that you remain with the person until the seizure is over. When the seizure is done, help them sit where they are safe until they alert and then inform them what has happened. Make sure to remain calm and comforting. Although a person is generally unable to respond to you while they are having a seizure, it is still important to continually provide verbal encouragement to help reorient and sooth the person as they come out of the seizure. Check if they have a medical bracelet or any other emergency information. Keep the people around you and yourself calm. Offer to call the person a ride like a taxi.




What do I do if it is a tonic-clonic (grand mal) seizure?


Help the person onto the floor Maneuver the person onto one side Move anything sharp or hard out of the area Place something soft and flat underneath their head Take off their eyeglasses If they have a tie or anything on them that may make it hard to breathe loosen it Keep track of how long the seizure has been taking place. If it has been taking place longer than 5 minutes than call 911. DO NOT RESTRAIN THEM OR ATTEMPT TO PUT ANYTHING IN THEIR MOUTH






First Aid Children

When do I call 911?


Unless your doctor tells you otherwise, a seizure in a child with epilepsy that ends after a couple of minutes does not usually require a trip to the emergency room. However, if it lasts more than 5 minutes without any sign of slowing down, is unusual in some way, or if a child has trouble breathing afterwards, appears to be injured or in pain, or recovery is different from usual, call 911 for emergency help. It is always a good idea to discuss with your doctor in advance what to do if your child should have a prolonged seizure.




What other concerns should I pay attention to when my child has seizures?


In most cases, seizure management or first aid means keeping a child safe while the seizure runs its course. Fortunately, most seizures are brief and stop within a few minutes. The first step in any seizure management plan is to get your doctor’s advice. He or she knows your child’s seizure history and is in the best position to help you plan an appropriate response.




How I manage status epilepticus in my child?


Prolonged or clustered seizures sometimes develop into non-stop seizures, a condition called status epilepticus. Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control. If your child has had episodes of non-stop seizures that had to be treated in the emergency room, you will want to have a plan of action ready in case they occur again. Ask the doctor if there are any new treatments for use at home or at school to stop a seizure from developing into status. If your child is experiencing continuous seizures, call an ambulance. Do not attempt to transport an actively seizing child in your car unless an ambulance is not available. Be aware of where the nearest hospital is, how long it takes to get there. If you live a long way from the hospital, you may plan to call earlier than you would if it were closer. If there are several hospitals nearby, ask your doctor in advance which one to call. Consider arranging for standing orders prepared by the doctor to be kept in the emergency room so the seizure can be managed as your doctor directs. Ask for a copy for yourself if you and your child travel out of town. Leave detailed written instructions with babysitters or adult caregivers. If you have been instructed in the use of in-home therapy, make sure that a responsible caregiver also receives instruction. Fortunately, most seizures, even those that are prolonged, end without injury. The important thing is to work with your doctor so that you have a plan to follow when they occur.




How do I manage partial seizures in my child?


A child who has partial seizures that affect his emotions or sense of the world around him may be intensely frightened by the episodes. Children with this type of epilepsy need lots of reassurance — and an adult who keeps track of how often the seizures occur. If they become prolonged and frequent, emergency treatment may be necessary. Managing complex partial seizures requires gentle monitoring during the seizure, keeping hazards out of the way, reassuring the child in a calm voice, and keeping track of how long the seizure lasts. Prolonged confusion and clusters of complex partial seizures may also require at-home therapy as prescribed, or emergency treatment. Treatment with Medicines Childhood epilepsy is usually treated with seizure-preventing medicines called antiepileptic or anticonvulsant drugs. If the drugs don’t work or if the child has a lot of side effects, surgery, the ketogenic diet, or vagus nerve stimulation (VNS) may be tried.





Treatment

When should surgery be considered?


If medicines do not control someone's seizures, he or she may be a candidate for surgery. The most common form of epilepsy surgery removes a fairly small area of the brain where seizures begin. Sometimes, larger areas are removed. Other surgeries, performed less often, block nerve pathways in the brain to stop the spread of seizures from one part of the brain to another.




What medicines do people with epilepsy take?


Children and adults take the same medication. It may be prescribed as tablets, sprinkles, capsules or in syrup. These drugs are designed to prevent seizures. Some are successful with a limited number of seizure types; others have a broader range of action. Whenever possible, doctors try to control seizures with one drug. Some adults or children, however, may have to take more than one. People with epilepsy may respond so well to medication that no further seizures occur so long as the medication is taken regularly and an effective level is maintained in the patient’s blood. Not having seizures does not mean that the medication is no longer needed. Most patients require a minimum of several years of therapy. Always ask the doctor before stopping antiepileptic medication. For parents, giving a child only part of the medication, or stopping it abruptly can cause a serious increase in seizure activity. If the drugs don’t work or if the patient has a lot of side effects, surgery, the ketogenic diet, or vagus nerve stimulation (VNS) may be tried.




Can the ketogenic diet help my seizures?


If medications fail to control a patient's seizures, your doctor may recommend a special high fat, low carbohydrate, restricted calorie diet. It is called a ketogenic diet. Calories are strictly limited, and parents have to be very careful not to allow the child to eat anything — even cookie crumbs or toothpaste — that isn’t on the diet or hasn’t been pre-measured and pre-weighed within the formula. The diet requires a team effort —the physician, the dietitian, the nurse education team, for children their family, and, if the patient is old enough, the patient themselves — all working together to make sure the diet is followed and any side effects are monitored. WARNING: The ketogenic diet is serious medicine. It is not a do-it-yourself diet. It could have serious effects if not monitored by a physician and dietitian.




Can Vagus Nerve Stimulation help my seizures?


Vagus nerve stimulation is a new type of treatment that may be tried when seizures cannot be controlled by other methods. The treatment works by sending regular small bursts of electrical energy to the vagus nerve, a large nerve in the neck that leads directly into the brain. The energy comes from a small, disk-like generator, about the size of a stop watch, that is surgically implanted under the skin on the chest wall. The generator is connected to lead wires under the skin, the ends of which are wound around the vagus nerve. The operation which places the device can be done on an inpatient or outpatient basis.




When should I consider specialized care for my epilepsy or my child's?


Specialized care for children and adults with hard-to-treat epilepsy is available at special centers around the country. They offer in-depth evaluation, surgery, the ketogenic diet, and VNS therapy.




How do I find the right medicine?


The search for the best medication for any individual may take quite a long time Children and adults, respond to medications in different ways. Several drugs or different combinations of drugs may have to be tried in an effort to get the seizures under control. The goal of treatment is to achieve the greatest level of control, the lowest level of side effects, at the lowest possible dose. Common side effects from antiepileptic drugs include fatigue, nausea, changes in vision, and weight gain. Some side effects are linked to high dosages. Others are due to individual sensitivity or allergic reaction. Some tend to happen when a new medication is started, but go away (or become less of a problem) as the child becomes accustomed to it.




How can I help my treatment or my child's treatment work effectively?


Ask your doctor about possible side effects associated with the medicine and what you should do if you see them in yourself or your child. -Keep follow-up appointments. Some medications require periodic blood tests that are important to your health or your child’s health. Ask the doctor at the end of each visit when he or she wants to see the patient again and make the next appointment then. -Don’t change the dose or discontinue seizure medicine on your own without checking with the doctor. -Ask for refills from your pharmacy several days before the medication is due to run out. -Ask your doctor whether any over-the counter medicines may interfere with the epilepsy drug you or your child is taking. Check with the pharmacist when buying other medicines. -For children, ask your doctor how to handle fever associated with childhood illness. Ask, too, about the best way to give medication when a child has a stomach virus and cannot keep medication down. Find out what you should do if you or your child misses a dose of medication. Parents often worry that long term use of antiepileptic drugs may lead to drug abuse or dependency in their children. Most doctors say there is very little if any abuse of these medications among young people with epilepsy. In fact, refusing to take the medication is a more common form of rebellion among teenagers.