What should I do if I have a seizure?
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What to Do If You Have a Seizure
Experiencing a seizure can be a frightening and confusing event. Knowing the appropriate steps to take can help manage the situation effectively and reduce potential risks. This article synthesizes current research on the management of seizures, particularly focusing on first-time unprovoked seizures.
Immediate Steps During a Seizure
Ensure Safety and Prevent Injury
The primary concern during a seizure is to ensure the safety of the person experiencing it. Clear the area of any sharp or hard objects that could cause injury. If possible, gently guide the person to the floor and place something soft under their head to prevent head injury3 9.
Do Not Restrain or Insert Objects
Do not attempt to restrain the person or insert any objects into their mouth. These actions can cause more harm than good. Instead, turn the person onto their side to help keep their airway clear and allow any fluids to drain from their mouth3 9.
Time the Seizure
It is important to time the seizure. If it lasts longer than five minutes, seek emergency medical assistance immediately, as this could indicate status epilepticus, a medical emergency requiring urgent treatment3 9.
Post-Seizure Care
Recovery Position
After the seizure subsides, place the person in the recovery position (on their side) to maintain an open airway and prevent choking. Stay with them until they are fully alert and oriented3 9.
Reassurance and Monitoring
Provide reassurance as the person regains consciousness. They may be confused or disoriented. Monitor their breathing and responsiveness, and be prepared to provide information to medical personnel if needed3 9.
Medical Evaluation and Treatment
Seek Medical Attention
After a first seizure, it is crucial to seek medical evaluation to determine the cause and assess the risk of recurrence. This typically involves a thorough history, clinical examination, electroencephalography (EEG), and brain imaging1 4.
Risk of Recurrence
Research indicates that the risk of seizure recurrence is highest within the first two years following an unprovoked first seizure, with recurrence rates ranging from 21% to 45%1. Factors that increase the risk of recurrence include a prior brain insult, EEG abnormalities, significant brain imaging findings, and nocturnal seizures1.
Antiepileptic Drug (AED) Therapy
Immediate AED therapy can reduce the risk of seizure recurrence within the first two years but does not necessarily improve long-term prognosis for seizure remission1 2 4. The decision to start AED therapy should be individualized, weighing the risks of recurrence against potential adverse effects of the medication1 2 4.
Counseling and Lifestyle Adjustments
Patients should receive counseling about lifestyle modifications, such as avoiding activities that could be dangerous if a seizure occurs (e.g., swimming alone, driving) and understanding the legal implications related to driving4. Educating patients and their families about seizure management and safety is a critical component of care2 4.
Conclusion
Managing a seizure involves ensuring immediate safety, seeking medical evaluation, and considering long-term treatment options based on individual risk factors. By understanding these steps, individuals and their caregivers can better handle seizure events and reduce associated risks.
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Appendix A: Summary of Evidence-Based Guideline for Clinicians: Management of an Unprovoked First Seizure in Adults.
Immediate antiepileptic drug treatment reduces seizure risk in adults with an unprovoked first seizure, but may not improve quality of life.
Systematic ReviewConsiderations in the Treatment of a First Unprovoked Seizure
Balancing risks and benefits is crucial in treating a first unprovoked seizure, with treatment generally deferred until a second seizure occurs.
Evaluation and Management of First-Time Seizure in Adults
First seizures in adults are often related to a provoking factor or acute brain insult, and typically do not recur, but early counseling on driving and lifestyle modifications is crucial.
Treatment Strategies After a Single Seizure
Waiting for a second seizure before treating epilepsy does not worsen the course of epilepsy or seizure control, but special considerations are needed for patients with certain conditions and neurosurgery.
Rescue Therapies for Seizures
Rescue therapies for seizures can help prevent prolonged or severe clinical events and aid in managing seizure emergencies.
Management of Seizures following a Stroke
Post-stroke seizure treatment in elderly patients should be individualized, with new-generation drugs like lamotrigine, gabapentin, and levetiracetam providing high long-term seizure-free periods and fewer side effects.
Rigorous JournalShould People Be Treated After a First Seizure
Seizures in children should be treated after a first seizure, but the frequency of seizures should be based on the severity of the seizure and the potential benefits of anticonvulsant therapy.
Emergency Management of Epilepsy and Seizures
Emergency physicians and neurologists must recognize and treat seizure- and epilepsy-related emergencies, which account for 5% of 911 calls and 1% of emergency department visits.
Treatment of drug-induced seizures.
Drug-induced seizures can be effectively treated with benzodiazepines, barbiturates, propofol, and pyridoxine, with potential for ketamine and levetiracetam roles.
Rigorous Journal
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