1. Epilepsy and Seizure Management
For EMS Personnel
This product was developed with support from the Centers for Disease Control and Prevention under cooperative agreement number 5U58DP Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

2. This training is designed to:
Prepare EMS responders to recognize and respond appropriately to seizures caused by epilepsy or as a result of trauma or other acute or chronic illness.

3. A seizure is:
A sudden, brief disruption of the normal functioning of neurons in the brain

4. A seizure may appear as:
A sudden cry and fall, followed by
Convulsive movements of all limbs
Shallow/interrupted breathing - cyanosis
Loss of bowel/bladder control
Slow return to consciousness, post-seizure confusion and/or fatigue
This is a generalized tonic-clonic or “grand mal” seizure.

5. or a seizure may be…
Blank staring, chewing, other repetitive purposeless movements
Wandering, confusion, incoherent speech
Crying, screaming, running, flailing
A sudden loss of muscle tone and fall
Picking at clothes, disrobing
This is one type of partial seizure known as a complex partial seizure.

6. Seizure Causes High fever, especially in infants
Drug use, alcohol withdrawal
Near-drowning or lack of oxygen from another cause
Metabolic disturbances
Head trauma
Brain tumor, infection, stroke
Complication of diabetes or pregnancy

7. A common cause of seizures is epilepsy –
Epilepsy (also known as a ‘seizure disorder’) is a chronic neurological disorder characterized by recurring seizures that are not otherwise provoked by an acute injury or health emergency.

8. Epilepsy is not contagious, it is not a mental illness or a cognitive disability The neurological dysfunction seen in epilepsy can begin at birth, childhood, adolescence, or even in adulthood.

9. Causes of epilepsy include:
Stroke
Brain tumor
Brain infection
Past head injury
Metabolic problems
Over 3 million Americans of all ages have epilepsy.
Other neurological conditions
Genetic factors

10. Epilepsy may occur with:
Cerebral palsy
Cognitive impairments
ADD/ADHD
Developmental disabilities
Autism

11. … but the majority of people who have epilepsy do not have other impairments and live very normal lives.

12. In a generalized seizure the electrical disruption involves the entire brain.

13. Tonic-Clonic Seizure -“grand mal”
Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking.
Breathing may stop temporarily skin, nails, lips may turn blue
Loss of bladder/bowel control may occur
Generally lasts 1 to 3 minutes
Followed by confusion, sleepiness

14. the electrical disruption involves a limited area of the brain.
In a partial seizure
the electrical disruption involves a limited area of the brain.

15. Simple Partial Seizure
Seizure activity in the brain causing:
Rhythmic movements isolated twitching of arms, face, legs
Sensory symptoms tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions
Psychic symptoms déjà vu, hallucinations, feelings of fear or anxiety
Usually last less than one minute
May precede a generalized seizure

16. Complex Partial Seizure
Characterized by altered awareness
Confusion, inability to respond
Automatic, purposeless behaviors such as picking at clothes, chewing or mumbling.
Emotional outbursts
May be confused with:
Drunkenness or drug use
Willful belligerence, aggressiveness

17. Anti-epileptic Medications
Depakote (Valproic acid)
Felbatol (felbamate)
Gabatril (tiagabine)
Keppra (levetiracetam)
Lamictal (lamotrigine)
Dilantin (phenytoin)
phenobarbitol
Neurontin (gabapentin)
Tegretol (carbamezepine)
Trileptal (oxcarbazepine)
Topamax (topiramate)
Zonegran (zonisamide)
Lyrica (pregabalin)

18. Medications Chart

19. Medications Chart (cont
Medications Chart (cont.) [This chart also found on pages 30 and 36 of the final Participant’s and Trainer’s Guides, respectively].

20. Surgical treatment Factors influencing decision:
Ability to identify focus of seizures
Area of brain involved can be safely removed – without resulting in a significant deficit
Other treatments have been unsuccessful

21. Vagus Nerve Stimulator
An implanted device that sends regular, mild electrical pulses to the brain via the vagus nerve
May also be activated by an external magnet
Functioning of the VNS may be affected by the use of a taser device.
More information about the VNS can be found at:

22. Patients with epilepsy may still have seizures due to:
Failure to take medication correctly
Variation in medication effectiveness
Sleep deprivation
Stress/ Illness
Hypoglycemia/dehydration
Alcohol/drug use or withdrawal
Hormonal fluctuations
Flashing lights or other triggers

23. Some epilepsy patients never achieve effective seizure control and may experience varying degrees of financial, social and legal problems.

24. Seizure Management for Emergency Medical Responders
DVD:
A Guide to
Seizure Management for
Emergency Medical Responders

25. Pre-hospital Treatment – Generalized tonic-clonic seizure
Assure scene safety
If trauma is not suspected, place patient in recovery position
Protect head/limbs from injury
Follow A B C protocol:
Maintain airway – suction PRN
Administer O2
Monitor cardio-respiratory status

26. During GTC seizure, assess for:
Traumatic injury
Possible aspiration (seizure in water)
Elderly, pregnant or diabetic patient
Check blood glucose
Seizure lasting longer than 5 minutes, or occurring in a series
When present, activate ALS and/or rapidly transport to receiving facility

27. After the seizure stops:
Continue to monitor cardiorespiratory status
Evaluate for injury
Assess for return of consciousness/re-orient
Obtain pertinent medical history and emergency contact information if possible
Activate ALS and/or rapidly transport to receiving facility if consciousness does not return, or confusion persists more than 20 minutes post-seizure

28. Question witnesses:
Description of seizure event
Identifying information for patient, emergency contacts
Prior history of seizures or other medical problems
After a first-time GTC seizure, or if there is another medical condition, medical evaluation is necessary to identify and treat the cause.

29. ALS response to a GTC seizure that has lasted longer than 5 minutes:
Per local protocols, administer meds to stop seizure activity:
Diazepam (Valium) – IV or
Diastat rectal gel form *
Midazolam (Versed) – IV, IM, buccal or intranasal
Lorazepam (Ativan) – IV or IM
Support ventilation PRN
*For more information about Diastat see:

30. Options for Treating Repetitive Seizures
The only FDA-approved treatment for acute repetitive seizures is rectal Diastat, but nasal or buccal midazolam have been shown to be equally effective Some services make arrangements to use alternate forms.*
* These alternate methods are currently in a Phase 1 FDA clinical trial. ( trials.gov) with an estimated completion date of April 2012.

31. After stabilizing the patient, transport to receiving facility
After stabilizing the patient, transport to receiving facility. Monitor vital signs.
Report to ED the type and dose of seizure rescue medication that was administered.

32. Pre-hospital Treatment – Complex Partial Seizure (CPS)
May be reported as
drunkenness/illegal drug use
medical conditions such as a stroke or diabetic reaction
“person acting strangely”
Look for sudden loss of awareness and automatic, purposeless behaviors such as picking at clothes, chewing, mumbling or wandering.

33. Response to suspected complex partial seizure:
Approach cautiously, speak calmly
Contain – don’t restrain
Prevent from injuring self
Look for medical ID, identifying information
Avoid triggering violent behavior by minimizing physical contact.

34. Post-ictal phase (post-seizure):
Monitor recovery, check blood glucose
Re-orient to surroundings
Evaluate for injury
More in-depth history as appropriate
Activate ALS and/or rapidly transport to receiving facility if injury is present or if confusion persists over 20 minutes after seizure ends.

35. Question witnesses:
Description of seizure event
Any known history of seizures?
If possible, obtain medical history, ID and emergency contact information
After a first-time seizure, medical evaluation is necessary to identify and treat the cause.

36. Or Click Here to Contact your Local Epilepsy Foundation Affiliate
Contact the Epilepsy Foundation for more information:
Or Click Here to Contact your Local Epilepsy Foundation Affiliate