MEDICAL PROBLEMS - Epilepsy
 
Epilepsy is defined as a disorder of the central nervous system characterised by loss of consciousness and convulsions. A convulsion, or fit, consists of involuntary contractions of many of the muscles in the body, caused by a disturbance in the function of the brain. Convulsions usually result in loss of, or impaired, consciousness.

Although fits are a feature of epilepsy, they may also be caused by head injury, some brain-damaging diseases, shortage of oxygen to the brain, and the intake of certain poisons.

There are 2 types of epilepsy; minor epilepsy and major epilepsy.
 

Minor epilepsy
Short of major epilepsy, there are many forms of epilepsy, including absence seizure which causes only a brief  blurring of consciousness, like daydreaming. On recovery, the casualty may simply have lost the thread of what he or she was doing. The level of consciousness varies in all forms of minor epilepsy, but a major fit sometimes follows a minor one.
 
Signs & Symptoms
  • Sudden 'switching off'; the casualty may be staring blankly ahead
  • Slight or localised twitching or jerking of the lips, eyelids, head or limbs
  • Odd 'automatic' movements, such as lip-smacking, chewing, or making noises
Treatment
We should aim to protect the casualty until he's fully recovered
  • Help him to sit down in a quiet place. Remove any possible sources of harm, e.g. hot drinks or sharp objects, from the immediate vicinity
  • Talk to him calmly and reassuringly. Do not ask repeated questions. Stay until you are sure he is himself again
  • If he does not recognise and know about his condition, advise him to consult his GP as soon as possible

Major epilepsy
This condition is characterised by recurrent, major disturbances of brain activity, resulting in violent seizures (tonic-clonic) and severe impairment of consciousness. Epileptic fits can be sudden and dramatic, but the casualty may have a brief warning period (aura) with, for example, a strange feeling or a special smell or taste.
 
Signs & Symptoms
An epileptic fit usually follows a pattern:
  • The casualty suddenly falls unconscious, often letting out a cry
  • He becomes rigid, arching his back (this is known as the tonic phase)
  • Breathing may cease. The lips may show a grey-blue tinge (cyanosis) and the face and neck may become congested
  • Convulsive movements begin (the clonic phase). The jaw may be clenched and the breathing may be noisy. Saliva may appear at the mouth - blood stained if the tongue or lips have been bitten
  • There may be a loss of bladder control
  • The muscles relax and breathing becomes normal and the casualty recovers consciousness, usually within a few minutes. He may feel dazed, or behave strangely in a state of 'automatism', being unaware of his actions. A fit may also be followed by a deep sleep
  • There may be evidence of injury, such as burns or scars, from previous fits
Treatment
We should aim to protect the casualty from injury while the fit lasts and provide care when consciousness has been regained.

Do not lift the casualty unless he's in immediate danger.
Do not use force to restrain him, or put anything in his mouth.
 
  • If you see the casualty falling, try to support him or ease his fall. Make space around him and ask bystanders to move away
  • Loosen clothing around his neck and, if possible, protect his head, e.g. put something soft under his head
  • When convulsions cease, place him in the recovery position
  • Check breathing and life signs and be prepared to resuscitate if necessary
  • Stay with him until he's fully recovered

NB If the casualty is unconscious for more than 10 minutes or convulsing for more than five minutes, is having repeated fits or his first fit, or is unaware of his condition call 999. Note the time and duration of the fit.
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