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 5U58DP000606-05. Its contents are
solely the responsibility of the authors and do not necessarily represent the official views
of the CDC.
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.
A seizure is:
A sudden, brief disruption of the normal
functioning of neurons in the brain
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, postseizure confusion and/or fatigue
This is a generalized tonic-clonic or
“grand mal” seizure.
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.
Seizure Causes

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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
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.
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.
Causes of epilepsy include:

Stroke

Brain tumor

Brain infection

Past head injury
Over 3 million
Americans
of all ages have
epilepsy.
Metabolic problems
 Other neurological conditions


Genetic factors
Epilepsy may occur with:
Cerebral palsy
 Cognitive
impairments
 ADD/ADHD

Developmental
disabilities
 Autism

… but the majority of people who have epilepsy
do not have other impairments and live very
normal lives.
In a
generalized
seizure
the electrical
disruption
involves the
entire brain.
Tonic-Clonic Seizure -“grand mal”

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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
In a partial seizure
the electrical
disruption involves
a limited area of
the brain.
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
Complex Partial Seizure

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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
Anti-epileptic Medications
•
•
•
•
•
•
•
Depakote (Valproic acid)
Felbatol (felbamate)
Gabatril (tiagabine)
• Neurontin (gabapentin)
Keppra (levetiracetam) • Tegretol (carbamezepine)
Lamictal (lamotrigine) • Trileptal (oxcarbazepine)
Dilantin (phenytoin) • Topamax (topiramate)
phenobarbitol
• Zonegran (zonisamide)
• Lyrica (pregabalin)
Medications Chart
Medications Chart (cont.)
[This chart also found on pages 30 and 36 of the final Participant’s and Trainer’s Guides, respectively].
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
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:
www.cyberonics.org
Patients with epilepsy may
still have seizures due to:
 Failure to take medication correctly
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Variation in medication effectiveness
Sleep deprivation
Stress/ Illness
Hypoglycemia/dehydration
Alcohol/drug use or withdrawal
Hormonal fluctuations
Flashing lights or other triggers
Some epilepsy patients never achieve
effective seizure control and may
experience varying degrees of financial,
social and legal problems.
DVD:
A Guide to
Seizure Management for
Emergency Medical Responders
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
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
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
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.
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:
www.diastatacudial.org
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. (www.clinical trials.gov) with an estimated
completion date of April 2012.
*
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.
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.
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.
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.
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.
Contact the Epilepsy Foundation for more information:
1-800-332-1000
www.epilepsyfoundation.org
Or Click Here to Contact your Local Epilepsy Foundation Affiliate