A guide for mental health professionals and carers.

 

Seizures are sudden episodes of abnormal electrical activity in the brain that can cause changes in behaviour, movement, sensation, or awareness.

Seizures can occur in anyone, but they are more common in people with certain mental health conditions, such as schizophrenia, bipolar disorder, depression, anxiety, and post-traumatic stress disorder (PTSD). Seizures can be triggered by various factors, such as stress, medication, substance use, sleep deprivation, infection, or brain injury.

Seizures can be life-threatening if they are not treated promptly and effectively. Therefore, it is important for mental health professionals and carers to know how to recognise and manage seizures in a mental health setting in the UK.

How to recognise a seizure

There are different types of seizures, and they can affect different parts of the brain and cause different symptoms. Some of the most common types of seizures are:

  • The person may also bite their tongue, lose bladder or bowel control, or stop breathing temporarily.
  • Absence seizures: These are brief episodes of staring, where the person appears to be unaware of their surroundings and does not respond to stimuli. They may also have subtle movements, such as blinking, lip-smacking, or hand twitching.
  • Myoclonic seizures: These are sudden, brief, and involuntary muscle jerks that can affect one or more parts of the body. They may occur in clusters or in isolation.
  • Atonic seizures: These are sudden loss of muscle tone, where the person may collapse or drop their head, arms, or legs. They may also lose consciousness briefly.
  • Focal seizures: These are seizures that affect only one part of the brain, and can cause a variety of symptoms, depending on the area involved. For example, the person may have abnormal sensations, such as tingling, numbness, or pain, or experience hallucinations, deja vu, or fear. They may also have motor symptoms, such as twitching, shaking, or weakness of one side of the body. They may or may not lose awareness during the seizure.

 

Some seizures may be preceded by an aura, which is a warning sign that a seizure is about to happen. An aura can be a sensory, emotional, or cognitive symptom, such as a strange smell, a feeling of nausea, or a sudden memory. However, not everyone has an aura before a seizure, and some people may not remember having one.

How to manage a seizure

The general principles of managing a seizure are to protect the person from injury, ensure their airway is clear, and monitor their vital signs. The specific steps may vary depending on the type and duration of the seizure, but some of the common actions are:

  • Stay calm and reassure the person and others around them.
    Remove any potential hazards, such as sharp objects, furniture, or hot liquids, from the person’s vicinity.
  • If the person is having a tonic-clonic seizure, gently roll them onto their side in the recovery position, and place something soft under their head. Do not restrain their movements, put anything in their mouth, or give them anything to drink.
  • If the person is having an absence, myoclonic, or atonic seizure, guide them away from danger, and
  • support them if they fall. Do not shake them or shout at them.
  • If the person is having a focal seizure, stay with them and talk to them calmly. If they are confused or agitated, do not argue with them or correct them. If they have motor symptoms, help them to sit or lie down.
  • Check the time when the seizure starts and ends. If the seizure lasts longer than five minutes, or if the person has repeated seizures without regaining consciousness, call 999 for an ambulance. This is a medical emergency, and the person may need urgent treatment with anti-seizure medication.
  • Where prescribed administer a benzodiazepine medication, normally rectally, for seizures that last more than 5 minutes, repeated seizures with limited recovery or prolonged seizures outside of the patient’s normal seizure pattern
  • After the seizure, check the person’s breathing, pulse, and blood pressure. If they are not breathing, start CPR. If they are breathing, keep them in the recovery position until they are fully awake and alert.
  • Any patient that has had to have benzodiazepine medication or has had a first seizure, head injury and/or seizure activity outside of their normal should be assessed in an acute hospital setting. They should be transported to this facility in an ambulance where emergency response can be given if they deteriorate.
  • Reassure the person and explain what happened. They may be confused, tired, or embarrassed after the seizure. Help them to rest and recover, and offer them water if they are thirsty. Do not leave them alone until they are stable.
  • Record the details of the seizure, such as the type, duration, symptoms, triggers, and any medication taken. This can help the person and their doctor to monitor and manage their seizures in the future.

 

How to prevent seizures

Seizures can be unpredictable and difficult to prevent, but there are some steps that can help to reduce the risk of having a seizure, such as:

  • Following the prescribed treatment plan, which may include anti-seizure medication, psychotherapy, or surgery. Do not stop or change the medication without consulting the doctor, as this can increase the risk of seizures.
  • Some people may also have specific triggers, such as stress, lack of sleep, illness, or hormonal changes. Keeping a seizure diary can help to identify and avoid these triggers.
  • Maintaining a healthy lifestyle, which includes eating a balanced diet, drinking enough water, getting enough sleep, exercising regularly, and managing stress. Some people may also benefit from following a special diet, such as the ketogenic diet, which is high in fat and low in carbohydrates.
  • Seeking professional help for any underlying mental health conditions, such as depression, anxiety, or PTSD, that may contribute to seizures. Cognitive behavioural therapy (CBT), mindfulness, relaxation techniques, or counselling may help to cope with these conditions and improve the quality of life.
  • Wearing a medical alert bracelet or carrying a seizure card, which can inform others about the condition and what to do in case of a seizure. This can also help to get the appropriate medical attention and avoid unnecessary interventions.
  • Joining a support group or a charity, such as Epilepsy Action, Epilepsy Society, or Young Epilepsy, which can provide information, advice, and emotional support for people with seizures and their carers. They can also help to raise awareness and reduce stigma about seizures and mental health.

 

Conclusion

Seizures are a common and serious complication of some mental health conditions, and they require prompt and effective management in a mental health setting in the UK.

Mental health professionals and carers should be able to recognise and manage different types of seizures, and help the person to prevent and cope with their seizures.

By doing so, they can improve the person’s physical and mental health, safety, and well-being. Any patient that has received benzodiazepine medication, has injured themselves or has abnormal seizure activity should be examined in an acute hospital setting transported there by ambulance.

 

References

Epilepsy Society. (2020). Types of seizures. Retrieved from https://www.epilepsysociety.org.uk/types-seizures#.X7k0hGhKjIU
NHS. (2018). Epilepsy. Retrieved from https://www.nhs.uk/conditions/epilepsy/
NICE. (2022). Epilepsies: diagnosis and management. Retrieved from https://www.nice.org.uk/guidance/cg137