First Aid for Seizures
Dr. William Gallentine leads an in-depth discussion on epilepsy and the warning signs and precautions that can be taken when someone is having a seizure.
Featured Speaker:
William Gallentine, DO
Dr. William Gallentine is a pediatric epileptologist (or pediatric epilepsy doctor) and Medical Director of Pediatric Epilepsy at Stanford Children’s Health. Transcription:
First Aid for Seizures
Scott Webb: Epilepsy is a common neurologic disorder that often begins in childhood. The Pediatric Epilepsy Center at Lucile Packard Children's Hospital Stanford focuses on identifying the epilepsy cause, treating seizures with leading edge techniques, like the ROSA Robot, and partnering with families and other caregivers to provide the very best in childhood epilepsy care.
And joining me today is Dr. William Gallentine. He's the Medical Director of Pediatric Epilepsy at Stanford Children's Health. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Dr. Gallentine, thanks so much for your time today. We're talking about seizures and epilepsy and all things related. So as we get rolling here, what exactly is a seizure?
Dr. William Gallentine: So normally, all the functions of a brain are a result of electrical current that kind of pass into and out of nerve cells. And so a seizure is actually the behavior that actually can occur as a result of these same nerve cells starting to fire electrically kind of over and over again.
The behavior that we see actually really depends on what parts of the brain are involved. If it happens to be a smaller area of the brain, you may get something as simple as this jerking of the hand. But if it involves the entire brain, you actually may end up having an entire body convulsion. So it really just depends on how much of the brain actually is involved electrically as to what type of behavior we may see on the outside.
Scott Webb: Yeah, I see what you mean. And how is a seizure different from epilepsy?
Dr. William Gallentine: Epilepsy really is just kind of the chronic condition that predisposes a person to actually having seizures. We all have the capability of having a seizure given the right circumstance. But in people who have epilepsy, they seem to just have a lower threshold for when a seizure may occur. And there really are like hundreds of causes of epilepsy. Most frequently, people will have a genetic predisposition. So there's something within their DNA that lowers that potential to have seizures. But really also any type of brain injury like a brain trauma or stroke or tumors or even defects of how the brain has been formed may actually cause epilepsy.
Scott Webb: Yeah. And I think we all, as parents, I have a couple of kids myself, neither has epilepsy or has ever had a seizure, but they've had friends who have, of course. So what do we do as a parent if our child or adolescent starts having a seizure?
Dr. William Gallentine: So the first thing and it's hard as it is, the first thing is probably the most important, is you just try to just remain calm during it. And the good news is for most individuals, the seizures really are only going to last one to two minutes in duration. And so for the most part, your role is just trying to be there to support them through the seizure and keep them safe.
So this would include if they happen to be standing or seated, lying them down and then rolling them on their side. This will kind of help protect their airway in the event that they should actually vomit during the seizure. This will prevent anything from going down the airway. And this is something that only rarely occurs, although it is important to kind of keep them in that rescue position.
The other thing to consider then also is to not stick anything into their mouth. We are much more likely to injure them or ourselves trying to do so. You know, there's this old wives' tale that people are going to swallow their tongues during seizures, that doesn't happen. Certainly, they may bite their tongue and we would much rather them do something like that then actually injured them further by trying to stick something in their mouth.
The other thing that I'll hear from time to time is that some people will try to either give them something to eat or drink during the seizure to try to help get them out of it. We don't want to do that. We don't want to stick anything in their mouth. You know, that's much more likely to cause harm.
The other thing that we want to do is not hold them down. A lot of times I often hear people will try to like kind of hold their arms and legs. We really just want to, again, just try to keep them safe. And the biggest thing that you can do there is maybe just slide a pillow underneath their head, so they're not hitting their head on something. But you're much more likely to injure them if you're trying to hold their arms and legs down.
And probably the most important thing that they can do actually is just look at their watch, and really time how long the seizure is lasting. It's going to seem like it's going to last a lot longer than it actually typically does, because they're extraordinarily scary whenever you're a parent or a loved one watching your child have a seizure. And so it's really important though for us to know how long the seizure has been lasting. And so if the seizures start to exceed more than five minutes, the likelihood of that seizure stopping on its own without any type of medical intervention actually is quite low. So it's important for us to know how long the seizure has been going on for.
Scott Webb: Yeah, I'm glad you addressed some of the old wives' tales, if you will. I can remember when I was a kid, you know, I remember one time seeing a kid having a seizure and someone put like a stick in his mouth. I have seen people use wallets before in this attempt to prevent them from biting their own tongues.
But as you say, you know, we can try to make them comfortable so they don't injure themselves. We shouldn't stick anything in their mouths. We just kind of have to let this run its course. And then the timing is key because the more information we have to provide to doctors or the emergency department, the better. But, I guess, I want to ask, if it does go on longer, as you say it, if this goes on five minutes or more, is that when we should call 911?
Dr. William Gallentine: Yeah. So in most circumstances, you know, once the seizure's over, the emergency is over. Particularly, you know, in patients who have known epilepsy, it's not really necessary to call 911 or go to the emergency department following a brief seizure. However, again, if that seizure exceeds that five-minute mark, that's when calling 911 would actually be important as it is likely that they're going to require some form of medical intervention for the seizure to stop.
Many patients are actually going to have a prescription that's been provided by their doctor that's a rescue medication that can actually be given during the seizure to kind of help stop the seizure. And typically, we recommend giving this medication at that five-minute mark. And then if there's no response within two to three minutes, then calling 911 would be appropriate.
Scott Webb: Got it. And you know, I've read that sometimes when people have seizures, they may be can stop breathing. So do we need to be prepared to perform CPR? Is that something that we should have sort of in our tool belt, if you will?
Dr. William Gallentine: I'd say in most circumstances, no. So during the seizure, what often happens is the body kind of tightens and stiffens and the chest wall tightens so the patients actually are not breathing very well. And this actually can result in them turning colors, either red or even blue. But fortunately for most cases, because it's only lasts a couple of minutes and then it resolves on its own, there's really no need to actually provide CPR. And again, we may actually cause injury in attempting to do so. Really kind of getting the seizure to stop is probably the most important thing. And then following the resolution of the seizure, they often will start breathing again.
Scott Webb: That's good to know, of course. And as we get close to wrapping up here, I want to ask you because it seems logical, but maybe it's not. Can a seizure cause injury to the brain? Like that's my sort of perception of that, that seizures aren't good. And the longer they go on it makes it even worse. But I'll ask an expert here. Doctor, can a seizure cause injury to the brain?
Dr. William Gallentine: Yes. We think single isolated brief seizures are really not likely to cause a significant brain injury. However, we know that status epilepticus, which is a term that's used to describe prolonged seizures, if this occurs and it exceeds more than 30 minutes, it does have potential to cause injury to the brain. And also those seizures have a tendency to become even more difficult to treat with seizure medications. And so this is why we typically would like to be very aggressive in treating seizures when they exceed that five-minute mark with those rescue medications as they're much more likely to be responsive to that therapy at that point, as opposed to letting a seizure just go on and on further and further, and then ultimately becomes very difficult to treat.
Scott Webb: Doctor, this is really educational today. As we wrap up, what are your takeaways for listeners on seizures, epilepsy, and what we should do if our child sort of unexpectedly has a seizure?
Dr. William Gallentine: It's certainly important to recognize that epilepsy and seizures are really common. And it's something that we likely are to at some point in our lives kind of run into somewhere along the way of someone having a seizure around us. So again, it's just kind of important that we remain calm and help support that person through the seizure. And then if necessary, reach out for help, if the seizure is exceeding that five-minute mark that we've previously talked about.
Scott Webb: Well, I really appreciate your time today and your expertise and hopefully this is really helpful to listeners. So doctor, thanks so much for your time and you stay well.
Dr. William Gallentine: Great. Thanks. I appreciate it.
Scott Webb: for more information, visit epilepsy.stanfordchildrens.org. And if you found this podcast helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.
First Aid for Seizures
Scott Webb: Epilepsy is a common neurologic disorder that often begins in childhood. The Pediatric Epilepsy Center at Lucile Packard Children's Hospital Stanford focuses on identifying the epilepsy cause, treating seizures with leading edge techniques, like the ROSA Robot, and partnering with families and other caregivers to provide the very best in childhood epilepsy care.
And joining me today is Dr. William Gallentine. He's the Medical Director of Pediatric Epilepsy at Stanford Children's Health. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Dr. Gallentine, thanks so much for your time today. We're talking about seizures and epilepsy and all things related. So as we get rolling here, what exactly is a seizure?
Dr. William Gallentine: So normally, all the functions of a brain are a result of electrical current that kind of pass into and out of nerve cells. And so a seizure is actually the behavior that actually can occur as a result of these same nerve cells starting to fire electrically kind of over and over again.
The behavior that we see actually really depends on what parts of the brain are involved. If it happens to be a smaller area of the brain, you may get something as simple as this jerking of the hand. But if it involves the entire brain, you actually may end up having an entire body convulsion. So it really just depends on how much of the brain actually is involved electrically as to what type of behavior we may see on the outside.
Scott Webb: Yeah, I see what you mean. And how is a seizure different from epilepsy?
Dr. William Gallentine: Epilepsy really is just kind of the chronic condition that predisposes a person to actually having seizures. We all have the capability of having a seizure given the right circumstance. But in people who have epilepsy, they seem to just have a lower threshold for when a seizure may occur. And there really are like hundreds of causes of epilepsy. Most frequently, people will have a genetic predisposition. So there's something within their DNA that lowers that potential to have seizures. But really also any type of brain injury like a brain trauma or stroke or tumors or even defects of how the brain has been formed may actually cause epilepsy.
Scott Webb: Yeah. And I think we all, as parents, I have a couple of kids myself, neither has epilepsy or has ever had a seizure, but they've had friends who have, of course. So what do we do as a parent if our child or adolescent starts having a seizure?
Dr. William Gallentine: So the first thing and it's hard as it is, the first thing is probably the most important, is you just try to just remain calm during it. And the good news is for most individuals, the seizures really are only going to last one to two minutes in duration. And so for the most part, your role is just trying to be there to support them through the seizure and keep them safe.
So this would include if they happen to be standing or seated, lying them down and then rolling them on their side. This will kind of help protect their airway in the event that they should actually vomit during the seizure. This will prevent anything from going down the airway. And this is something that only rarely occurs, although it is important to kind of keep them in that rescue position.
The other thing to consider then also is to not stick anything into their mouth. We are much more likely to injure them or ourselves trying to do so. You know, there's this old wives' tale that people are going to swallow their tongues during seizures, that doesn't happen. Certainly, they may bite their tongue and we would much rather them do something like that then actually injured them further by trying to stick something in their mouth.
The other thing that I'll hear from time to time is that some people will try to either give them something to eat or drink during the seizure to try to help get them out of it. We don't want to do that. We don't want to stick anything in their mouth. You know, that's much more likely to cause harm.
The other thing that we want to do is not hold them down. A lot of times I often hear people will try to like kind of hold their arms and legs. We really just want to, again, just try to keep them safe. And the biggest thing that you can do there is maybe just slide a pillow underneath their head, so they're not hitting their head on something. But you're much more likely to injure them if you're trying to hold their arms and legs down.
And probably the most important thing that they can do actually is just look at their watch, and really time how long the seizure is lasting. It's going to seem like it's going to last a lot longer than it actually typically does, because they're extraordinarily scary whenever you're a parent or a loved one watching your child have a seizure. And so it's really important though for us to know how long the seizure has been lasting. And so if the seizures start to exceed more than five minutes, the likelihood of that seizure stopping on its own without any type of medical intervention actually is quite low. So it's important for us to know how long the seizure has been going on for.
Scott Webb: Yeah, I'm glad you addressed some of the old wives' tales, if you will. I can remember when I was a kid, you know, I remember one time seeing a kid having a seizure and someone put like a stick in his mouth. I have seen people use wallets before in this attempt to prevent them from biting their own tongues.
But as you say, you know, we can try to make them comfortable so they don't injure themselves. We shouldn't stick anything in their mouths. We just kind of have to let this run its course. And then the timing is key because the more information we have to provide to doctors or the emergency department, the better. But, I guess, I want to ask, if it does go on longer, as you say it, if this goes on five minutes or more, is that when we should call 911?
Dr. William Gallentine: Yeah. So in most circumstances, you know, once the seizure's over, the emergency is over. Particularly, you know, in patients who have known epilepsy, it's not really necessary to call 911 or go to the emergency department following a brief seizure. However, again, if that seizure exceeds that five-minute mark, that's when calling 911 would actually be important as it is likely that they're going to require some form of medical intervention for the seizure to stop.
Many patients are actually going to have a prescription that's been provided by their doctor that's a rescue medication that can actually be given during the seizure to kind of help stop the seizure. And typically, we recommend giving this medication at that five-minute mark. And then if there's no response within two to three minutes, then calling 911 would be appropriate.
Scott Webb: Got it. And you know, I've read that sometimes when people have seizures, they may be can stop breathing. So do we need to be prepared to perform CPR? Is that something that we should have sort of in our tool belt, if you will?
Dr. William Gallentine: I'd say in most circumstances, no. So during the seizure, what often happens is the body kind of tightens and stiffens and the chest wall tightens so the patients actually are not breathing very well. And this actually can result in them turning colors, either red or even blue. But fortunately for most cases, because it's only lasts a couple of minutes and then it resolves on its own, there's really no need to actually provide CPR. And again, we may actually cause injury in attempting to do so. Really kind of getting the seizure to stop is probably the most important thing. And then following the resolution of the seizure, they often will start breathing again.
Scott Webb: That's good to know, of course. And as we get close to wrapping up here, I want to ask you because it seems logical, but maybe it's not. Can a seizure cause injury to the brain? Like that's my sort of perception of that, that seizures aren't good. And the longer they go on it makes it even worse. But I'll ask an expert here. Doctor, can a seizure cause injury to the brain?
Dr. William Gallentine: Yes. We think single isolated brief seizures are really not likely to cause a significant brain injury. However, we know that status epilepticus, which is a term that's used to describe prolonged seizures, if this occurs and it exceeds more than 30 minutes, it does have potential to cause injury to the brain. And also those seizures have a tendency to become even more difficult to treat with seizure medications. And so this is why we typically would like to be very aggressive in treating seizures when they exceed that five-minute mark with those rescue medications as they're much more likely to be responsive to that therapy at that point, as opposed to letting a seizure just go on and on further and further, and then ultimately becomes very difficult to treat.
Scott Webb: Doctor, this is really educational today. As we wrap up, what are your takeaways for listeners on seizures, epilepsy, and what we should do if our child sort of unexpectedly has a seizure?
Dr. William Gallentine: It's certainly important to recognize that epilepsy and seizures are really common. And it's something that we likely are to at some point in our lives kind of run into somewhere along the way of someone having a seizure around us. So again, it's just kind of important that we remain calm and help support that person through the seizure. And then if necessary, reach out for help, if the seizure is exceeding that five-minute mark that we've previously talked about.
Scott Webb: Well, I really appreciate your time today and your expertise and hopefully this is really helpful to listeners. So doctor, thanks so much for your time and you stay well.
Dr. William Gallentine: Great. Thanks. I appreciate it.
Scott Webb: for more information, visit epilepsy.stanfordchildrens.org. And if you found this podcast helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.