Transcription:
Seizure First Aid: Learn How to Help

Scott Webb (Host):  One in ten people will have a seizure in their lifetime. Would you know what to do if you experienced a seizure or saw somebody experiencing one? VCU Health is home to a Level 4 Epilepsy Center, a designation indicating the highest level of care in the country. To celebrate Epilepsy Awareness Month in November, we are speaking with Dr. Victor Gonzalez-Montoya. He loves a challenge and treatment of epilepsy and seizures is his specialty, particularly those episodes that are hard to control. So, let us talk to Dr. Gonzalez-Montoya, Interim Chief of Epilepsy.

This is Healthy with VCU Health. I’m Scott Webb. Doctor, thanks for joining me today. Let’s start here. What is a seizure and are there different types of seizures?

Victor Gonzalez-Montoya, MD (Guest):  A seizure is basically an abnormal phenomenon that occurs in the brain. It is usually triggered by excessive electrical activity in the brain that sometimes is manifested in different ways from a confusion spell to involuntary movements, loss of awareness or convulsions. It has many variations. In addition, there are multiple classifications of the seizures as well.

Host:  Okay, so let’s go through the different classifications.

Dr. Gonzalez-Montoya:  So, these classifications have changed a lot throughout the years because the more we learn, the more we realize that it is a little bit complex to box them all in one place. The most current classification that we have for seizures is if it is a focal event, which means that a part of the brain is giving you excessive activity in the brain, and whether that part of the activity affects your consciousness or your awareness.

Another group of seizures is the ones where patients lose complete tone of their bodies and have convulsions and drop to the ground. It used to be known as petite mal or absence seizure. It is a brief episode of interruption of awareness with an immediate returning to their baseline, almost instantaneously.

There are also sensory seizures, which we call focal seizures with no alteration of their awareness. In addition, there are seizures with hallucinations, visual hallucinations, auditory hallucinations, and sounds. So in general terms, it is basically whether the awareness is affected or not.

Host:  Obviously, a lot of variations and factors to consider. Are some types of seizures more common than others?

Dr. Gonzalez-Montoya:  Traditionally, it depends on the group age. Pediatric patients tend to manifest – the list is statistically speaking. Certain kinds of seizures they are more frequent than adults and the other way around. Most of this has to do with the reasons for having epilepsy. Pediatric patients usually have genetic causes for epilepsy compared with adult patients who have other reasons like traumatic brain injury, strokes or tumors, et cetera.

Host:  And along those lines Doctor, if someone is experiencing seizures, does that mean that they automatically have epilepsy?

Dr. Gonzalez-Montoya:  That is a very good question. A seizure – the way I try to explain this to my patients – a seizure is just a phenomenon that can happen to anyone. One person in ten could have a seizure in their lifetime but that doesn’t mean they have epilepsy. Epilepsy implies the risk of having seizures or recurrence of seizures with no trigger factors. Having that propensity to have seizures is what makes someone epileptic. And they are the ones who need antiepileptic medications.

Host:  And what about the medications? Are they affordable? In addition, how would someone be prescribed medication to treat his or her seizures?

Dr. Gonzalez-Montoya:  First, what is important is to formally have a diagnosis of epilepsy and every time someone goes through this process, it is typically in alliance with a neurologist. That neurologist will run some tests trying to identify reasons for that risk of having seizures. Based on the other medical problems that the patients may have or not have, we can tailor those treatments for that particular patient.

Thankfully, we live in a country that the amount of – the variation of seizure medications that are available is big. So, that is a significant advantage of living here. The cost of them, well that’s a different topic. Typically, newer medications tend to be more expensive than older medications, but it does not mean that the older medications are not good. I mean every time I am asked what the best medication for seizures is, it’s like asking what the best wine is. Well, the ones that you like. Therefore, when I have to say what is the best medication for seizures that would mean that the medications that stopped the seizures without giving them side effects that would affect their daily living.

Host:  And Doctor, are there side effects and should newly diagnosed patients be prepared for a period of trial and error as their doctors work to find the best course of treatment?

Dr. Gonzalez-Montoya:  Absolutely. Probably the most important part that any patient, I would be emphatic – when some gets a diagnosis of seizures, this is shocking for them. They have to – like what do you mean I have epilepsy. Is this like a genetic thing and all these questions immediately start coming into their heads? Starting with the statistics, every time someone receives a diagnosis of epilepsy or seizures, the numbers are on their side. Statistically speaking we can stop the seizures with just medications in two third of patients. Which is a pretty good number.

Based on that, we’ll need to address what kind of medications we can address by each scenario. Typically, side effects of medications for seizures are usually drowsiness, and dizziness. For some people, it depends on the dosing - the higher the dose, the easier for the patients to have side effects. But it doesn’t mean it’s a failure of the medication. In some, we need to use trial and error, test other medications, change the doses, or change the way the medication is delivered, so the patients experience the least amount of side effects and still experience the good effects of the medication.

Host:  What can the rest of us do when we see someone that is having a seizure, especially one that includes convulsions?

Dr. Gonzalez-Montoya:  Probably the best and most important will be to identify someone who is in need of help because of a seizure. For that, when someone is having a convulsion for example, that is usually an easy identification, right, we see someone shaking on the ground. The most important thing is make sure the surroundings of the patients are safe for them. Hot objects, hot surfaces, or sharp objects that could endanger their physical integrity of the patient– it is important to remove them. Also, time the event. It is probably the second most important part of this because the duration, about 95% of seizures end by themselves in less than five minutes.

But there’s a smaller number that lasts longer than that and those patients need emergent treatment to break this cycle because there is a concern of an entity that we call status epilepticus, which is like a nonstop seizure state. Our friends in the emergency medical services are trained to give medications in the field so they can break this as fast as possible. Also, do not leave the patients by themselves. Stay with them until the whole event ends. Stay calm which is actually very difficult. We try to help, and we surround patients who are having seizures and sometimes that may not be the best. I have seen people actually trying to hold the patients from having the convulsions and not allowing them to move or shake. That doesn’t change anything.

Additionally, avoid putting objects inside people’s mouth because sometimes with the movements, they can actually bite their tongues, they can bleed, and that is visually difficult for someone to see. People may try to stick objects in their mouths and that could be dangerous because they can break a tooth, they can choke on it and that could be very, very harmful.

Host:  Thanks for clearing that up Doctor, because I think it’s a common misconception that we should try to have them bite down on something.

Dr. Gonzalez-Montoya:  I have heard stories of people sticking their fingers inside when the patient does not have control of their bodies.  A seizure is like this excessive activity that is shooting and making the muscles contract – all of them are contracted and one can break their fingers if put in the mouth. So, in any scenario it is not a good idea to stick anything in their mouth. The tongue is a muscle. I mean there is going to be injury after a convulsion, but it tends to heal pretty fast within days. Compared with the dangerous consequences of sticking something in someone’s mouth and having an asphyxiation problem because of the missing tooth or whatever.

Host:  Are there warning signs for people that they are about to have a seizure and if so, what should they do to safely deal with them?

Dr. Gonzalez-Montoya:  Unfortunately not everyone has a warning that a seizure is coming. Some seizures spread too fast within the brain that there is no time for the patient or anyone to do anything about it other than just deal with the consequences of falling or something like that. For the ones that actually have the luxury, relatively speaking, of having a warning sensation. Patients usually are trained to say okay, make sure they are in a safe position, to sit down or on your heels just to make sure that there is no falls. And then call for help if you can call for help.

Let us say that patients sometimes have family members that have seen multiple seizure types on their loved ones, well they are usually trained to do a seizure plan. Some of them suffer from clusters. Some of them have rescue medications that can be delivered in different routes. Some of them have devices within their bodies that give them electrical stimulus and could break the seizure from evolving into a more complex problem. Nevertheless, all those scenarios will be tailored for that specific patient from their neurologist.

Therefore, yes, it is very important to be educated in seizures and a first aid plan, which is usually led by the neurologist.

Host:  Doctor, I know that Epilepsy Awareness Month is coming up in November. What do you all have planned to raise awareness?

Dr. Gonzalez-Montoya:  November is a very good month for us and October as well for the Epilepsy Awareness. What we are trying to do is educate and raise awareness within the community of the people that suffer from this. Multiple health systems try to put out a little piece on this. What we have is something we call Bike Riding for the Epilepsy Foundation of Virginia that is takes place on October 12. It’s a Saturday. Probably one of the most anticipated events for the patients with epilepsy in the community.

Host:  Doctor, is there anything more that we can share with listeners about epilepsy, seizures or treatment options?

Dr. Gonzalez-Montoya:  I would like to pass on to get educated in seizures, get educated in epilepsy. Education is going to remove the taboo status and it’s going to promote patients to go to look for healthcare. Patients with epilepsy have to be seen by a neurologist. If their medications are not stopping the seizures, the level of care has to be raised to an epileptologist that is a neurologist with a sub-specialty in epilepsy. Family members, friends, co-workers of someone who has epilepsy, they need their help. They will need to be educated. They have to be active and I guess promoting education in seizures will be extremely helpful for everyone.

Host:  Thanks Doctor. It sounds like the common theme here is education both for those that suffer from seizures and for the rest of us who want to help them. That’s Dr. Victor Gonzalez-Montoya, Interim Chief of Epilepsy at VCU Health. For more information about seizures and epilepsy, visit the VCU Health website at www.vcuhealth.org. To hear more about how you can take control of your health, listen to the other episodes of Healthy with VCU Health at www.vcuHealth.org/podcasts. This is Healthy with VCU Health. I’m Scott Webb. Thanks for listening.