Blog #24: You Witness a Convulsion. What SHould You Do?

(This blog was originally posted on June 29, 2012)

   

 

            You see it happen, or you hear a commotion. Someone has fallen. He is on the ground thrashing, and jerking, uttering strange animal-like moaning and groaning sounds. The eyes may be open and rolled back or squeezed shut. There is blood on the lips and teeth; long, expiring breaths blow out pink, blood-tinged bubbles. Breathing stops as rigidity is followed by jerking of the arms, legs and torso. The lips and skin assume a blue-gray hue as the person holds his breath.

            Is the person dying? Certainly something terrible seems to be happening. It is awful to watch, but not as serious as you think. Almost always, the jerking stops after one or two minutes. Then you hear a prolonged sigh as the muscles in the person’s jaw, limb and torso relax and breathing resumes. You see wetness as it’s common for involuntary urination and even bowel movements to occur from loss of bodily function control. Several minutes to an hour or more later the person awakens but is confused. His speech may be gibberish and nonsensical as his mind recalibrates and returns to normalcy. He is embarrassed to have caused this commotion. He is exhausted and groggy; he arises, collects himself mentally, and goes on his way. He’s done this before, probably many times before.

            What should you do happening upon the scene of an ongoing convulsion?

•           If there’s an opportunity to prevent injury at the beginning of the convulsion, protect the head and lower the person to the floor.

•           Turn him on his side so that any excess saliva or vomit will fall out of the mouth and not be breathed into the lungs, resulting in choking.

•           Loosen tight neck buttons, scarves and ties, etc.

•           Do not attempt to stick an object or your finger into the person’s mouth trying to prevent tongue-biting. If at the start the tongue is positioned in the mouth so as to be bitten there’s nothing you can do to prevent it. If the tongue is not bitten at the start, it won’t be as the jaws have already clamped shut. If you see blood on the lips, that is the explanation. No one swallows or bites off the tongue during a convulsion! It looks frightening but it’s not serious. The person will have a painful mouth; the laceration will heal in days.

•           The cessation of breathing and the blue-gray coloring is part of the convulsion. Breathing automatically restarts at the end of the jerking. There is no need to try mouth-to-mouth resuscitation.

•           The loss of bladder or bowel control is embarrassing, not serious.

•           Stay with the person until his senses and comprehension returns, usually after minutes to over an hour.

            If you know the person and you are aware of his epilepsy follow the above steps and wait out the jerking until the seizure “runs its course.” Calling for an ambulance is usually unnecessary. Help him home where he can sleep and rest. Family members of these patients are very familiar with this routine. Medical alert bracelets are often worn to alert by-standers that the person has been diagnosed and is under treatment for epilepsy. Treatment with medications completely controls seizures in only one-half of the epilepsy population. The rest will still have an occasional seizure despite the anti-seizure medications.

            If the convulsing person is unknown, has no companion and wears no medical alert bracelet then call an ambulance.

            If the convulsive jerking lasts more than three or four minutes without stopping, definitely call an ambulance. This represents a potentially serious and even lethal epilepsy complication known as status epilepticus. It results in lack of oxygen which leads to dangerous brain or heart damage or pneumonia.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.