Epilepsy is a group of nerve disorders characterized by episodes known as “seizures” or “convulsions.” Seizures occur when the brain’s electrical system misfires. Instead of sending out signals in a controlled manner, a surge of haphazard energy goes through the brain. These abnormal signals can cause involuntary muscle contractions, loss of bladder control, and changes in mental status. A person who has convulsions is sometimes called an “epileptic”. At least 50 percent of epilepsy cases are “idiopathic”, that is, without a known cause.

Seizures may range from being almost undetectable to long periods of violent shaking. A person having a seizure may seem confused or look like they are staring at something that isn’t there. Severe seizures can cause a person to fall, quiver, and become unaware of what’s going on around them. If a seizure lasts more than 5 minutes, it is called “status epilepticus” and may result in permanent damage.

In the last few years, a new classification of seizure disorders has been instituted. For example, the time span for status epilepticus was previously 30 minutes. The basic types of convulsive disorders have also changed. They are now called generalized and focal (once called partial). Focal seizures involve a particular area on one side of the brain. Generalized seizures start on both sides of the brain or, at least, quickly affect networks of brain cells on both sides.

Having said that, the classic definition of certain types of seizures remains easier to understand and identify:

Grand Mal seizures: This type, now called “tonic-clonic seizures,” is what most people associate with epilepsy. Loss of consciousness, bladder control, and sometimes violent shaking and jerking is seen. Strange sensations known as “auras” (smells, colors, etc.) may herald an upcoming convulsion. They may present as:

• An unusual smell or taste.
• Numbness or tingling.
• Twitching of a finger or other body part.
• A wave-like sensation passing through the head.
• Visual hallucinations, like colors or flashing lights.
• A feeling of intense fear or other emotion.

Once the convulsion has passed, the victim is usually lethargic for a time. This is referred to as the “post-ictal state.”

Petit Mal seizures: Not associated with violent, involuntary spasms, Petit Mal seizures (also called “absence” seizures because the victim is mentally absent), can present as a momentary loss of concentration or even consciousness. Blank staring or repetitive movements like lip-smacking may be noted. Some patients experience auras before an episode.

Other variations of generalized seizures include “atonic” seizures, where there is a sudden and complete loss of muscle tone, like a sack of potatoes. There is often a deficit in consciousness as well, but the entire episode lasts no more than about 15 seconds. The opposite might be the “myoclonic” seizure, where the shaking and jerking of a Grand Mal seizure occurs, but without the loss of consciousness. The risk of injury from either of these is as significant as with a Grand-Mal.

Focal seizures, also known as “partial” or “Jacksonian” seizures, are caused by abnormal signals from one part of the brain. They may involve involuntary shaking of just one limb or other specific behaviors. Occasionally preceded by auras, simple focal seizures don’t involve loss of consciousness, while complex focal seizure do.  

Variations of focal seizures may involve localized spasms, twitching, or even emotional outbursts, with or without awareness of the situation.

There are various causes of convulsive disorders, such as:

• High fever (in children, mostly)
• Head injury
• Meningitis (Infection of the central nervous system)
• Stroke
• Brain tumors
• Genetic predisposition

In an austere setting, there won’t be sophisticated equipment such as EEGs (electroencephalograms) and brain scans, so you will have to watch for symptoms to identify the problem. It is important to know that one seizure does not make someone an epileptic. At least two witnessed episodes are required to be certain. In some cases (especially in childhood seizures associated with fevers), a person might even “outgrow” the condition.

In addition to auras that give some warning an attack may be imminent, there are triggers which sometimes cause a convulsion. A good example is a bright flashing light. Avoidance of these triggers will decrease the number of episodes.

The most important aspect of treatment, if intravenous medication is not available, will be to prevent the patient from injuring themselves during an attack. A tongue depressor with gauze taped around it and placed in the mouth was once a standard recommendation, but caused injuries to both the patient and the rescuer. Keep everything away from the patient’s mouth (especially your fingers).

You shouldn’t restrain the person physically, but remove nearby objects that could cause injury. An exception is if the patient is standing when the seizure starts. In this case, grab the patient and gently lower them to the floor. Placing them in the CPR “recovery” position will help keep their airway open and avoid aspirating vomit or other fluids down the windpipe.

Do not give oral fluids or medications to an epileptic after a seizure until they are fully awake and alert. If the convulsion is caused by a fever, as in children, cool them down with wet compresses, but don’t let shivering begin (it causes the body to raise the internal temperature again). Anyone in your survival group with a convulsive disorder should work towards stockpiling their medicine. Popular oral drugs are phenytoin (Dilantin), carbamazepine (Tegretol), valproic acid (Depakote), and diazepam (Valium). Injectable diazepam, if available, would be effective in treating status epilepticus. Emphasize the importance of stockpiling extra medications in cases of natural disaster or other emergencies to all group members.

Natural alternatives have long been claimed to decrease the frequency and severity of convulsions.   Many vitamins and herbal supplements have a sedative effect, which calms the brain’s electrical energy. They may be taken as a tea (1 teaspoon of the herb steeped in a cup of water) or as a tincture (an extract with grain alcohol). Here are some that have been reported as beneficial for prevention or to decrease the frequency of episodes:

• Bacopa (Bacopa monnieri
• Chamomile (Matricaria recutita)
• Kava (Piper methysticum) – (too much may damage your liver)
• Valerian (Valeriana officinalis
• Lemon balm (Melissa officinalis),
• Vitamin B12 supplements
• Vitamin E supplements

Proponents of the ketogenic diet, which restricts carbohydrates, is thought to decrease the frequency of childhood epileptic episodes in those resistant to standard drugs. It provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. It may prove useful for the adult epileptic as well.

Joe Alton MD

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