Treatment:

A person who has seizure for the first time should be taken to an emergency room. They may have a serious, underlying medical condition that needs to be treated.

FIRST AID

First-aid measures should be performed as appropriate.

• Protect the person from injury. Remove furniture or other objects from the area so they do not cause injury if the person falls during the seizure.
• Do not attempt to force a hard object (such as a spoon or a tongue depressor) between the teeth. You can cause more damage than you can prevent.
• Do not try to hold the person down during the seizure.
• Turn the person to the side if vomiting occurs to keep vomit or mucus from going into the lungs. Keep the person on his or her side while sleeping after the seizure is over.
• If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from blocking the airway. Breathing usually starts on its own once the seizure is over.
• CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.

If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This an emergency situation - seek immediate medical help.

TREATMENT BY A MEDICAL TEAM

The health care team may need to take measures to protect the airway. This may include using tubes to keep the airway open. Breathing will be supported as needed.

If a cause is identified, treating the cause may stop seizures. Treatment may include medication, surgery to repair of tumors or brain lesions, or other therapies.

An isolated seizure due to an obvious trigger (such as fever or a drug) is treated by eliminating or avoiding that factor. An isolated seizure without an obvious trigger may not require treatment.

Antiseizure medicines may prevent or reduce the number of future seizures. Medicines may be used alone or in combination with another drug.

Patients who continue to have seizures despite several medications may benefit from a vagal nerve stimulator (implantable device similar to a heart pacemaker that stimulates a nerve in the neck) or from brain surgery to remove tissue responsible for causing the seizures.

Informational jewelry or cards (such as Medic-Alert bracelets) alerting others about the seizures may help a patient receive prompt medical treatment if one occurs. Patients who have seizures that could result in loss of motor control or consciousness should be advised not to drive, swim alone, or engage in other activities during which a seizure could endanger themselves or others. Every state has rules about driving and seizures, but they are different from state to state.

Support Groups:

Epilepsy Foundation of America -- www.epilepsyfoundation.org

Expectations (prognosis):

How well a person does depends on the underlying cause of the focal seizures. Patients who have recurrent seizures that are not due to a temporary condition (for example, a drug side effect or infection) have a chronic condition called epilepsy.

Seizures that occur alone or in a closely associated group are commonly triggered by an acute condition such as brain injury and may occur as an isolated incident, or they may lead to a long-term seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop. EEG and MRI findings may help determine whether the condition is likely to become chronic.

Death or permanent brain damage from seizures is rare, but either can occur if the seizure lasts for a long time or if many seizures occur in close proximity.

Serious injury can occur if the seizure occurs while the person is driving or operating dangerous machinery. These activities may be restricted for people with poorly controlled seizure disorders.

Infrequent seizures, however, need not severely restrict lifestyle. Work, school, and recreation do not necessarily need to be restricted, but precautions should be taken to reduce risks if a seizure should occur.

Complications:

• Injury from falls, bumps, and biting oneself
• Injury to oneself or others if seizure occurs during driving or operating machinery
• Inhaling fluid into the lungs, pneumonia
• Learning disorders
• Permanent brain damage
• Prolonged or closely occurring seizures without returning to normal behavior (status epilepticus)
• Medication side effects
• Seizure disorder

Women who are pregnant or planning to become pregnant may need to take additional medications or vitamins, such as folic acid supplements, to reduce the risk of birth defects associated with certain antiseizures drugs. Such women may need to be followed in a high-risk pregnancy clinic.

Certain antiseizure drugs may cause or worsen osteoporosis. People taking these medicines for a long period of time should discuss their risk of osteoporosis with their doctor.

Calling your health care provider:

Call your local emergency number (such as 911) if this the first time a person has had a seizure or a seizure is occurring in someone who is not wearing a medical ID bracelet and does not carry instructions explaining what to do in the event of a seizure.

If the person has had a seizure before, call for an ambulance if:

• The seizure lasts longer than unusual
• The person is having an unusual number of seizures
• Repeated seizures occur over a few minutes
• Repeated seizures occur and the person does not wake up (regain consciousness) or act normally between each one

Call the health care provider if a person with seizures has new symptoms, inluding:

• Confusion
• Extreme sleepiness
• Drowsiness
• Hair loss
• Nausea or vomiting
• Problems with coordination
• Rash
• Restlessness
• Tremors or abnormal movements