Epilepsy - Treatment

Treatment

Immediate Seizure Treatment

You cannot stop a seizure, but you can help the patient prevent serious injury.

First, it is extremely important to remain calm and not panic. Then take the following actions:

• Wipe away any excess saliva to prevent obstruction of the airway. Do not put anything in the patient's mouth. It is an old wives' tale that people having seizures will swallow their tongues.
• Turn the victim gently on the side. Do not try to hold the patient down to prevent shaking.
• Rest the patient's head on something flat and soft to protect it from banging on the floor and to support the neck.
• Move sharp objects out of the way to prevent injury.

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Do not leave the seizure victim alone. Anyone nearby should call 911. Patients should be taken to an emergency room if:

• Any seizure lasts beyond 2 - 3 minutes
• The patient has been injured
• The patient is pregnant
• The patient is diabetic
• Parents, caregivers, or bystanders are at all uncertain

Children with seizures caused by fever rarely require any treatment other than taking precautions to prevent obstruction and reduce the fever. Research on adult patients has found that only 5.7% of adults with epilepsy who refused to go to the hospital following a seizure had a subsequent seizure during the study's 3-day follow-up period. Hospitalization may not be necessary in many patients whose seizure is not severe or repetitive, and who have no risk factors for complications. All patients or caregivers, however, should contact their doctor after a seizure occurs.

Drugs Used for Managing Acute Repetitive Seizures

The initial treatment for acute repetitive seizures (two or more seizures that occur over minutes to hours separated by periods of consciousness) are anti-anxiety drugs known as benzodiazepines. They include diazepam (Valium, Diastat) or lorazepam (Ativan). These drugs are available in the following forms:

• Tablets taken orally or under the tongue (sublingual). Oral tablets are difficult to give a patient who is convulsing, however.
• Rectal solutions, gels, or suppositories. Rectal administration is preferred. Solutions and gels work faster than suppositories. Diastat is rectal gel form of diazepam and, although more expensive than rectal solutions, it can be administered at home by a trained caregiver. The gel is safe and effective in reducing seizure frequency in both children and adults, and it may help prevent status epilepticus. Studies suggest that it significantly reduces the rate of hospitalization, and may even prove to be an alternative to drug therapy among children with prolonged or repetitive seizures.