How to help during a seizure: important do's and don'ts for caregivers
National Epilepsy Week, observed from February 10 to 16, aims to raise awareness about epilepsy and advocate for the rights and well-being of people living with this neurological condition.
Despite being one of the most common chronic brain diseases, epilepsy remains widely misunderstood, often leading to stigma and social exclusion.
Dr Themba Hadebe, a clinical executive at Bonitas Medical Aid, sheds light on epilepsy, its causes, types, treatment, and the misconceptions that continue to affect those living with the condition.
"Epilepsy affects an estimated 50 million people worldwide, across all ages, cultures, and backgrounds. In South Africa, approximately 1 in every 100 people live with epilepsy," says Hadebe.
"Despite its prevalence, many individuals particularly in low and middle-income countries do not receive the treatment or understanding they need."
What is epilepsy?
Epilepsy is a chronic condition characterised by recurrent seizures, which occur due to abnormal electrical activity in the brain.
These seizures can range from mild, momentary lapses in awareness to severe convulsions that cause loss of consciousness.
A single seizure does not mean a person has epilepsy, but if someone experiences two or more unprovoked seizures, they are usually diagnosed with the disorder.
What causes epilepsy?
Epilepsy can develop due to various factors, including:
- Structural issues: Brain damage from birth complications, severe head injuries, or strokes.
- Genetics: Some individuals inherit a predisposition to epilepsy.
- Infections: Conditions like meningitis, encephalitis, and neurocysticercosis (a tapeworm infection common in tropical regions) can trigger epilepsy.
- Metabolic and immune disorders: Rare conditions affecting brain function.
- Unknown causes: In nearly 50% of cases, the exact cause remains unclear.
Types of seizures
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Seizures are generally classified into two categories:
Focal seizures (affecting one part of the brain)
Simple focal seizures: The individual remains conscious but may experience unusual sensations, such as strange tastes or visual disturbances.
These may alter awareness and involve repetitive movements like hand-wringing or lip-smacking.
Generalised seizures (affecting both sides of the brain)
Tonic-clonic seizures: Stiffening of muscles followed by jerking movements and loss of consciousness.
Absence seizures: Brief lapses in awareness, often mistaken for daydreaming.
Myoclonic seizures: Sudden, jerky movements of the limbs or body.
Atonic seizures: Sudden loss of muscle tone, which can cause falls or head drops.
Beyond the physical symptoms, epilepsy can affect mental health, relationships, and employment.
Hadebe adds, "Many people with epilepsy experience higher rates of anxiety and depression due to the unpredictability of seizures and the stigma they face.”
The risk of premature death is up to three times higher for people with epilepsy than the general population, particularly in low-income regions where access to medical care is limited.
Treatment and management
Although epilepsy is a long-term condition, seizures can often be controlled with medication.
"Antiseizure drugs help up to 70% of people with epilepsy live seizure-free lives,” explains Hadebe.
When medication is ineffective, other options include:
Surgery to remove the affected brain area.
Vagus nerve stimulation (VNS) using a device to reduce seizure frequency.
Dietary therapy, such as the ketogenic diet, which is particularly beneficial for drug-resistant epilepsy.
Can epilepsy be prevented?
Of some epilepsy cases around 25% are preventable. Strategies to reduce the risk include:
Preventing head injuries with proper safety measures.
Improving maternal and perinatal care to avoid birth-related complications.
Managing stroke risk factors like high blood pressure and diabetes.
Reducing the spread of infections such as meningitis.
Addressing neurocysticercosis in tropical regions through better sanitation and food safety.
The ketogenic diet, a high-fat, low-carbohydrate regimen, has been shown to reduce seizures in both children and adults. It works by inducing ketosis, a metabolic state where the body burns fat for energy instead of carbohydrates.
What to do (and not do) when someone has a seizure
Knowing how to respond appropriately during a seizure can help prevent injury and provide reassurance.
5 Do’s:
✔ Stay calm and time the seizure. If it lasts more than 5 minutes, seek medical help.
✔ Keep them safe. Move sharp objects away and cushion their head with something soft.
✔ Turn them onto their side. This helps keep their airway clear.
✔ Stay with them. Offer comfort as they regain awareness.
✔ Let them rest Seizures can be exhausting; allow them time to recover.
5 Don’ts:
❌Don’t panic: Stay composed to assist effectively.
❌Don’t restrain them: Holding them down can cause injuries.
❌Don’t put anything in their mouth: They will not "swallow their tongue," and forcing objects in can cause choking.
❌Don’t attempt CPR: Unless they stop breathing after the seizure ends.
❌Don’t leave them alone: Even after the seizure, they may be disoriented and need support.