Seizures Emergencies (cont.)

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• Common generalized seizures often begin when the person cries out or makes some sound. This may be followed by several seconds of abnormal stiffening, progressing to abnormal rhythmic jerking of the arms and legs.
  • The eyes are generally open, but the person is not responsive or alert.
  • The person may not appear to be breathing. They are, however, actually usually breathing adequately for the brief duration of the seizure. The person often breathes deeply for a while after an episode.
  • He or she will return to consciousness gradually over several minutes.
  • Incontinence, or loss of urine, is common.
  • Often people will be combative briefly after a generalized seizure (a seizure that involves the entire brain).
• Many other seizure types exist, including isolated abnormal movements of a single limb, staring spells, or abnormal stiffening without the rhythmic jerking.

A first seizure is a reason to visit the doctor or a hospital's emergency department. For a person with a seizure disorder, a change in seizure patterns or more frequent seizures are reasons to seek medical care.

Many people with recurrent seizures may have a seizure and awaken fully. Immediate medical attention is not often needed if the person is fully awake and has not suffered injury and is known to have recurrent seizures.

Other conditions, however, call for immediate medical attention.

• A seizure that continues more than 5 minutes or a series of seizures without full recovery between them
• Persistent breathing difficulty (Often the person may appear to stop breathing briefly during the seizure, but breathing should resume quickly; if it does not, call 911, check for a pulse and if necessary, begin CPR.)
• Injuries sustained during a seizure
• Persistent confusion or unconsciousness
• A first seizure
• A significant change from that person's usual seizure pattern in terms of seizure type, seizure length, or associated symptoms

A doctor should evaluate any questionable seizure.

Not all of the following diagnostic tests are necessary for every seizure type, and many are not necessary upon first evaluation in the emergency department. Some may be arranged with a primary care doctor later as an outpatient.

The evaluation and treatments needed may include these procedures:

• Blood tests
• Imaging (head CT scan or MRI)
• Spinal tap
• EEG (electroencephalogram or a brain wave tracing)
• Medications to stop or prevent seizures

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