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| Introduction
Epilepsy: a guide for teachers Epilepsy: free time and leisure
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We have more than 2000 reasons for writing this pamphlet for you. That's how many Maltese have epilepsy (seizure disorders). You may see several of them in a day,
and not even know it. People with epilepsy look just like everyone
else ... except when they have a seizure. Even though you might not recognise what you were seeing.You might not know that the actions or movements taking place were being caused by a temporary medical condition. The lack of knowledge might lead you to take actions that you, and the person with epilepsy, might later regret.If you are someone who deals frequently with the public, and if you have not been taught first aid for seizures, this short summary should help you recognize a seizure when it happens, and know how to give basic first aid ... if it's needed. What is epilepsy? Epilepsy is a common neurological condition.
It is the general term for more than 20 different types of seizure
disorders produced by brief, temporary changes in the normal functioning
of the brain 's electrical system. These brief malfunctions mean that more
than the usual amount of electrical energy passes between cells.
The sudden overload may stay in just one small area of the brain,
or it may swamp the whole system.Of course, you can't see what's
happening inside a person's brain. But you can see the unusual
bodily movements, the effects on consciousness, and the changed
behaviour that the malfunctioning areas are producing. These changes
are what we call seizures. A single seizure may be caused by a
number of health conditions. In addition to these, about one person
in 100 has recurring seizures, known as epilepsy. Epilepsy in adults may be the
results of head injury - often from auto accidents - or may date
from their childhood years. Epilepsy is not contagious at any
age.Recognition of seizure disorders and knowledge of first aid
is important because it is very easy to mistake some seizures
for some other condition.A generalized tonic clonic seizure is
a convulsion. But it may look like a heart attack, and CPR techniques
may be used when they are not necessary.A period of automatic
behaviour may be interpreted as being drunk or high on illegal
drugs. The fact that a person undergoing this kind of seizure
may have Types of seizure Seizure disorders take several forms, depending on where in the brain the malfunction takes place and how much of the total brain area is involved.Generalized tonic clonic seizures are the ones which most people generally think of when they hear the word 'epilepsy'.In this type of seizure the person undergoes convulsions which usually last from two to five minutes, with complete loss of consciousness and muscle spasms. Absence seizures take the form of a
blank stare lasting only a few seconds. First aid for seizures in special circumstances A seizure in water If a seizure occurs in the water, the person should be supported in the water with the head tilted so his face and head stay above the surface. He should be removed from the water as quickly as possible with the head in this position. Once on dry land, he should be examined and, if he is not breathing, artificial respiration should be begun at once. Anyone who has a seizure in water should be taken to an emergency room for a careful medical check-up, even if he appears to be fully recovered afterwards. Heart or lung damage from ingestion of water is a possible hazard in such cases. A seizure in an airplane A seizure on a bus
When seizures are continuous or any of these conditions exist, immediate medical attention is necessary.The following are some suggestions to help people with epilepsy avoid unnecessary and expensive trips to the emergency room and to help you decide whether or not to call an ambulance:No need to call an ambulance
If the ambulance arrives after consciousness has returned, the person should be asked whether the seizure was associated with epilepsy and whether emergency room care is wanted. Antiepileptic Drugs Treatment with antiepileptic drugs currently enables over 70% of people with epilepsy to live free of seizures. In the last few days years several new drugs have become available and more at an advanced stage of research. Why are
drugs prescribed? Are drugs
the only treatment for epilepsy? What are
the most common antiepileptic drugs?
Rectal diazepam may be prescribed to prevent a series of seizures or as an intervention measure in the case of status epilepticus. (an unusually long seizure). Parents and other carers can use rectal diazepam for a child having a febrile convulsion. How about
new drugs? How do
antiepileptic drugs work? What about
side-effects? Women who take antiepileptic medication and wish to use some form of oral contraception should seek medical advice, as many antiepileptic drugs can reduce the effectiveness of the contraceptive pill. These carbamazepine (Tegretol), phenytoin (Epanutin), primidone (Mysoline), phenobarbitone, and the newer drug topiramate (Topamax). Women on antiepileptic medication, who want to have a baby, should ideally consult their doctor before becoming pregnant as there may be a small risk to the baby from their treatment. Changing or reducing the antiepileptic medication prior to pregnancy may be advised. In addition, folic acid should be taken by all women planning a pregnancy, as this can have a protective effect on the baby. A woman who is already pregnant should discuss with her doctor the best course of action to minimise the risks to herself and to her baby. (Further information relating to women, epilepsy and pregnancy is available from the Epilepsy Association of Scotland). Why is
a particular drug chosen? Medication usually comes in the form of tablets. However, syrups or dispersible tablets can be used for children who have difficulty in swallowing tablets. Changes in the make of the usual tablet or capsule are best avoided as the amount of the drug absorbed from different kinds of pills can vary. What is
the right amount of antiepileptic drug to take? Should
the drug level be measured?
If occasional
nights are spent away from home, you can avoid missed doses by
carrying a spare dose or two to cover unexpected circumstances.
When holidaying abroad, it is important to take a supply of your
drugs with you sufficient to cover the period away from home,
as it may not always be possible to get the same drug, tablets
or capsules in a foreign country. It is also advisable to carry
with you a letter from your doctor and a prescription in case
of emergencies. A list of available drugs and their different
trade names in other parts of the world can be obtained from the
Epilepsy Association of For how
long will treatment be necessary?
Recognising the signs of Childhood
seizures When the seizure is over, the child's brain goes back to working properly again. Seizures are a common disorder of childhood and adolescence. Some seizures happen because of very high fever. Some happen because of an illness that affects the brain. Usually the seizures go away when the fever drops or the illness is over. These seizure disorders are not called epilepsy. Epilepsy is the name given to seizures that happen more than once in an otherwise healthy youngster, or when the child has a physical condition that causes seizures from time to time. Why seizures are sometimes hard to recognise If all seizures were convulsions, there
would be no need for this information. But convulsions are just one type of seizure that a child or teenager may have. Other kinds of seizures are hard to recognize because they last such a short time and they look so much like the normal things that children do. The following are some of the signs that may mean a young child is having seizures:
Sometimes seizures start in the teen years. These seizures, too, may be hard to recognize. It is easy to mistake the behaviour they produce for signs of drug or alcohol abuse. The following behaviour or reported feelings may be signs that a teenager is having seizures: A blank stare, followed by chewing,
picking at clothes, mumbling, random movements
What to
look for All children daydream sometimes. Babies make all kinds of movements without anything being wrong. Falling is a natural part of learning how to walk and so on. The thing to be alert for is a pattern of behaviour, something unusual that happens too often to be just a matter of chance. For example, a child who suddenly flops to the ground without tipping over anything may just have lost his balance. But if it happens frequently, the doctor should be told. If a child gazes into space every once in a while but is alert when you speak to him, there is probably nothing wrong. But if he does it often, make a point of speaking to him while he's looking blank. Try to find out if he knows what's going on around him. Touch him gently to get his attention. If a child seems completely unaware of his surroundings while glazing blankly (And especially if his teacher say's he's doing the same thing at school), get medical check-up. Look for any blinking or chewing movements during the blank spells and tell the doctor about them, too. A convulsion, of course, isn't difficult to recognize. But suppose it only happens when the child is asleep? If a child sleeps by himself it is possible for sleep seizures to go unnoticed, too. Still, there may be some clue. When a child has a convulsive seizure
is followed by a period of deep sleep. And there may be good reasons for all the things- a late night, forgetting to go to the bathroom before bedtime, a canker sore, pulled muscle from the previous day's plan. But if a parent sees these events happening together from time to time without any obvious reason, it's worth telling the doctor about it. Seizures in infants are especially hard to spot. Babies move in lots of ways. Muscle jerks, bending forward, nodding, reaching with both arms- these are all normal movements, except when there is a pattern. If a parent sees repeated movements that strike him 'not quite right', he should tell the doctor. Recognising these tiny seizures in infants is important. Early treatment may offer best chance of normal development in future. Sometimes even a doctor will miss seeing the symptoms. He or she may assume the parents they have nothing to worry about and this may be absolutely correct. However, a parent sees a child more often than the doctor does. A parent who still sees a clear pattern of unusual movements that look like the signs of childhood seizures should trust his or her instincts- get a second opinion from a neurologist.
Learning disabilities- because those brief blanking out seizures are making it difficult to follow instructions and understand the lessons at school. Safety risks -because sudden loss of awareness in certain situations (like while climbing or in water) can lead to injury; Behaviour problems - because the world seems disorderly. The child keeps missing things other people have understood, and doesn't know why; Social problems - because the child, his family, and others with whom he comes in contact will not understand the cause or nature of unusual actions or behaviour. Children's Safety If your child has seizures, most of the safety tips for adults are just as useful for keeping your child safe from harm. In addition, parents of children with seizures learn to childproof their homes by doing the same things other parents do such as placing gates in front of the stairs and other dangerous places, locking up household chemicals and cleaning supplies and covering electrical outlets. A greater risk to a child's wellbeing may be over-protection if parents try to foresee every risk and head off every injury. It is part of a child's normal development to explore the environment and try new things. As a parent you will want to strike a balance between safety and overprotection. Some of the following safety tips may help, depending on how old your child is, what type of seizures he or she has, and how often they happen. A monitor in the child's bedroom may alert you to the sound of a typical seizure. Avoid top bunks. A lower bunk, a regular bed, a futon or even a mattress on the floor is a safer place to sleep for a child with seizures. A well-fitting helmet with a face guard may protect against head and facial injuries from severe drop seizures. Choking is a risk for any child, especially if the child has frequent seizures and other disabilities. Children sometimes retain food in their mouths and it's a good idea to check if this is a problem. Put a list of first aid steps on the refrigerator or some other place where it's easy to find. Write down the phone number where you or a relative can be reached; include the doctor's number and the one for emergency squad on the same sheet. If your child is gong to sleep at a friend's or relative's house overnight, make sure a copy of the list goes with him or her and that an adult in the house knows what to expect and what to do if a seizure happens. If your child has had an episode of status epilepticus (seizures that won't stop, or a series of seizures), check with the doctor on what to do if he or she has another one. Make sure everyone in the family knows what to do. Avoiding
over protection Parents may limit a child's participation in the usual childhood activities because of fear that a seizure will occur during the activity, or that exertion will somehow trigger a seizure. This is unfortunate for several reasons. First, vigorous physical activity is not generally associated with a greater number of seizures; in fact, studies suggest fewer seizures will occur when the average child is active. Secondly, the child is excluded form experiences that would help him develop social skills and self-confidence. This sense of being different, of being unable to join what others are doing, encourages dependence in the child and keeps him socially immature. The school experience offers the child with epilepsy a unique opportunity to break this pattern of over-protection and isolation. Wherever possible, he should be encouraged to take part in all school activities. Careful supervision is needed when a child who is still having some seizures takes swimming or gym, but with appropriate safeguards these activities can be safely undertaken. Communication When good communications exist between parents and teachers, the teacher can feel comfortable asking questions that will help him do his best for the child. These questions may include:
If the child is having very infrequent seizures, or has complete seizure, or has complete seizure control, this kind of basic information may be all that is needed. However, if the seizures are frequent, the teacher will want to discuss with the parents how they should be handled, how he or she plans to explain the condition to the other children, whether the child has an understanding of his disorder and would feel comfortable answering questions that the other children might have. If the child is old enough and the parents agree, he or she could be part of the discussion. Summary When a child has epilepsy, an informed teacher is essential to that child's educational and social development.
This information is addressed to those who teach children and young people who have some form of epilepsy. Because the vast majority will receive their education in mainstream schools, it is more than likely that every teacher will encounter epilepsy at some time in his or her career. The parents will not always inform the school, and sometimes the teacher may be the first to realise that a child has epilepsy. In any event, the importance of the role of the tea to accept the condition sensibly cannot be over-stressed. What is epilepsy? Epilepsy is a tendency to brief disruptions in the normal electro-chemical activity of the brain, which can affect people of all ages, backgrounds and levels of intelligence. It is NOT a disease or illness, but it may be a symptom of some physical disorder. However, its cause -especially in the young- may have no precise medical explanation. How does
it affect a child? Can epilepsy
damage, or change, the personality? Medication If the child starts having an increased number of seizures, or appears drowsy, overactive or inattentive, it may be that the medication needs adjusting. An alert teacher recognising such behaviour is advised to discuss the matter withthe parents and school health team.
This type of seizure may last several minutes, after which the child will recover consciousness. The child may be dazed or confused - a feeling that can last for a few minutes to several hours and may want to sleep or rest quietly after the seizure. Although alarming to the onlooker, this type of seizure is not harmful to the child and is not a medical emergency unless one seizure follows another and consciousness is not regained. Should this happen, medical aid should be sought without delay. This condition is known as 'status epilepticus' Complex partial seizures, sometimes called temporal lobe seizures, which occur when only a portion of the brain is affected by excessive electrical discharge. There may be involuntary movements, such as twitching, plucking at clothing or lip smacking, The child appears conscious, but may be unable to speak or respond during this form of seizure. Absence or Petit Mal which may easily pass unnoticed by parents and teachers. The child may appear to daydream or stare blankly. There may be frequent blinking of the eyes, but otherwise none of the outward signs associated with tonic-clonic seizures. Though brief, these periods of clouded consciousness can be frequent. They can lead to a series of learning problem if not recognised and treated, because the child is totally unaware of his surroundings and receives neither visual nor aural messages during such a seizure. Calm observation of any seizure may well provide vital information for the doctors, who rarely see the child having a seizure. Co-operation between teachers, parents school medical service personnel and the family doctor/paediatrician can prevent a child with epilepsy from becoming a handicapped adult. Classroom
First Aid
School
Activities Some seizures can be triggered by TV and this should be borne in mind when lessons use this medium. Sitting at a distance is usually sufficient precaution.
Women with epilepsy have many questions about epilepsy and their own health, pregnancy, and the well being of their future children. This pamphlet will help to provide general information and make it easier to ask questions when visiting your family doctor, neurologist, gynaecologist or obstetrician. Menstruation
& Epilepsy Keeping a record of seizures may help identify a relationship between seizure frequency and menstruation and assist your doctor in formulating a suitable treatment plan. Oral Contraceptive
Pill Generally, the main concern women with epilepsy have is the effectiveness of oral contraception in preventing conception. Some medications for epilepsy can reduce the effectiveness of the pill, leading to possible 'pill failure' and pregnancy. Breakthrough bleeding may also occur. These problems may be overcome by using a higher dose pill. Pre-Pregnancy
Counselling Some medications for epilepsy are associated with a higher risk of birth defects than others. Pre-pregnancy planning allows your doctor to reassess your treatment and if needed:
While the risk of birth defects exits, 95% of women with epilepsy have healthy babies. Can anything
be done tom minimise the risk of birth defects? Pregnancy Will pregnancy
affect seizure control? Is it necessary
to continue taking medications while pregnant? Unplanned pregnancy In the event of an unplanned pregnancy, you should continue taking your medication and speak to your doctor as soon as you can. Ongoing medical supervision will ensure the best outcome for you and your future child. Breast feeding Most mothers wish to breast feed and are usually encouraged by their doctor to do so. The presence of antiepileptic medications
in breast milk rarely causes problems to the baby. If your baby
continually appears drowsy seek specialist advice. Medication Will any
changes have to be made to my medication before I become pregnant? It should be taken into consideration what the effect would be on that person's lifestyle if they had another seizure eg the loss of a driving licence or possible employment implications. If someone is still having seizures the medical practitioner will want to make sure that the individual is on the lowest dose of the most effective treatment which gives the best control of seizures. Any changes to medication should always be under the supervision of the doctor. During pregnancy the body uses up more of the anti-epileptic medication and the levels of the drug within the blood may fall so blood levels should be monitored regularly and the dose may have to be increased. How great
are the risks of taking anti-epileptic medication during pregnancy? What are
the risks? Sometimes malformation of the limbs may occur and more rarely of the internal organs. Problems associated with anti-epileptic drug also include that of neural tube defects (an example of which is spina bifida).
In about 50% of women their epilepsy can be controlled during pregnancy, often because they are more careful about getting enough sleep and about taking medication regularly.
Introduction General
Safety Rules You may consider a gate at the kitchen entrance which will ensure that an inquisitive toddler cannot reach a hot cooker while your attention is diverted or if you are unconscious as a result of a seizure. A cooker guard is also a good idea to prevent hot pans being pulled over. A stair-gate is a wise precaution in a home with easy access to the stairs, and the use of a playpen is recommended when domestic chores such as ironing is being done. A sturdy gate with a secure lock is essential when the child is playing outside. Bathing Carrying Feeding Nappy changing Medicines Children love to imitate adults, and a toddler who watches a parent take tablets every day may be tempted to copy the action. Keep all medicines out of the reach of your child. Outside
the home Reins will prevent a toddler from wandering off if you have a seizure in the street, but the child should always carry identification in case of this eventuality. However, even a very young side can learn to sit by your side while you recover. Explaining
Epilepsy
Most people with epilepsy today manage to hold down a job successfully. True, epilepsy can sometimes pose problems at work and some people with epilepsy may find it hard to obtain a job that uses their skills and experience to the full. However, very few jobs are barred by law to people whose seizures are under control and with patience, perseverance and a positive outlook, you should be able to find work that you enjoy and that uses your skills and talents. This information gives some practical advice for those readers seeking employment, but worried about what impact their epilepsy will have. Further advice on any of the issues mentioned is available. What to tell your employer:
Some employers know very little about
epilepsy. For example they may assume- wrongly-that-you cannot
use a computer or VDU because of photosensitivity Telling people you work with Once you have found a job it's up to you to decide what to tell your workmates. This can be tricky, but we at BEA believe that it is best to be honest. If other people know about your epilepsy and what to expect if you have a seizure there is less likelihood of embarrassment and anxiety all round. *Think about doing some further training. Good job skills will stand you in good stead, whether or not you have epilepsy. Problems jobs for people with epilepsy Certain jobs are completely barred by law to people with epilepsy; while others are governed by health regulations (for instance you may need to have been seizure-free for a period of time before applying). The rules governing employment can also depend on whether you have an established history of epilepsy when you apply for a job or whether you develop it while you are in post. The rules are complicated and subject to changes so the advice here is only general. For more specific advice contact our Helpline. Jobs that are subject to special rules include: aircraft pilot; ambulance driver; armed services; coastguard; drivers; fir brigade; LGV/PCV and taxi drivers, merchant seafarer; nurse and midwife; police; prison service; teacher in a state school; train driver. Some activities pose special dangers for people who seizures are not controlled. These include jobs which involve working.
Most people with epilepsy can work without
worrying about safety issues. Jobs can often be made safer with a
few changes. Employers are, in many cases, required by law to
make such changes or accommodations.
What is epilepsy? Epilepsy is the most common neurological disorder affecting people of all ages. It's important to understand that epilepsy is a physical rather than mental disorder. As you know, the brain is a highly complex and sensitive organ. Our brain cells work together, communicating via electrical signals. Occasionally there is an abnormal electrical discharge from a group of cells, resulting in a seizure. There are many different types of seizure*, which are divided into two main groups: i) Generalized seizures which occur when the disturbance is spread across all of the brain ii) Partial seizures when only part of the brain is affected. The kind of seizures you have will depend on where in your brain the disturbance first starts and how far it spreads. Most seizures are short-lived and need no medical attention. Why me at my age? Epilepsy can affect anyone at any time of life. It is more usually diagnosed in people under the age of 20 or those aged over 60. Epilepsy can have many causes. However,
when epilepsy is diagnosed in later life it usually occurs as
a result of another condition such as a stroke, heart attack,
neuro-vascular disease or a diminished supply of blood to the
brain. Your doctor may be able to tell you
more about the cause of your epilepsy. Will I feel any different before or after a seizure? Here are some of the more common feelings associated with seizures. i) Prodrome - can precede a seizure and is a vague sensation or intensified emotion indicating a slight disturbance in the brains electrical activity. Usually this builds up over a period of hours or days before the seizure occurs. ii) Aura - this is a brief event which may take the form of a strange taste or smell, a funny feeling or sensation. You may hear a familiar piece of music or a non-existent sound. An aura is in fact a seizure already happening but it can serve as a useful warning that the disturbance may spread causing a major seizure with loss of consciousness. It can enable you to let someone know what is going to happen or help you to find some place where, if necessary, you can sit or lie down. After a seizure some people fell very tired and want to sleep, or ache because their muscles have worked quite hard. Sometimes people feel confused or disorientated afterwards or are forgetful. Occasionally incontinence may occur during a seizure but advice and help is available. Sometimes, following a seizure people may have difficulty moving a part of their body for a short time, but this is quite rare. For many people, however, seizures happen without warning, only last a short time and they experience no lasting ill effects. It is important to remember that each person's epilepsy is different so each person's experience of epilepsy will be an individual one. Are there treatments? The majority of people with epilepsy have their seizures under control by taking anti-epileptic medication. A good understanding of your treatment will help you get the best from it. Here are some suggestions to discuss with your doctor: i) Why you are taking anti-epileptic medication and for how long will you need to take it. ii) Some people need to take medication for many years, some for the rest of their life iii) The importance of taking your anti-epileptic medication as prescribed. iv) The possibility that alcohol* can reduce the effectiveness of your anti-epileptic medication. The aim of your anti-epileptic medication is to stop your seizures without causing side effects. Some possible side effects include sleepiness, nausea, unsteadiness and slurred speech. Discuss this with your doctor if you experience any of these symptoms. For a few selected patients who do not respond to medication, surgery may be considered. Others find benefits from complementary therapies such as aromatherapy, although their effectiveness is still to be proven. How can others help? You are likely to feel anxious and concerned about your epilepsy and so too will your family and friends. There are practical ways, however, that your family and friends can help. A first step is for them to understand your epilepsy. A second is for them to know what to do if a seizure occurs. Some simple safety precautions can also be put in place in your home to help reduce the risk of injury. How will I feel about my epilepsy? It is important to make every effort to carry on as usual in your everyday activities and to continue to do the things you enjoy. Keeping busy and feeling content will have a positive effect on your epilepsy. If you should have a seizure, life should carry on in as normal a way as possible. If worries arise about things which were not a problem before epilepsy was diagnosed, you may benefit from the experience of others who have lived with epilepsy through a local support group If the unpredictability of seizures makes you concerned about such things as travelling, swimming or taking care of your grandchildren, you can overcome these worries by building in a few safety provisions. Some small changes can prevent you from giving up something important to you. Coming to terms with the condition can help you feel better about yourself and restore your self-confidence which may have taken a knock. Recording of seizures Keeping a record in a dairy of numbers of attacks and what happens before, during and after your seizures will help your doctor in the management of your epilepsy. It will also help to give a clearer picture of the pattern your condition takes. It may also help to identify if there are any triggers for your seizures; for instance do they occur mostly when you are tired, or under stress or bored? Knowing this could help you control the seizures by avoiding or reducing these factors. Bear in mind that many people do not have any triggers or patterns to their seizures and they can occur out of the blue. What can I expect from our family doctor? Your own doctor is likely to be the person you will go to following your first seizure, who should refer you on to a consultant to make the diagnosis and prescribe treatment. Your ongoing care will be in the hands of your family doctor who should see you twice a year or more and refer you back to the consultant at least annually if seizures continue. If you notice any changes in your epilepsy, e.g. side effects of medication appearing, seizures increasing in severity and/or frequency, you should contact your doctor. When you visit your family doctor or consultant it is often very helpful to take with you: i) Someone who has seen your seizures and who can give an eye witness account. ii) Your seizure diary iii) A list of question you want to ask iv) A list of other medications you are taking including ones bought over the counter. Do I need to tell anyone? This is a question many people ask.
Being open about your epilepsy can prevent People you work or socialise with, friends and relatives are likely to be more understanding if you tell them about your epilepsy. They can also help you if they know what to do and what not to do when a seizure occurs and who to contact for help. Are there safety precautions I can take? It may be useful to keep a mobile phone at hand. Agencies such as "Fall Call" run schemes and produce aids which can be helpful. You may also wish to get a safety pillow, particularly if you have seizures during your sleep. Other precautions that may be helpful include putting gates across stairs and reinforcing glass panelled doors in your home. Swimming with a friend and informing the lifeguard at the pool is advisable if your epilepsy is not controlled. Wearing an identity bracelet,
necklace or carrying a card containing information about your
epilepsy will allow people to help if you have a seizure in a
public place and can give you confidence when away from home.
Swimming
and Epilepsy How dangerous
is a seizure in the water? How can
swimming be made safe foe people with epilepsy? The companion should also be able to recognise a seizure immediately it starts and must be physically capable of supporting the person he is responsible for in deep water, or the bather should be restricted to helper's standing depth. How can a seizure be recognised in the water? Watch for loss of co-ordinated movement. Some people with epilepsy continue the activity they were performing in the early stages of the attack, but their stroke becomes uncoordinated and starts to break up. Direction becomes vagueand involuntary head movements may start. How can a seizure be dealt with? First priority is to keep the face above water, and it is best to approach the swimmer from behind. If it is possible, tow him to shallow water and hold his head until the attack passes. He will do less damage to himself in water than on land if his breathing is functioning. However, after the convulsion is over the swimmer should be removed from the poolside. If breathing has stopped, normal resuscitation measures should be taken. Close surveillance of someone liable to tonic-clonic seizures is especially necessary, and familiarity with the particular type of seizure is obviously desirable on the part of the companion. Absence seizures are brief, but the swimmer may suddenly sink. Staff should be familiar with first aid measures in case of tonic-clonic seizures. Is medical assistance necessary? No, provided resuscitation is not required, there is no injury and one seizure does not follow another without the person regaining consciousness in between (status epilepticus). This is rare, but when it does occur it is a medical emergency and help should be summoned immediately. General Points
Water Sports Sailing canoeing and windsurfing also need not be ruled out provided that there is someone on hand to manage the seizure if necessary. Other more dangerous water sports such as sub-acqua diving, involve much greater risks and are not advised. Discos and Nightclubs Going to discos and nightclubs is often part of the social life of many young people. Generally, it is only strobe lights which may trigger a seizure in people who have 'photosensitive epilepsy'. This form of epilepsy is rare and can be diagnosed during a routine EEG test and is usually easily controlled by medication. Where strobe lighting is unavoidable, covering one eye will reduce the photosensitive effect. Television and Computer Games Electronic screens are widely used in our daily life and they may sometimes cause problems for those with uncontrolled photosensitive epilepsy. Taking regular breaks away from the screen is recommended and simple precautions can reduce the risk of seizures further: a fact sheet is available from the NSE. Social drinking For most people with epilepsy who take anti-epileptic medication the occasional alcoholic drink causes no problems. However, over-indulgence in alcohol has been known to cause seizures and so heavy drinking is best avoided. Travel When flying it is advisable to
inform the cabin crew of the liklihood of seizures but if someone
is very anxious or excited about flying or is tired due to 'jetlag'
this may trigger a seizure. It is important that you have sufficient
medication to cover the time away as there may be difficulty in
obtaining medication abroad. Brand names are often different and
formulations may vary from country to country. It is advisable
to carry written information about epilepsy and the drugs being
taken.
Drinking alcohol in moderation can be an enjoyable experience. A pint of beer can satisfy a genuine thirst, while a glass of wine can be a welcome relaxant after a hard day's work. Going to the pub means contact with friends, and social life is important for everyone. However, anyone who drinks alcohol must have a responsible attitude to it if they are to avoid the often serious health and social problems which can result from alcohol misuse. The person with epilepsy may require taking more care than others if drinking alcohol. There are good reasons for this.
It is important to bear in mind that a person taking drugs which act on the brain is likely to be more sensitive to the effects of alcohol than other people. This means that rather less than the recommended amounts for activities such as driving might affect their competence. It is possibly best for the person with epilepsy not to drink any alcohol before driving. At other times consumption of alcohol should be carefully monitored. Driving and Transport When a person with epilepsy wishes to drive for the first time the normal application form must be completed in full. A further form will be sent to the applicant requesting details about the epilepsy and information will be requested from the applicant's doctor. A driving licence will be issued providing all normal requirements are fulfilled and the applicant has been completely free of seizures for one year providing they are not likely to be a source of danger to the public. What if seizures only occur during sleep? A licence can be granted to an applicant who continues to have seizures providing they only occur during sleep and three years have elapsed since this pattern was established. Applicants must also be fit to drive without being likely to be a source of danger to the public. The licence granted will be a renewable three year licence. Precautions for drivers with epilepsy The performance of any driver can be affected by tiredness, time of day, medication taken for other minor ailments etc. The driver with epilepsy is often more sensitive to such factors and so should take special care. The following precautions are advised:
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