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A brief, strong surge of abnormal electrical activity affects part or all of the brain, which leads to transient symptoms and signs from convulsions and loss of consciousness to more subtle symptoms such as blank staring, lip smacking, or jerking movements of arms and legs. It can occur due to provoking factors, such as fever, infection, alcohol, drugs, certain medications, or other medical conditions.
Chronic/two or more recurrent unprovoked seizures from an underlying neurologic condition.
When providing seizure first aid for generalized tonic clonic (grand mal) seizures, these are the key things to remember:
- Keep calm and reassure other people who may be nearby.
- Don't hold the person down or try to stop his movements.
- Time the seizure with your watch.
- Clear the area around the person of anything hard or sharp.
- Loosen ties or anything around the neck that may make breathing difficult.
- Put something flat and soft, like a folded jacket, under the head.
- Turn him or her gently onto one side. This will help keep the airway clear.
- Do not try to force the mouth open with any hard implement or with fingers. A person having a seizure CANNOT swallow his tongue. Efforts to hold the tongue down can injure teeth or jaw.
- Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
- Stay with the person until the seizure ends naturally.
- Be friendly and reassuring as consciousness returns.
- Offer to call a taxi, friend or relative to help the person get home if he seems confused or unable to get home by himself.
Is an Emergency Room Visit Needed?
An un-complicated generalized tonic clonic (grand mal) seizure in someone who has epilepsy is not a medical emergency, even though it looks like one. It stops naturally after a few minutes without ill effects. The average person is able to continue about his business after a rest period, and may need only limited assistance, or no assistance at all, in getting home.
In other circumstances, an ambulance should be called. Also, when these conditions exist, immediate medical attention is necessary: diabetes, brain infections, heat exhaustion, pregnancy, poisoning, hypoglycemia, high fever, head injury, etc.
No Need to Call an Ambulance if —
- medical I.D. jewelry or card says "epilepsy," and
- the seizure ends in under five minutes, and
- consciousness returns without further incident, and
- there are no signs of injury, physical distress, or pregnancy.
An Ambulance Should Be Called if —
- the seizure has happened in water.
- there's no medical I.D., and no way of knowing whether the seizure is caused by epilepsy.
- the person is pregnant, injured, or diabetic.
- the seizure continues for more than five minutes.
- a second seizure starts shortly after the first has ended.
- consciousness does not start to return after the shaking has stopped.
- The person has been injured as a result of the seizure
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.
Department of Motor Vehicle (DMV) of NC regulations for seizures – It is the patient’s responsibility to report the incidence of the seizure in the state of NC. North Carolina has no statutory provision requiring physicians to report patients diagnosed with epilepsy or seizures to a central state agency.
The recommended requirement for a driver’s license in NC for an individual with epilepsy is that they be seizure-free for 6-12 months. However, the DMV may consider the following exceptions to this general rule where: (1) a physician-directed change in medication causes a seizure and the individual immediately resumes the previous therapy which controlled seizures; (2) there is a history of nocturnal seizures or seizures which do not involve loss of consciousness, loss of control of motor function, or loss of appropriate sensation and information process; and (3) an individual has a seizure disorder preceded by an aura (warning) lasting 2-3 minutes. While the DMV may also give consideration to other unusual circumstances which may affect the general requirement that drivers be seizure-free for 6-12 months, interpretation of these circumstances and assignment of restrictions is at the discretion of the Medical Advisor. The DMV also considers compliance with medical therapy essential for safe driving. [The North Carolina Physician's Guide to Driver Medical Evaluation (June, 1995 ed.)] The Department learns of an individual's condition by inquiring on the application form or renewal form, a physician's report to the DMV, an accident report or from correspondence from the individual. The person may be required to submit a Medical Report Form either annually or semi-annually.
A person whose license has been denied for medical reasons may request a hearing in writing within 10 days of the notice of cancellation. The licensee may retain his or her license during the hearing process until advised otherwise by the Review Board.
North Carolina has adopted the federal Department of Transportation's medical standards for licensing individuals to drive commercial vehicles intrastate. Persons with epilepsy may apply to the state for a waiver; however, no specific criteria exists for determining eligibility. Decisions are made on a case by case basis by the DMV's Medical Advisor. Persons with epilepsy may be licensed to drive passenger carrying vehicles such as taxis; however, they are restricted from driving buses or school buses.
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