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The right way to describing and recording seizures

Dr. Sangeeta Ravat, MD (Medicine). DM (Neurology), Prof. and Head Deptt. of Neurology Seth G.S. Medical College and K.E.M Hospital, Consultant Neurologist at Global Hospital, Director of Comprehensive Epilepsy Care Center, K.E.M Hospital & Global Hospitals, Mumbai

Published: Apr 12, 2022 10:36:35 AM IST
Updated: May 4, 2022 10:15:44 AM IST

The right way to describing and recording seizures1. Observing & Recording Seizures

There are many different types of seizures. The doctor must know which kind you or your child has before the right medication can be prescribed. Sometimes it's difficult to tell certain kinds of seizures from others. The doctor may not see the seizures so they must rely on you, along with what is found from the medical tests, to decide which medication to use. The better you are in describing the seizure, the easier and possibly quicker it will be for the doctor to start getting the seizures under control. It is possible for you or your child to have more than one type of seizure. If you recognize more than one kind, be sure to describe each one separately and record the type you think it is. The following list of things to look for should help you in describing what happens before, during, and after the seizure.

•    What was the person doing at the time of the seizure?
•    What was the exact time of day?
•    What took place just before the seizure?
•    Had the person just awakened in the morning or had he/she just started or finished taking a nap?
•    What called your attention to it (cries out, fall, stare, head turn, etc.)?
•    How did the seizure develop (suddenly, gradually, one part of the body, etc.)?
•    Did the person's body become stiff? Were there jerks, twitches, or convulsions?
•    What part of the body moved first?
•    Did the eyelids flutter or the eyes roll?
•    Did the skin show changes (flushed, clammy, blue, etc.)?
•    Did the breathing change?
•    Did he/she talk or perform any actions during the seizure?
•    Did he/she become drowsy or sleepy afterward?
•    Did the person urinate or lose bowel control during the seizure?
•    How long did the seizure last? (The best way to tell is by actually looking at a watch or clock during the seizure – “real time” and how long the time “felt” may be very different).
•    Could you make contact with the person during the seizure? Did he/she respond?
•    What was the person's behavior like after the seizure (alert, drowsy, confused, could they remember what happened, etc.)?
•    Did he/she report any unusual feelings, sensations or perceptions that he or she remembers before the seizure? If the person is taking medication, when was the last dose? Any other things associated with the seizure you think the doctor should know?

2. Keeping a Seizure Record

The following form will help you keep a record of when seizures occur. You should find it useful for making an accurate report during visits to the doctor. It will be particularly helpful during the early visits when the doctor is developing the proper medication program. Only use the record as long as it is useful to you and your family.

Possible triggers: Note patterns or any factors that may make event more likely to occur.
•    Time of day or month
•    For females, note the day of your menstrual cycle, if pregnant, on any birth control or other hormonal treatment
•    Missed or late medicines, changes in medicine doses
•    Not sleeping regularly, not enough sleep, other sleep problems
•    Not eating regularly, bothered by specific foods
•    During or after exercise, note the kind of exercise such as jogging
•    During or after fast breathing
•    Alcohol or other drug use
•    Emotional stress, worry, excitement
•    Sounds, flashing lights or patterns, bright sunlight
•    Other illnesses or infections
•    When taking other medicines, over-the-counter products, or supplements

What happens during the event: Note changes in the following...
•    Awareness, alertness, confusion
•    Ability to talk and understand – clear speech, responds with only a few words or noises, speech doesn't make sense, unable to talk
•    Thinking, remembering, emotions, perceptions
•    Seeing, hearing, tasting, smelling, feeling - May have different or unusual sensations, or may sense something that is not really there
•    Facial expression – staring, twitching, eye blinking or rolling, drooling
•    Muscle tone – body becomes stiff or limp
•    Movements - jerking or twitching movements, unable to move, body or head turning to one side, falls
•    Automatic or repeated movements – lipsmacking, chewing, swallowing, picking at clothes, rubbing hands, tapping feet, dressing or undressing
•    Walking, wandering, running
•    Color of skin, sweating, breathing
•    Loss of bladder or bowel control

Part of body involved: Note where the symptoms started, whether it stayed in that area or spread to other parts of the body, and which side of the body was involved (right, left, or both).

What happens after the event (postictal or recovery period): Is the person...
•    Able to respond to voice or touch
•    Aware of their own name, observer's name, place, time
•    Able to remember what happened
•    Able to talk or communicate
•    Weak or numb in any part of the body
•    Having a change in mood or behavior
•    Tired or need to sleep
•    Other symptoms – for example headache, upset stomach, pain

How long it lasted:
•    Length of aura or warning
•    Length of seizure – from beginning to end, but not counting the recovery period
•    Length of recovery or postictal period - how long before the person returns to normal activity.

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