Electrical storm

Wednesday, June 2, 2010

There aren’t very many freebies in medicine but they do exist and it may be that the seizure that Jeremy Shockey experienced may be just that. The New Orleans Saints player was in the locker room after a workout and became unresponsive and seized. Teammates described the frightening scene of shaking episode but trainers were able to assist until the seizure stopped and Mr. Shockey was transported to the hospital for care.

Seizures happen because the brain becomes irritated and an electrical storm occurs. Instead of normal connections occurring between the cells in the brain, an electrical storm occurs. This causes the brain to try to shut down because of the electrical surge. The muscle shaking occurs because the brain is ending out signals to every muscle group asking them to contract. Most seizures are self limiting and are followed by a post-ictal period, where the brain reboots and restarts all its programs just like a computer does when it has to restart.

Seizures are a common event and 4% of people will experience one in their lifetime. The potential to have a seizure depends upon the threshold of the brain to withstand excess electrical activity. In infants and children, high fevers can cause the threshold to lower and febrile seizures may occur. A blow to the head can cause an electrical spike causing a seizure and sometimes seizures just happen.

The patient needs evaluation to look for the reason for the seizure. Is there an infection? Are there electrolytes abnormalities in the blood? Is there a structural problem in the brain? Often there is no solid reason why the first seizure occurred and CT or MRI imaging of the brain and EEG (electroencephalogram) may be considered to look for a cause.

Most people get a freebie seizure before requiring medication but that doesn’t mean that the event should be ignored. The chance of having another seizure sometime in the future is about 20% and that may be why patients need to be seizure free for 3-6 months before being allowed to drive a car (time varies between states) , scuba dive, jump out of an airplane or other situations where a seizure could put the patient or others in danger.

Generalized seizures are frightening to witness. There is loss of consciousness, the body stiffens, arches and may shake, grunting sounds may be heard and it seems as if the person has been possessed. But most seizures stop themselves and the role of the good samaritan, bystander, friend or family is to protect the patient from himself:

• The first step is to take a deep breath and try to stay calm.
• Make certain that there is nothing nearby that can be struck by the patient.
• Don’t hold the patient down. A seizure is a violent and forceful event and bystander injury is a possibility.
• Do not put anything in the mouth. Seizing patients don’t swallow their tongue and usually are breathing adequately. Forcing open the jaw can break teeth or get fingers bitten.
• If the seizure lasts more than 3-5 minutes, call 911
• After the seizure stops, lay the person on their side and stay with them until they are awake or until help comes.

Mr. Shockey’s seizure may have a variety of explanations but he was fortunate that it was short in duration, occurred in a safe place and he returned to normal function relatively quickly. The goal for him and all patients who experience a seizure is to normal activity at work and at play. For some, like Shockey, work and play are the same thing and his expectation is to be on the football field and ready to defend a Super Bowl championship.

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