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Lets face it, life is always a bit risky. However, for those who live with seizures, we know that the idea of risk quickly gets notched up a peg or two. This is partly because seizures are unpredictable and can make people very risk adverse, cautious or timid. The risk of accidents and other unwanted outcomes from seizures such as having a seizure in front of work colleagues, having a seizure on public transport or at a special event, can be a source of fear for many people. With this in mind, being aware of the risks and taking reasonable steps to manage them, people with epilepsy need not cut themselves off from the kinds of fulfilling lives they should be living. Many people with epilepsy lead full and active lives.

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• Epilepsy Risk Management
• Epilepsy Management Plan
• Safety Checklist
  • Around the Home
  • Leisure Activities
  • Work / School

Epilepsy Risk Management

People who continue to have seizures are more susceptible to the potential risks associated with living with epilepsy. Cause, type, and frequency of seizures vary between people. The evaluation and management of risk needs to take into account the persons seizures and their unique circumstances. Ensuring that seizures are correctly diagnosed, that treatment plans are followed and that first aid information is available, minimizes risks.

Although many people who witness a seizure fear that the person may be harmed, especially by a generalized convulsion, the risk of brain damage or death from a seizure is low. Based on the medical assessment the doctor will recommend guidelines in relation to driving, the use of dangerous machinery, working above ground level and high-risk activities such as scuba diving.

Injury

Anything that affects a persons conscious state, awareness or judgement can increase the risk of accidents. Burns-related injuries are often reported in people who experience complex partial seizures and tonic-clonic seizures. Most common are injuries due to scalding in the kitchen or bathroom. Reducing hot water temperature to 50 Celsius can protect against 3rd degree burns. Similarly strategic placement of indoor heating appliances can minimize the risk of burns in the event of a tonic-clonic seizure.

A person is at most risk of harm if they are doing something dangerous, such as driving, when a seizure occurs.

Driving

There are laws about driving after seizures and in general people who have had a seizure are required to notify the licensing body and stop driving until a medical report is supplied. Most people can return safely to driving but the length of time a person must wait varies between individuals.

Swimming and Bathing

Swimming and taking a bath alone are not recommended and special care needs to be taken when using hot water. Turning on the cold tap first in the shower or basin and lowering the temperature of the hot water are good safety hints for any home. Showers and baths and running water in any context, appear to be conducive to seizures in some people. A precautionary measure is to take medication first thing in the morning, 20 -30 minutes before taking a shower.

Check for hazards

Take a few moments to think about your home, work and leisure activities. Consider any risks that your seizures might create. Could you hurt yourself if you had a seizure? Is there a way that you could reduce the risk of harm to yourself or others?

There are many general safety strategies that you may not be using which would be useful. Do you have smoke alarms, fireguards, or power breakers fitted in your home? Is the hot water temperature controlled? Is your shower safe for anyone who falls, not just someone who has a seizure? Do you wear a bicycle helmet when riding? Safety checklists are available from Epilepsy Australia Affiliates and various community agencies.

Emergency Identification

Some people choose to wear a medic alert bracelet or pendant with epilepsy information, in case of an accident. However this is a personal choice and does not appeal to everyone. Another option is to carry medical information in your wallet.

At work or at school

When assessing epilepsy related risks in the workplace or at school, an accurate understanding of the persons condition is required to form the basis of case by case decision making. Strategies need to be realistic, appropriate and practical.

Status epilepticus

Status epilepticus refers to seizures that are prolonged or occur one after the other in quick succession. In some seizure types status, if untreated, can cause brain damage and can be life threatening. Status is uncommon and the treatment of epilepsy aims to prevent status occurring and, if it occurs, to treat it rapidly.

Some patients who are considered at higher risk of status may be prescribed emergency medication, such as rectal diazepam or intranasal midazolam, for out of hospital use. These medications should be kept in an appropriate safe place, the use by dates should be checked regularly, and training should be provided to anyone who might be required to administer the medications.

Death

You may hear about a phenomenon called SUDEP [Sudden Unexpected Death in Epilepsy] which is the name given to deaths that unexpectedly follow some seizures. Although it is uncommon, a person with epilepsy may die suddenly with no obvious cause of death. The cause of SUDEP is not well understood and estimates of SUDEP vary from 1:1000 to 1:100 people with epilepsy. The higher overall risk appears to relate to a higher frequency of seizures. Key risk factors noted are:

• Young adult
• Generalized tonic-clonic seizures
• Seizures at night
• Abrupt and frequent changes of medication in people whose seizures are not well controlled

Deaths occur with many illnesses, from influenza to asthma, however we emphasize that in epilepsy it is uncommon and that working to control any illness is the best way to minimize risk.

If you would like to get a better understanding of SUDEP, a copy of Epilepsy Australia's free publication Sudden Unexpected Death in Epilepsy: a global conversation is available upon request.

What you can do to help minimize risk factors

• Ensure seizures are correctly diagnosed
• Have regular medical reviews of your epilepsy
• Learn about your epilepsy
• Tell your doctor if you are having seizures
• Follow the treatment plan and ask for advice if you are having unpleasant side effects
• Identify and avoid any seizure triggers for you, such as lack of sleep or excessive alcohol
• Carry out a risk assessment of your home and work environment
• Give accurate first aid information to those who might care for you

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Epilepsy Management/Action Plan

An Epilepsy Management/Action Plan is a risk management tool that lets anyone, who has a person with epilepsy in their care, know what to do and what not to do when that person has a seizure.

Epilepsy Management Plans are often required by schools, pre-schools, child care centres, disability services, supported accommodation and respite services, and disability employment services. Plans help staff recognize seizure activity and provide documented procedures to follow should an emergency arise.

Plans should include the following information:

• Type of seizure/s
• Known triggers
• A description of the seizure pattern
• Who to contact in an emergency
• Name & dose of antiepileptic medication/s, and
• The time medication is administered.

Plans should also include step by step instructions from the treating doctor on

• how to manage the seizure and
• if emergency intervention treatment is required,
• the specific circumstances under which it is to be administered, and
• the time-frame in which an ambulance should be called.

If the seizure activity requires emergency intervention, ensure that the medication is readily accessible. Intervention medications generally prescribed are rectal diazepam, and more often today, midazloam.

Your Epilepsy Australia Affiliate can provide information and training in the administration of these treatments.

Download

Epilepsy Management / Action Plan

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Safety Checklist

Around the Home

Kitchen

• Consider a microwave instead of stove top or oven
• If using a stove use the back elements and turn pan handles away from the stove
• Consider a temperature controlled hot water service
• Serve hot dishes from a bench instead of carrying them to the table
• Use cordless electrical appliances with automatic switch off and appliances like food processors rather than using sharp knives
• Use rubber gloves when washing dishes
• Use non breakable crockery and have hot drinks in a mug with a lid
• If using a dishwasher place points and sharp objects down and close door when not in use
• Consider cupboards with recessed handles
• Minimise the use of knives; Consider buying pre sliced food

Living Room

• Use fixed fireguards around a fireplace
• Consider round rather than square or rectangular coffee tables
• Use shatterproof glass for big windows
• For photosensitive seizures reduce the contrast of the television screen by turning on the lights in the room and sit at least 3 metres from the set. A quality TV (with 100hz refresh rate), LCD or plasma screens are also useful
• LCD screens for computers are flicker free and useful for people with photosensitive epilepsy

Bathroom

• Consider a temperature controlled hot water service
• Always turn on cold water first
• Use a handheld shower attachment in the shower and in the bath if no shower available. Remember to leave the plug out.
• Consider shower curtains rather than a glass screen or in the case of a glass screen use reinforced glass
• Consider rubber backed mats
• Avoid the use of electrical appliances like hairdryers and electrical razors near water
• Consider the use of a shower chair
• In the toilet an outward opening door is very important
• Toilet roll holder on the floor beside or behind the toilet may minimise injury if someone has a seizure while on the toilet

Bedroom

• Dont sleep on top bunk and if possible use a low bed
• Consider tightly fitted sheets
• Sleep without a pillow or use a firm porous pillow
• Consider bed alarms or other monitor devices

And more generally . . .

• Install smoke alarms
• Minimise clutter
• You might want to consider walkways are clear before going to bed at night
• If electrical cords are a consideration, tape them to the floor
• Consider doors that are outward opening, sliding, half doors or doors that are easily removed
• Dont lock internal doors and if using a deadlock leave the key in the lock. Use security sets for bathrooms and toilets if needed. These can be unlocked from the outside if necessary
• Consider having safety switches in the metre box installed by an electrician
• Minimise sharp edges and corners
• Avoid living in accommodation with stairs or consider a safety gate at the top of the stairs
• Wear an Identification bracelet or have information available in case of a seizure
• Keep medications out of reach of children. Store in a cool dry place and do not remove from pillbox or webster pack ahead of time
• Push button phones can be programmed so that pushing a particular button after a seizure alerts a relative or friend that the person may need some help
• Minimise glass for example in doors, cupboards and table tops
• Consider ramps rather than stairs
• Consider chairs rather than bar stools

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Leisure Activities

Activities shouldnt be restricted to the point where an individual cannot follow their interests or have some fun, however while seizures are not controlled some restrictions should be considered, particularly with those activities that carry greater risks. Ensure someone knows what you are doing.

Swimming and water sports

• Never swim alone and while participating in water activities take a friend or carer with you
• Let a lifeguard know about your condition
• Wear lifejackets in boats and when fishing
• Avoid scuba diving and high board diving
• Avoid water that is too hot in spas and keep up fluids

Cycling

• Always wear a helmet (this is law anyway)
• Use bike tracks / lanes where possible

Rock Climbing

• Always use a safety harness

And more generally . . .

• Whenever participating in an activity where a fall may be possible or it poses the risk of a head injury, use protective head gear
• Be aware of over exertion or over heating
• Drink plenty of water
• If possible try to choose activities that take place on softer surfaces such as grass, mats etc
• Consider if it is useful to have a gym buddy, if using weights, stationary equipment etc.

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Work / School

• What safety considerations are needed?
• Have you informed someone that you have epilepsy?
• Are policies and procedures in place should a seizure occur?
• Is an individual emergency plan necessary?
• Have guidelines with driving and use of machinery been understood?
• Does the workplace or school need some epilepsy education?
• Does the school or workplace have a recovery room?
• Are they aware of helpful resources?

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Epilepsy Australia National Help Line 1300 852 8653