The World Health Organization has classified epilepsy as one of the five most intractable neurological diseases. The latest epidemiological data shows that there are approximately 50 million people with epilepsy worldwide, with about 10 million in China. Of these, at least 6 to 8 million are children, and children under the age of 15 account for approximately 40% to 50% of all pediatric epilepsy cases. This year marks the 13th International Epilepsy Day, with the theme “Epilepsy and Public Health.” When we suddenly encounter someone having an epileptic seizure on the street, do you feel frightened and afraid, trying to avoid them at all costs and keeping your distance? Or do you reach out to help and step forward to provide assistance? Pinching the philtrum, prying open the mouth, forcibly holding down the body… Are these commonly believed first-aid measures for epilepsy correct? In which situations should you immediately call 120 for help? Guan Yuguang, Deputy Director of the Functional and Epilepsy Center at Sanbo Brain Hospital of Capital Medical University, provides professional answers to these questions.
Seizures in people with epilepsy are unpredictable
Epilepsy is commonly known as "sheep-horn wind" in Chinese folklore; during a seizure, patients may experience convulsions and foaming at the mouth, making the situation extremely critical. In fact, epilepsy is a brain disorder and the second most common chronic neurological disease after stroke (commonly known as a “brain attack”). It is characterized by recurrent, episodic, and paroxysmal dysfunction of the central nervous system caused by excessive electrical discharges in brain neurons, and it can affect people of any age, region, or ethnicity. The symptoms of an epileptic seizure are not limited to the commonly recognized sudden fainting, whole-body convulsions, and foaming at the mouth; they also include brief loss of consciousness, shouting, auditory hallucinations, olfactory hallucinations, upper abdominal discomfort, dizziness, and more. The symptoms are diverse and highly variable.
Since epilepsy is caused by excessive neuronal discharges in the brain resulting from various factors, leading to sudden, recurrent, and transient partial or complete dysfunction of brain function, seizures in people with epilepsy generally occur unpredictably and can happen at any time and in any place. When someone with epilepsy has a sudden seizure in a public place, the first thing to do is to avoid any discrimination or prejudice. Most people with epilepsy lose consciousness during a seizure and cannot control their movements or behavior. Our priority should be to rush to their aid, move them away from any danger, and ensure their safety.
With proper and appropriate treatment, epilepsy can be managed in approximately 70% of patients. However, due to a lack of accurate understanding of the condition, most patients with epilepsy do not receive appropriate and effective treatment.
How to Respond When Someone Has a Seizure
Cardiopulmonary resuscitation (CPR) for cardiac emergencies is a skill that anyone can learn through training, as heart disease is indeed a common condition, and cardiac arrest requires immediate first aid; otherwise, the optimal window for rescue will be missed. As for epilepsy, during a seizure, most patients’ vital signs—including breathing and heart rate—remain stable. Therefore, do not assume you need to take action; instead, it is best to move the patient away from any danger and ensure their safety.
In the general public’s understanding, first-aid measures for epilepsy—such as pinching the philtrum, prying open the mouth, or forcibly restraining the body—are all incorrect. Stimulating acupoints like the philtrum and Hegu with fingers can easily cause skin abrasions and, in severe cases, leave scars; Forcibly stuffing items such as towels into the patient’s mouth is an even more dangerous and prohibited practice. During a seizure, a patient’s jaw clenches with great force. Forcibly prying open the patient’s mouth and inserting objects can cause fractures of the jawbone or other bones, joint dislocations, and increases the risk of the object being aspirated into the trachea, potentially leading to suffocation; Forcibly restraining a patient’s convulsing limbs, if the pressure is not properly controlled, may cause secondary injuries such as soft tissue damage, joint dislocations, and fractures, including femoral fractures.
Improper first aid can not only harm the patient but also put the rescuer at risk. There is no way to immediately stop a seizure; approximately 90% of seizures resolve naturally within 3 minutes. Therefore, on-site management of seizures must adhere to two key principles: first, ensure the airway remains open and prevent injury. The correct procedure is to place the patient in a safe location, away from dangerous areas such as roads or ponds. Lay the patient flat on their back, remove any hazardous objects from the vicinity, loosen their collar, and turn their head to one side (to allow secretions to drain from the mouth) to prevent the airway from becoming blocked. If available, administer oxygen promptly. Second, after the patient regains consciousness following the seizure, do not give them food or medication; at this point, the patient needs rest. Seek emergency assistance in the following situations: if the seizure lasts longer than 3 minutes; if multiple seizures occur within a day with very short intervals between them; if the patient experiences difficulty breathing or is at risk of suffocation; if the seizure results in physical injury; or if the seizure occurs in water or during pregnancy. In these cases, call 120 immediately and have the patient transported to the hospital for emergency care.
Children and adolescents are a high-risk group for epilepsy
Epilepsy is common in childhood; it is a chronic condition characterized by sudden abnormal electrical discharges in the brain’s neurons, leading to temporary brain dysfunction. An electroencephalogram (EEG) can detect these abnormal discharges.
Yang Guang, Deputy Director of Administration in the Department of Pediatrics at the General Hospital of the Chinese People’s Liberation Army, said that while genetic factors are the most commonly recognized cause of epilepsy, the actual causes are highly complex. The onset of epilepsy results from the interaction between internal genetic factors and external environmental factors, and the relative contribution of these two factors varies from child to child.
The International League Against Epilepsy classifies epilepsy into six major categories: genetic, structural, metabolic, immune, infectious, and idiopathic. Experts explain that the incidence of epilepsy can be reduced through preventive measures. First, people with epilepsy should avoid marrying someone with a family history of the condition. Second, if a child has epilepsy and the parents are planning to have a second child, prenatal diagnosis can be performed early in pregnancy to identify children with hereditary epilepsy at an early stage, allowing for the option of terminating the pregnancy.
It is not the case that having epilepsy necessarily leads to intellectual or cognitive delays. With proper treatment, most children can attend school normally as long as their epilepsy is controlled and their intellectual development proceeds normally; only a small percentage of patients experience some degree of intellectual or cognitive delay. As with any disease, early detection and treatment are beneficial for the prognosis, and epilepsy is no exception. Early detection and intervention can help prevent further damage to the brain.
In summary, consistent, long-term, and proper use of antiepileptic drugs remains the first-line treatment for childhood epilepsy. With proper treatment, most children can return to normal school and daily life, and parents should have full confidence in this. However, antiepileptic drugs do carry a risk of side effects. Therefore, parents must administer the medication appropriately under a doctor’s guidance and closely monitor for side effects. Only in this way can they ensure the drug’s efficacy while maximizing the child’s safety.
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Precautions for Children with Epilepsy in Daily Life
First, avoid factors that can trigger a child’s epileptic seizures, including emotional stress, lack of sleep, excessive fatigue, colds, and fevers. Second, regarding diet, a balanced diet is recommended. Avoid foods containing stimulants such as alcohol and caffeine; strong tea, coffee, cola, and spicy foods should be avoided as much as possible. However, so-called “trigger foods” such as beef, lamb, and seafood can be consumed. Third, regarding daily activities, if the child’s seizures are not yet well-controlled, supervision should be increased, and excessive physical activity should be avoided. If the child’s condition is stable, there is no need to overly restrict their physical activity; however, extreme sports such as diving and bungee jumping are still not suitable. Fourth, there are no restrictions on watching television, but it is not recommended to watch scary or stimulating content, and prolonged video game play should be avoided.
You can get vaccinated if you have not had an episode for 3–6 months.
Vaccination is a key method for preventing childhood diseases; however, many vaccine package inserts state that “vaccination is contraindicated for children with epilepsy.” According to the “Expert Consensus on Vaccination for Children with Special Health Conditions” published in the *Chinese Journal of Practical Pediatrics* in 2019, it is clearly stated that children with epilepsy, regardless of whether they are taking antiepileptic medication, may generally receive vaccinations according to schedule as long as their seizures are well-controlled—typically with no seizures for 3 to 6 months. If a child has had a seizure within the past 6 months, vaccination should be postponed.
Experts recommend that children receive their vaccinations promptly after their seizures have been brought under control. Even if a vaccination triggers a seizure, it does not significantly affect the child’s overall prognosis. It is important to note that two vaccines should not be administered at the same time. Parents should closely monitor the child’s physical and mental condition, and postpone vaccination if the child shows any signs of discomfort.
(Source: People's Daily Overseas Edition)
