Most of us have an idea of what a seizure is like, or maybe we have even seen or suffered one; involuntary muscle movements, sometimes so violent that they resemble more a case of demonic possession (usually not the case, unless the affected person starts speaking in Latin. If that happens, you may want to check this instead. Holy water not included.). In case we see someone having a seizure in front of us, we know that it is time to be the hero, and hold the patient while we put something, like a wallet, in his mouth to prevent him from biting or swallowing his tongue. We do not know exactly from where we know that, but that's the right thing to do, correct...?
Well, as in many other things (it seemed so real that babies were brought by storks, I know), we have been lied to. Who would say that TV shows are not a good source of medical knowledge?
What really needs to be done will come a little later, first, let's talk a bit about exactly what a seizure is, since even this is not very clear among the general public. To begin with, there are two classifications of seizures: the partial seizures, which only affect one area of the brain, and whose pathological manifestations depend on the acts performed by that area. In this type of seizure there is no loss of consciousness, that is, the patient does not faint and can usually remember the convulsive episode, although it is possible that there are alterations in the state of consciousness, such as confusion or disorientation. People with this type of seizure usually do not present very dramatic manifestations; These are usually limited to staring at nothing in specific, a shaking of the lips, speaking in an unintelligible way, or moving your arms and legs abnormally (the perfect excuse for when you wave at someone by mistake). It can be difficult to differentiate this condition from common drunkenness, or from the beginning of a stroke, but generally this type of crisis is of short duration, and it is unlikely to cause the affected to call his ex saying that he misses her.
Then we have the generalized seizures, which affect a wide area of the brain, and are usually what we think about when we talk about seizures: loss of consciousness, involuntary muscle movements similar to those of your friend who thinks he knows how to breakdance after a few drinks, and loss of memory of the event and sometimes even of the previous moments. There are many types of generalized convulsive seizures, but the most common (and those that have to do with the topic at hand, come on, we are deviating from the point of the article) are the tonic-clonic seizures, those in which the muscles contract (tonic part) and then they relax (clonic part), creating that typical movement similar to that of a fish out of water that we all know. During these seizures, it is common for the sufferer to clench his teeth, foam at the mouth, and can even bite his tongue or hit his head during the crisis.
But, is it true that you have to try to force something inside their mouth to prevent possible death by suffocation or hemorrhage?
The truth is that this method so often seen on television ** _is not effective in the prevention of complications _**, and in fact if one tries it could make things worse for both the affected and for you. You see, during seizures it is common for the person to open and close their mouth uncontrollably; after all, this movement is also controlled by muscles. And taking into account that the bite of a human can exert 171 pouds of force per square centimeter, you can begin to imagine the consequences if the patient decides to close his mouth with all his strength just when you have your fingers inside it, trying to put your wallet to prevent him from biting his tongue (besides, the taste of leather is quite unpleasant), or what could happen to his teeth if you try to introduce something more solid. And not only this; trying to open the mouth forcibly while the affected is trying to close it can dislocate or even break the jaw, turning those 2-3 minutes of convulsions into possibly several days eating through a straw. To finish cementing this myth, it is physically impossible to swallow your own tongue, so while it is common for patients to bite their tongues during seizures, it is usually not very serious, and trying to force some object into their mouth for them to bite will only make everything worse, in addition to the fact that the danger of suffocating with his tongue is non-existent, although this can happen with any object you introduce in his oral cavity.
The final verdict for this medical myth: FALSE
So, what can we do to help someone who is convulsing?
Having left it clear that the mouth is not to be touched, proper handling consists in trying to protect the affected person from the initial fall, although this can be difficult. Once the tonic-clonic movements begin, the best thing to do is to put the patient on his side, and although it may seem counter-intuitive, do not prevent him from moving. Basically, you have to treat it like a bad hangover or an acid trip; let the affected person wait out the manifestations of the crisis, which usually occurs in about 3 minutes, while protecting his head from possible blows and holding him gently to keep him from hitting the ground or nearby objects, and if necessary, you can loosen the clothes around the neck to avoid a possible suffocation.
It´s also important to note that this is not the only type of generalized seizure, there are also the so-called absence crisis, which may not be diagnosed for years because they are short-lived, the patient does not remember them, and the manifestations are usually extremely subtle for other people watching. In addition, it is important to discover and treat the cause of all types of seizures; either with drugs or with other therapeutic methods. This topic goes much beyond what was discussed here, if you want to write more about it, feel free to leave your opinion below and I will make sure to explain the individual types of seizures, along with their manifestations, diagnosis, and treatment, all as simple as possible, and with the same style as the one used here. But later, of course; Dr. House is about to begin.
References:
- Beers, Mark H., et al. The Merck Manuals of Diagnosis and Therapy, 11th ed., 2007.
- Kasper, D. L., Fauci, A. S., et al. Harrison´s Principles of Internal Medicine, 19th ed., 2016.