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CALEA Update Magazine | Issue 105

Responding to Epilepsy and Seizure Incidents — A Guide for Law Enforcement

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During your shift, have you ever encountered someone exhibiting confused behavior? Have you come across someone who was not able to communicate? How about someone who has a combative response to your efforts to direct him or her?  All of these could resemble the signs of someone who is publicly intoxicated, under the influence of drugs and/or alcohol, and your first inclination might be to restrain the person and place him or her in custody. In some cases, your inclination might be right. However, there could also be a medical explanation for the behavior, where restraining the individual could be hazardous to his or her health and cause injury. The medical explanation is referred to as a seizure.

What is a seizure…and what is epilepsy?
A seizure is a sudden, brief disruption of the normal function of neurons in the brain which causes some nerve cells to fire erratically and spread to other nerve cells. This surge of electrical activity can involve part or all of the brain, last from seconds to a few minutes and include a variety of outward signs. About one in ten Americans will have a seizure during their lifetime.

People have seizures as the result of trauma or acute or chronic illnesses, but a common cause of seizures is epilepsy, which is a diagnosis of two or more unprovoked seizures. An estimated three million Americans of all ages have seizures caused by epilepsy. Epilepsy is not contagious, is not a mental illness, or a cognitive disability. The neurological dysfunction seen in epilepsy can begin at any age. Epilepsy may occur with developmental disabilities, cerebral palsy, cognitive impairments, ADD/ADHD or autism, but the majority of people who have epilepsy do not have other impairments and live very normal lives.

Many of the problems that might arise when law enforcement personnel respond to a seizure could be due to the lack of familiarity with the real nature of these episodes. Officers might react to a person’s dazed behavior, inability to obey directives, and combative response to restraint as actions that the person can control. In fact, when a person with epilepsy has a seizure, he or she is physically unable to control their actions; their actions are completely involuntary. If an officer acts with force and tries to restrain the person, it could result in injury, and even a lawsuit. The Americans with Disabilities Act asserts that arrests that are seizure-related may constitute denial of rights and discrimination on the bases of disability. To this end, it is of extreme importance that law enforcement personnel recognize seizures and are trained in the correct response and unique needs of individuals with epilepsy who are taken into police custody for any reason.

What does a seizure look like?
Seizures are classified as generalized and partial. While there are over 20 types of seizures, the ones most often encountered by law enforcement are generalized tonic-clonic and partial (complex and simple) seizures. In generalized tonic-clonic seizures, the electrical disruption involves the entire brain. This results in a loss of consciousness and the “tonic” phase where the limbs stiffen and breathing may stop temporarily. This is followed by the “clonic” phase - rhythmic shaking of the body and limbs (convulsions). Muscles relax as the clonic phase subsides and there may be a loss of bladder and bowel control. The actual seizure usually lasts from one to three minutes followed by a period of confusion and sleepiness (called the postictal period).

Complex partial seizures are characterized by altered awareness. Although the person remains conscious, they are confused and are unable to respond. Symptoms may include: a blank stare and inability to answer questions, smacking lips, chewing, excessive blinking, mumbling and wandering. One hallmark of complex partial seizures is repetitive, purposeless movements (such as picking at clothes, wringing hands, or fumbling with an object). Occasionally there are emotional outbursts. In simple partial seizures, the person remains conscious, is oriented and will respond verbally. Symptoms last less than one minute and may include motor changes (shaking of one arm or leg), sensory symptoms (distortion of vision, hearing, smells) or emotional reactions (fear or anxiety, sense of déjà vu).

Can epilepsy be treated?
For most individuals living with epilepsy, treatment is through regular use of one or more anticonvulsant drugs. The medicines do not cure epilepsy, even though some people have stopped taking them after years of seizure control. In some cases, surgery can remove the area of brain which is causing the seizures. Vagus Nerve Stimulation (VNS) can be tried when other medications fail to stop seizures; VNS is a type of treatment in which short bursts of electrical energy are directed into the brain via the vagus nerve in the neck. The ketogenic diet is another type of treatment which is very high in fats and low in carbohydrates, making the body burn fat instead of glucose for energy. This treatment can be very effective for children living with epilepsy. Above all, it is important to remember that the large majority of people living with epilepsy are able to manage their conditions with medication or another form of treatment and lead full lives.

How can the Epilepsy Foundation help law enforcement personnel?
The Epilepsy Foundation is a national non-profit organization that is dedicated solely to the welfare of the nearly 3 million people with epilepsy in the U.S. and their families. The organization works to ensure that people with seizures are able to participate in all life experiences; to improve how people with epilepsy are perceived, accepted and valued in society; and to promote research for a cure. In addition to programs conducted at the national level, epilepsy clients are served by fifty Epilepsy Foundation affiliates throughout the United States.

The Epilepsy Foundation recognizes the growing need to provide information to First Responders in the field, such as law enforcement officers, regarding issues in responding to individuals with epilepsy and calls related to epileptic seizures. The key to a more appropriate law enforcement response is training. The Law Enforcement Personnel Training Program consists of a field-tested curriculum, which includes a training manual and DVD. To order copies of the training manual and DVD, or to find out more information about epilepsy and locate the Epilepsy Foundation affiliate nearest you, go to www.epilepsyfoundation.org or call 800-332-1000. Additionally, the Epilepsy Foundation has partnered with CentreLearn to launch an online Law Enforcement Training, titled “Epilepsy and Seizure Management for Law Enforcement,” at www.epilepsyfoundation.org/firstrespondertraining.

In summary, the Epilepsy Foundation offers the following key points for Law Enforcement personnel to remember about seizures and epilepsy as you serve and protect our communities:

       When a report states someone is acting strangely or creating a disturbance, always consider the possibility that a seizure could be taking place.

       People with epilepsy have an episodic medical disability over which they do not have control. As with anyone with a medical condition, they should be treated with respect.

       People taken into custody for any reason should be allowed to take their seizure-preventing medication.

       An individual seen shaking and falling followed with confusion is probably having a seizure and should be treated accordingly.

Ms. Tia Simmons, CHES, Program Manager, National Office of the Epilepsy Foundation
Mr. Tom McCarrier, NREMT-B, Epilepsy Foundation Professional Advisory Board 

FIRST AID FOR SEIZURES

What Can Be Done

What Should Not Be Done

Check the time elapsed since seizure began. Call for medical assistance after five minutes if the individual has not recovered.

Don't put anything in the mouth.

Ask bystanders what they saw, when it began, and if there is a history of seizures.

Don't restrain the individual while trying to prevent jerking. Such a practice can lead to injury or asphyxiation (especially if someone is restrained face-down and/or their limbs are bound), and restraint can prompt involuntary struggling, which, in turn, could lead to cardiac arrest.

Loosen tight clothing, like shirt collars and necklaces; remove eyeglasses.

Don't start CPR unless water was inhaled or breathing fails to start when seizure is over.

Turn individual on side to clear airway and prevent choking if there is no suspicion of head or neck injury.

When no medical assistance appears necessary, rather than leave the individual alone after the seizure is over or letting him/her drive, seek the assistance of a responsible person such as a relative or friend, or give the individual a ride home.

Eliminate hazards nearby and move bystanders back or away from the immediate area, especially if it is a dangerous crowd situation. Use a gentle, persuasive manner.

Try not to raise your voice or appear threatening.

Check for epilepsy or seizure disorder I.D.

Don't give liquids or medications during or immediately after the seizure.

Speak calmly to the individual and others nearby. Reorient the individual with easy questions such as name and day of week. Reassure the individual that a seizure has occurred and that everything will be alright.

Don't act in a manner that implies lack of confidence.

Distinguishing epileptic seizures from other episodes resulting in seizures is beyond reasonable expectations of law enforcement. Once the seizure ends, appropriate follow up and questioning can take place. Inquiries about seizure history, name of physician, treatment and medications can be explored.

Author
Ms. Tia Simmons, CHES
Program Manager
National Office of the Epilepsy Foundation
Landover, Maryland
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