Autonomic dysreflexia is the term used to describe the paralysed body’s autonomic response to painful stimuli perceived below the level of the lesion. The sympathetic nervous system responds to these pain signals by vasoconstriction of blood vessels throughout the paralysed areas of the body resulting in gross hypertension (high blood pressure). It can be a fatal complication for any SCI person living with a lesion above T6 because a lesion at this level blocks the signals from the brain to most of the sympathetic ganglia (T2-T10) which would stop the malignant hypertension. As the systolic during AD can reach up to 330/160mm/Hg it therefore follows that unresolved it can cause cerebral bleeding and death. It is also important to remember that AD can occur at any time following the injury whether the injury is complete or incomplete and it is estimated that 90% of people with tetraplegia (all four limbs affected) will experience it – just because someone has never experienced one before doesn’t mean they can’t.

Although blood pressure is important and knowing the normal blood pressure for our client it is however vital never to delay investigations purely based on systolic or diastolic blood pressure reaching a certain level. Every client should have a management plan for the treatment of AD and it is important that you know the contents of this document.

Chronic Obstructive Pulmonary Disease (COPD) is the umbrella term for a group of conditions that cause breathing difficulties. It is a common condition that mainly affects middle-aged or older adults who smoke. Many people do not realise they have it and put the cough down to ‘smokers cough’. The breathing problems gradually worsen over time and limit normal activities
The most common conditions classified as COPD are

Without treatment, the symptoms will get progressively worse. There may also be periods when they get suddenly get worse, known as a flare-up or exacerbation and these are often during the winter.
Most people with COPD do not have any noticeable symptoms until they reach their late 40s or 50s., which generally towards the latter stages of the disease

The lungs absorb oxygen from the air you breathe in and transfer it into your bloodstream so that it can get to every part of your body. As the cells in your body work, they produce a waste gas called carbon dioxide that is released into the bloodstream. Your lungs get rid of this waste gas when you breathe out.

Chronic obstructive pulmonary disease (COPD) happens when the lungs and airways become damaged and inflamed and It’s usually associated with long-term exposure to harmful substances.

The damage to the lungs caused by COPD is permanent, but treatment can help slow down the progression of the condition and include:

The outlook for COPD varies from person to person. The condition cannot be cured or reversed, but for many people, treatment can help keep it under control, so it does not severely limit their daily activities. But for some people, COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems.

Depression is a relatively common complication of COPD as, for many, the disease has far-reaching effects into every aspect of daily life and, unfortunately, the condition is often irreversible. Because fatigue plays such a major role in COPD, it can cause feelings of sadness and loss of enthusiasm or interest in everyday activities

Pulmonary hypertension occurs when there is abnormally high pressure within the blood vessels of the lungs. Normally, blood flows from your heart to pass through your lungs, where blood cells pick up oxygen and deliver it to the body. In pulmonary hypertension, the blood vessels in the lungs become thicker and narrower. This means less blood is able to flow through them. Pressure rises and the heart muscle must work harder to get the blood through the lung’s blood vessels. Ultimately, less oxygen reaches the body.

Pneumothorax is an accumulation of air or gas in the space between the lung and the chest wall. It occurs because of a hole that develops in the lung, which allows air to escape. This causes the lung to collapse partially or completely. People who have COPD are at greater risk for a pneumothorax because the structure of their lungs is weaker and more vulnerable to the spontaneous development of these types of holes.

Secondary polycythaemia in addition to the complications of ineffective breathing, the body is stimulated to make more red blood cells in an effort to compensate for hypoxia in the tissues. This results in thickened blood, with possible risk for thromboembolism and pulmonary hypertension as the pressure within the lungs increases. The blood flow from the pulmonary artery backing up into the heart can eventually lead to left-sided heart failure. If a person is a smoker, the chronic irritation to the alveoli also stimulates the inflammatory response, which creates vasodilation, release of histamines, and alveolar stiffening. With chronic hypoxia, the person can also develop chronic hyperventilation as a compensatory mechanism.

Cor Pulmonale is heart failure on the right side of the heart—the side that pumps blood from the organ to the lungs. Caused by an increase in blood pressure in the pulmonary artery, which is the main route for blood to travel from the right side of the heart to the lungs. Elevated blood pressure in this artery can strain the heart muscle on the right side. This then causes the right side of the heart to become enlarged and to develop heart failure, which means it can’t pump blood properly.

Respiratory failure is due to the inefficient transfer of putting oxygen into the blood and removing waste carbon dioxide from the blood. Symptoms of respiratory failure include shortness of breath, extreme tiredness and fatigue, confusion, and rapid breathing. This can be a medical emergency if these symptoms develop suddenly,

Cyanosis is a condition in which your blood oxygen levels have fallen drastically low and the body has difficulty getting enough oxygen to the extremities. This results in a blue or greyish cast to the skin, especially the lips and the area around the eyes. If this is a new symptom for someone then it should be treated immediately.

Dementia is increasingly common around world affecting 36 million of whom it is estimated 26 million do not have a formal diagnosis. In the UK the number is estimated at 850,000 and rising. Although currently there is no cure for dementia, given these high numbers a lot of research on-going trying to identify possible causes and risk factors for dementia so it can be prevented or cured for those with the disease.
There are currently four types of dementia recognised

Alzheimer’s is arguably the best-known form; it is a caused by degeneration of the nervous system especially those neurons in the brain. Protein plaques form most commonly in the temporal lobe of the brain, an area in which memories are formed. The plaque tangles lead to insufficient blood supply to the brain cells, and these eventually will die off. As the disease progresses the area affected gets bigger and symptoms worsen.

The cause is unknown, some research has suggested that up to 70% of cases are due to person’s genes while others believe lack of dietary vitamin B or because of an underactive thyroid gland.

Vascular dementia is caused by reduction in the blood supply to the brain due to diseased blood vessels. To survive the cells of the brain, need a constant supply of blood delivering the oxygen and nutrients they need. If these blood vessels leak or block, then the supply is reduced, and cells can eventually die. Vascular dementia can be split into three types depending on the cause of the damage.

This type shares many characteristics of Alzheimer’s and Parkinson’s disease, and many believe underdiagnosed. Lewy bodies are small deposits of proteins that sit in a nerve cell, but the link between these deposits and dementia is not fully understood. However, is believed there is an association with low levels of neurotransmitters which send messages between the cells and when these nerve cells die this leads to loss of brain tissue. How a person is affected is dependent on where in the brain the Lewy bodies are located. If they are in the base of the brain then motor skills are likely to be impacted, cognitive function will be impaired if located in the outer layers of the brain. Often these two diseases occur together and sometimes people with Parkinson’s will develop dementia as well. Together these diseases are known as Lewy body dementias.

This is also known as ‘Picks disease’ or ‘frontal lobe dementia’. Frontotemporal refers to the area of the brain called the forebrain which is an area regulates an individual’s behaviour, emotion and language. Nerve cells within these areas die due to lack of chemical messages between them and when this happens the lobes shrink in size resulting in changes in a person’s personality and behaviour, they may also have difficulty with language.

It is important to understand the difference between cause and risk as they are not the same

• Cause is something that has made something happen
• Risk factor is something that increases the likelihood of something happening

An example of cause and risk. A woman trips over the strap of her handbag, falls breaking her wrist, the cause would be the fall, but the risk factor was introduced when the woman put her handbag on the floor. If the bag hadn’t been put on the floor, she would be less likely to trip and sustain a fracture.
In terms of dementia this would mean that a person whose mother had dementia might ultimately be the cause of them developing the disease but if they smoked and had a poor diet, they have also increased their risk factor of developing the condition. Alternatively, a person whose mother has dementia but was none smoker with a good diet might still be diagnosed, but they have reduced their risk.

The table below outlines some of the causes of dementia and how they contribute to the development of the disease.

The table below outlines some of the causes of dementia and how they contribute to the development of the disease.

Signs and symptoms of the common types of dementia

Early signs and symptoms – this stage is often referred to a pre-dementia

The individual may have noticed changes but are hiding signs and symptoms from friends and family.
Most common signs and symptoms

At this stage there will have been a dramatic decline in memory, and they will no longer be able to hide it from others. They may require assistance with care, and it can be a very stressful time for family because they can appear to be a very different person than they were although they may have periods of lucidity

Most common signs and symptoms

This is classed as severe or advanced and the person will be totally dependent on care givers. Often this is the stage when family think about moving them into residential care as the person is more likely to display challenging behaviour and family find it increasing difficult to manage

Most common signs and symptoms

Early diagnosis is important even though there is no cure it means that the progress of the condition can be managed, diagnosis offers the following

Reassurance – Gives the person reassurance and rules out any other health problems – often relief that they know what is wrong and they can plan what they do next. Although some people are angry and upset obviously

Assistance/support – Gives family practical and emotional support -from a variety of sources.
Practical support can come from.

▪ GP’s ▪ dieticians ▪ SALT ▪ OT’s ▪ mental health teams ▪ physiotherapists ▪ counsellors ▪ social services who may be able to offer respite ▪ Support groups can offer physical and emotional support
Emotional support is arguably as important as practical help. Often the individual with the diagnosis accepts things before their family do, therefore emotional is important to all the family
Other types of emotional support include

Contrary to popular belief, Lorem Ipsum is not simply random text. It has roots in a piece of classical Latin literature from 45 BC, making it over 2000 years old. Richard McClintock, a Latin professor at Hampden-Sydney College in Virginia, looked up one of the more obscure Latin words, consectetur, from a Lorem Ipsum passage, and going through the cites of the word in classical literature, discovered the undoubtable source. Lorem Ipsum comes from sections 1.10.32 and 1.10.33 of “de Finibus Bonorum et Malorum” (The Extremes of Good and Evil) by Cicero, written in 45 BC. This book is a treatise on the theory of ethics, very popular during the Renaissance. The first line of Lorem Ipsum, “Lorem ipsum dolor sit amet..”, comes from a line in section 1.10.32. Contrary to popular belief, Lorem Ipsum is not simply random text. It has roots in a piece of classical Latin literature from 45 BC, making it over 2000 years. The first line of Lorem Ipsum, “Lorem ipsum dolor sit amet..”, comes from a line in section 1.10.32. Contrary to popular belief, Lorem Ipsum is not simply random text. It has roots in a piece of classical Latin literature from 45 BC, making it over 2000 years.

Treatment – An early diagnosis means treatment can be started immediately and if one treatment or medication doesn’t appear to be working it can be changed and an alternative tried, plus in some cases where some aspects of the dementia is due to vitamin deficiency, or a brain tumour treatment can reverse this. Medication available in the UK include, Donepezil, Rivastigmine Galantamine Memantine (Alzheimer’s only). These drugs work by making the remaining brain cells work harder although not cure they do make significant difference to a person’s day to day living.
Other non-medication treatment options available

Forward Planning – early diagnosis means the person can plan ahead whilst they still have the mental capacity to be involved in areas like financial planning, getting benefits, possibly appointing a Lasting Power of Attorney (LPA). Where and who do they want to help care for them as often they don’t want to burden the family with this task.

Monitoring – is vital as someone can deteriorate rapidly and someone who seemed to have been living independently with a low level of care may suddenly need much more input. It is important that care givers and family monitor the person to keep them safe.

Other common conditions mimic the signs and symptoms of dementia, so it is important that an accurate diagnosis is made ensuring the correct care and treatment is given. However, people with dementia can have stress, delirium, and depression as co-morbid conditions and making diagnosis more difficult

The four most common conditions

Depression this is the most common as the early symptoms are almost identical and include memory loss, confusion, lack of concentration, and behavioural changes. Treatment options are totally different and the wrong treatment dramatically reducing the prospect of recovery from depression

Stress, like depression, the person may present with memory loss, confusion, lack of concentration, behavioural changes, and mood swings, they may also feel they have no control at work or in a relationship. A key difference between the two conditions is the memory lapses, someone with dementia may not acknowledge what they have forgotten even when prompted but someone suffering with stress may initially forget but quickly recalls when prompted

Delirium most commonly occurs in older people causing confusion, communication problems, sleep disruption, rambling and mood swings all common in dementia. Delirium can be caused be illness, infection, dehydration, malnutrition, medication side effects but once the cause has been eliminated then the symptoms resolve

Mild cognitive impairment (MCI) also known as late-life forgetfulness. Forgetfulness is part of the ageing process, but it does not have a debilitating effect on an individual’s ability to carry out day to day activities as would happen in dementia – for example a person with MCI will not forget how to get home from the shops nor would they make unsound judgement or behave inappropriately but they might forget where they put the car keys occasionally

Colette and Martin are both 67 they have been married for 30 years and have lived in the same house since they married. They have three children, and 9 grandchildren who visit quite often.
Martin was supposed to meet Colette in town and completely forgot until he was texted asking where he was. As it had started raining Colette asked him to bring an umbrella with him, but he forgot and left it at home. Colette was very worried and persuaded him to see his GP for his memory lapses. Martin agreed as he had forgotten other things recently like the date of Colette birthday and was worried he had missed it. He also had forgotten one of his grandsons’ names when telling a friend a story about him although he was able to recall it a few minutes later.
Martin is a keen fisherman and enjoys long walks, doing embroidery especially cross stitch, going to the pub and socialising. He loves reading books and reads anything from Enid Blyton to historical romances especially Mills and Boon novels.
Question. Is it possible Martin has dementia? Explain your answer with at least two reasons.

Diagnosing dementia is difficult and certainly not in the remit of a care worker. But it is important to be aware of the possibility of dementia in the elderly and to report any concerns you may have because having assess to this information could assist the health professional make a formal diagnosis.

Reporting in the first instance is often verbal to the office but it’s not enough just to say you think Betty has dementia as this is your opinion, you need to report facts – why you think this is the case giving actual instances and times and should be followed by a written report and must be recorded by the office. Early stages are of dementia are difficult to spot as the person may cover themselves with excuses rather than admit any problem, also they are less likely to display symptoms consistently.
The following would be important information for a doctor to have access to when assessing for dementia

It is important to record information not only to assist with diagnosis but ensure that the correct treatment is in place following diagnosis to identify if the person needs any assistance and help them be as independent as possible. Information recording also

Memory loss is one of the first and most prominent symptom of dementia and cannot be reversed and is divided into short- or long-term memories

Short-term memory – this enables someone to hold onto information up to about 30 seconds so that it can be recalled immediately for usage or remembered by sending it to long term. An example of short-term memory is when someone is trying to remember a phone number the beginning of the number is held in short term memory so the rest of it makes sense

Long-term memory – more complex because information is stored withing it is separated into different types of which these are the most associated with dementia

When an individual with dementia is losing the short-term memory, the area effected is in the prefrontal cortex of the brain as this is where short term memories are held. This can be very debilitating they will struggle to remember the context of a sentence or conversation they have just had or remember someone’s name they have just been introduced to. Additionally, it is common for someone to repeat themselves over and over or repeatedly read an article in a paper.

Long term memory is stored in two different area in the brain, and it is possible for their long-term memory to be intact with total recall from years ago despite poor short-term memory. Autobiographical memories tend to stay longer than any other memory unless the disease is attacking the cells in that area, they can with little prompt recall fine detail and discuss their history. If the hippocampus area of the brain is affected, then individuals will have problems recalling memories held in long-term store. This can be very upsetting for families the person is unable to recall who they are because ethe area of the brain responsible for matching a face to a name is no longer accessible to them. As long-term memory is stored in separate stores then it is possible that a person can remember how to wash and dress themselves (procedural memory) but cannot remember their occupation prior to retirement (autobiographical memory) or they may remember when their first child was born (emotional memory) but cannot recall their name (autobiographical memory).
When an individual is unable to recall information from either short or long-term memory if can have a significant impact on that person on

Personality may change due to frustration at not being able to remember and can turn someone who was very gentle and happy to have bouts of anger and display changes in behaviour like irritability and disrespecting others.

Mental and physical health physical health many deteriorate as the person may forget to take medication or that they have a c condition which needs to be managed like for example diabetes. Depression is more prevalent more prevalent as they can o longer live the life they used to and are still aware of this and they are aware that their condition is only going to get worse.

Lifestyle and sociability are affected by memory loss as individuals may not feel like socialising as they feel embarrassed by their condition, if they are unable to recall someone’s name, they can their become isolated which is another risk factor in depression. Activities that they once may have enjoyed are not possible as they are unable to remember how to carry out this activity.

Memory problems may lead to changes to the environment and could even necessitate a move into residential care if no longer able to care for themselves and their behaviour may be seen as too risky for them to remain at home.

Communication occurs in two ways, verbal and non-verbal. All forms of dementia present with communication difficulties but greatly depends on types of dementia and how advanced it is. In Frontotemporal dementia problems with language are one of the first symptoms. Additionally, language can fluctuate from day to day. Inability to find the correct word or suitable word to use in the context of a sentence is common and happens to us all now and then, but in dementia it’s the frequency and total inability to think of any idea of what word to use is the problem.

If someone is unable to follow a conversation, they feel embarrassed and/or frustrated and as such are likely to avoid a similar situation in the future. Loss of ability to use appropriate language leads to social isolation as family may feel embarrassed if the person uses challenging language, inappropriate tone of voice, words, or sentences. During the latter stages the individual can reach a stage where they can barely communicate, known as expressive dysphasia which can result in differing symptoms which include:

Being able to follow instructions and the sequence something needs to be done in, may seem automatic to someone not suffering with dementia, however if the deterioration is in the brain which deals with these functions, then this becomes problematic. The person with dementia may be able to carry out each individual aspect of personal care but not get it in the correct sequence for example putting underwear on after trousers or trying to put socks on over their shoes.

Inability to recognise faces including their own and objects and places and can be challenging for the individual and their family. Simple tasks like how to use and what the spoon is used for means they do not connect it with eating, likewise cups may not be associated with drinking. It can therefore be a challenge when caring for someone. Unable to recognise even closed family can be distressing for family but scary for the individual as everyone are strangers to them.

If they person does not recognise their environment, they are likely to wander off looking for somewhere they do remember, so it is important that they are not left alone in a place where they could wander off and get lost. At Sphere Specialist Healthcare we encourage our services users to complete the Winnie Protocol or Herbert Protocol documentation

Some causes of non-epileptic seizures include.

Epilepsy can start at any age and there are many different types. Some types of epilepsy last for a limited time and the person eventually stops having seizures. But for many people epilepsy is a life-long condition. Epilepsy is one of the most common serious neurological conditions in the world. It affects around 600,000 people in the UK. This means that almost 1 in 100 people in the UK have epilepsy. Around 87 people are diagnosed with epilepsy in the UK every day.

Epilepsy is caused by disruption in the activity of the brain. We have thousands of cells in the brain, and they communicate and relay messages to each other by either chemical or electrical activity and this is happening in our brain all the time. A seizure happens when there is a sudden burst of intense electrical activity in the brain causing a temporary disruption to the way the brain normally works, so the brain’s messages become mixed up. The result is an epileptic seizure. Possible causes of epilepsy include:

But in over half of all people with epilepsy, doctors can’t find a cause. It’s thought that our genes play a part in who does and who doesn’t develop epilepsy. This may explain why some people develop epilepsy with no clear cause. Researchers have found several genes linked to particular types of epilepsy. There are many types that doctors suspect are genetic, but they don’t yet know which genes are involved.

The main way doctors diagnose epilepsy is by taking a detailed description of the seizures. They may also arrange for some tests to help give them more information about the possible type and cause of the epilepsy. This can also help rule out any other conditions that could be causing seizures. These tests can include blood tests, an EEG (recording of the brainwaves) and a brain scan. But there isn’t a single test that can prove if someone does or does not have epilepsy.

The main treatment for epilepsy is epilepsy medicines. These are sometimes called anti-epileptic drugs or AEDs. The medicine doesn’t cure epilepsy but helps to stop or reduce the number of seizures.

Many people find that their seizures stop with the first or second medicine they try. But some people need to try a few medicines before they find one that works well for them. And some people need to take 2 or more epilepsy medicines together.

If epilepsy medicine doesn’t work well for someone, their doctor might suggest other types of treatment. Other types of treatment include brain surgery, another type of surgery called vagus nerve stimulation, and a special diet called the ketogenic diet which is sometimes used for children.

There are many different types of seizure. What happens to someone during a seizure depends on which part of their brain is affected, and how far the seizure activity spreads. During some types of seizure, the person may remain alert and aware of what’s going on around them, and with other types they may lose awareness. They may have unusual sensations, feelings, or movements. Or they may go stiff, fall to the floor and jerk.

When an epileptic seizure starts in one side of the brain, it’s called a focal onset seizure or a focal seizure. Both terms mean the same thing and until recently these seizures were called partial seizures.

There are many types of focal seizures, but they can be split in to two categories according to the level of awareness during the seizure

During a focal aware seizure, you stay fully aware of what’s happening around you, even if you can’t move or respond. This type of seizure used to be called a simple partial seizure. The duration is usually between few seconds and two minutes.

Some people with epilepsy use the word ‘aura’ to describe the feeling they get that warns them they’re about to have tonic-clonic seizures The aura is in fact the seizure starting in one side of the brain as a focal aware seizure. To become a tonic-clonic the seizure then spreads to affect both sides of the brain. See focal to bilateral tonic-clonic seizures but they can also happen on their own, without developing into another seizure type. Some people who have focal aware seizures on their own also call them auras.

If your awareness of what’s happening around you is affected at any time during your seizure, it’s called a focal impaired awareness seizure, this used to be called a complex partial seizure. The duration of these seizures tends to be one to two minutes. Someone having a focal seizure may not be aware of their surroundings or what they are doing. They may have unusual movements and behaviour such as plucking at their clothes, smacking their lips, swallowing repeatedly, or wandering around. You should guide them away from danger, such as open water or roads and stay with them until recovered. But don’t restrain them or act in any way that could frighten them like shouting and remember they may be unaware of what they are doing.

Motor or non-motor

Doctors may also use the words motor or non-motor to describe focal seizures. Focal motor describes focal seizures where the main symptoms involve muscle activity, such as jerking, loss of muscle tone or repeated movements. Focal non-motor describes seizures where the main symptoms don’t involve muscle activity. They can include things like changes in emotions, thinking and sensations

.What happens during a focal seizure depends on which area (lobe) of the brain is affected, and whether the seizure spreads to affect other areas. Some people just experience one symptom during a focal seizure, while others experience several.

The symptoms of frontal lobe seizures can sometimes be mistaken for mental health problems or sleep disorders. Some people who have frontal lobe seizures only have them in their sleep. They are usually brief, but often happen in clusters, with several happening in a short space of time. Your awareness may or may not be affected.

Symptoms of seizures in the frontal lobes can include:

Seizures starting in the occipital lobe often spread to involve other lobes. Symptoms of seizures starting in the occipital lobe include:

Seizures starting in the parietal lobe often spread to involve other lobes. Symptoms of seizures starting in the parietal lobes can include:

If you have been diagnosed with temporal lobe epilepsy (TLE) it means you have seizures starting in one or other of the temporal lobes. Seizures starting in the temporal lobes are usually focal impaired awareness seizures, but focal aware seizures can also happen. You might start the seizure being aware of what’s happening, and then lose awareness as the seizure progresses. Symptoms of seizures in the temporal lobes include:

After a temporal lobe seizure, you are likely to be confused, and may find it hard to speak for a short time.
After someone has a focal seizure varies from person to person. Some people may feel fine and able to get back to what they were doing straight away. Others might feel confused or tired for some time afterwards and may need to sleep. Some people find they have temporary weakness or can’t move part of their body after they’ve had a seizure. This is called Todd’s paresis or Todd’s paralysis. It can last from a few minutes up to 36 hours, before going away.

These are sudden, short-lasting jerks that can affect some or all of your body. They are usually too short to affect your consciousness. The jerking can be very mild, like a twitch, or it can be very forceful. Sometimes if the jerk is very forceful it can make you throw something you’re holding, or make you fall over. Usually, last only a fraction of a second although some people can have clusters over a period of time and following the seizure the person can go back to their normal routine.

These can be generalised onset, meaning they affect both sides of the brain from the start. Or they can be focal onset, meaning they start in just one side of the brain. Tonic seizures usually last less then 60 seconds.

If a tonic seizure starts in both sides of the brain, all your muscles tighten, and your body goes stiff. If you’re standing, you may fall to the floor. Your neck will extend, your eyes open wide and roll upwards. Your arms may raise upwards and your legs stretch or contract. You may cry out and stop breathing during the seizure. If a tonic seizure starts in one side of the brain your muscles tighten in just one area of the body.

Once the seizure has ended the person may feel sleepy or confused afterwards.

These can be generalised onset, meaning they affect both sides of the brain from the start. Or they can be focal onset, meaning they start in just one side of the brain. Atonic seizures are sometimes called drop attacks. They are very brief, usually lasting just one or 2 seconds.

If you have atonic seizures, usually all your muscles go limp and you drop to the floor. This can result in injuries to your head, nose or face. Sometimes you might not completely fall, but your head may drop forward or you might sag at the knees.

Your muscle tone returns as soon as the seizure is over. If you’ve fallen, you can get up again straight away.

Tonic-clonic seizures are the type of epileptic seizure most people recognise. In the past they were called grand-mal seizures. Tonic-clonic seizures can have a generalised onset, meaning they affect both sides of the brain from the start. When this happens, the seizure is called a generalised tonic-clonic or bilateral convulsive seizure. Some seizures start in one side of the brain and then spread to affect both sides, this is called a focal to bilateral tonic-clonic seizure

There are 2 phases in a tonic-clonic seizure: the ‘tonic’ phase, followed by the ‘clonic’ phase.

During the tonic phase:

The length of time it takes to recover after a tonic-clonic seizure is different from one person to the next. Some people feel better after an hour or so, but others it can be several days to feel ‘back to normal’

Protect them from injury (remove harmful objects from nearby)

Absence seizures are a type of generalised onset seizure, meaning both sides of your brain are affected from the start. In the past absence seizures were called petit-mal seizures.
The 2 most common types of absence seizure are typical and atypical.

During a typical absence seizure, the person will be

Some people have hundreds of absences a day and often have them in clusters of several, one after another, and they are often worse when they are waking up or drifting off to sleep. Typical absence seizures almost always start in childhood before the age of 14

These absences are like typical absences but last up to 30 seconds and they start and end more slowly. They may be able to move around, but the muscles might go limp or ‘floppy’, making them appear clumsy. You may be able to respond to someone during an atypical absence seizure.

Atypical absences often have learning disabilities or other conditions that affect the brain. Atypical absences can happen at any age.

After the individual can go straight back to what they were doing beforehand, however following a cluster of several absence seizures some feel confused

If a person with epilepsy uses a wheelchair or has mobility problems, their GP or epilepsy specialist should have a management plan and include advice on how to help the person if they have a seizure.
General advice

The person’s care plan should give advice on what to do after the seizure has finished. For example, it should say if it is safe to move them from the wheelchair to put them in the recovery position.

Most people with epilepsy have seizures that last a short time and stop by themselves. But sometimes, a seizure can last too long and become status epilepticus. Some people may need emergency medicine to treat status epilepticus.

Status epilepticus (sometimes just called status) is seizure activity that lasts too long. It happens when a seizure doesn’t stop in the usual time, or when someone has seizures one after another without recovering in between. Status epilepticus can happen with any type of seizure and occur in people who have never had a seizure before. For example, it can happen because of a stroke or head injury, or because of drug or alcohol abuse.

Convulsive status epilepticus is when:

If either of these things happen, the person needs urgent treatment to stop the status before it causes long-term damage. If convulsive status epilepticus lasts for 30 minutes or longer it can cause permanent brain damage or even death.

Some types of status, such as absence status and focal impaired awareness status, can be harder to spot. If someone is in one of these types of status (often called non-convulsive status) they may not show any obvious signs of having a seizure. They may appear confused and less responsive than usual or have changes to their speech or behaviour for no clear reason. Sometimes these changes can last for hours or even days.

Unlike convulsive status epilepticus, there is not much evidence to say when other types of status become an emergency, or whether they cause long-term damage. If someone you care for is at risk of any type of status epilepticus, their specialist should tell you the signs to look out for, and when to give treatment or get help

There are two main types of emergency medicine licensed for use in the UK:

Water sports in general

If the seizures are completely controlled, then sensible precautions are advised and MUST be risk assessed before Sphere Specialist Healthcare

If the person is still experiencing seizures

Swimming
If your seizures are completely controlled, you don’t need to take any greater safety precautions than anyone else. If you are still having seizures, you need to consider safety precautions. For example:

Tonic-clonic seizures – basic guidelines:

Protect the person from danger, for example by guiding them away from deep water or by holding their head above the water. When they recover, check if they need to get out of the water as they may feel confused and need to rest.