Dementia and seizures
People with Alzheimer’s disease have a 10-22% chance of having at least one unprovoked epileptic seizure during the progress of this disorder. These seizures usually occur in later stages of AD (about 6 years into the disease on average). Some seizures are also more subtle than others and may occur without being detected. And further, antiepileptic drugs may exacerbate overall dementia symptoms.
What is a seizure?
Our brains are constantly emitting electrical impulses that travel from neuron to neuron. Sudden, abnormal electrical activity is thought to create seizures. Epileptogenesis is the term for this process by which a normal brain develops epilepsy. But people can also experience seizures without being diagnosed with epilespy (non-epileptic seizures or paroxysmal events).
Some of the more common symptoms of a seizure include symptoms that…
Precede the seizure (known as the Aura stage):
- Feeling of déjà vu
- Light headedness or dizziness
- Unusual and possibly inappropriate emotions
- Altered visions and/or hearing, even hallucinations
During the seizure (tonic phase, the shortest part of the seizure):
- loss of consciousness
- muscles tense
- may moan or scream
During the seizure (clonic phase, or more violent aspect of the seizure):
- muscle spasm (muscles stiffen and jerk – muscles contract and relax rapidly)
- convulsions – twitching of limbs, vibrating, violent shaking
- roll and stretch
- eyes rolled back or closed
- possible incontinence
- May experience (first time) feelings of sickness like light headed, vomitting, and nervousness.
- Tired, hungry or sick as a trigger for seizure?
- Odd smell or taste? Did color change – pale or blue? Breathing change?
- Confusion (as seizure passes)
A generalized tonic-clonic (grand mal) seizure may last 2-3 minutes. If a seizure lasts more than 5 minutes you should call 911 right away. Also call for help if one or more seizures occur after the first episode or when it is the first seizure you have ever witnessed the person experiencing.
The best procedure during a grand mal seizure is to:
- Ease the person to the ground
- Do not try to restrain them as more injury could occur from this struggle for them and/or you
- Protect their head from injury
- Turn them on one side with face downwards to assist breathing
- Loosen collars and clothing to also assist breathing
- Bend their outer knee (this will help keep them turned over)
A person may experience a “complex partial seizure” – the person may appear drunk or under the influence of other drugs. Their awareness is impaired and they may be walking around aimlessly (wandering). They may also tug on their clothing and have unusual lip movements. These seizures are usually short in duration and your main goal should be to gently steer them out of harm’s way.
With regards to dementia, an “absence seizure” (or petite mal, or “nonconvulsive status epilepticus”) is particularly intriguing as it increases in incidence in the elderly. The person’s eyes may roll back or flutter, or they may stare for a few (about 20) seconds into space. They may suffer some small jerking motions and awareness usually returns quickly. Anytime an elderly person exhibits this zoning out, it may be worth considering other seizure symptoms – seizure medications might be helpful.
Petite mals are easily induced by hyperventilation. You can test this by having the person over-breathe for 3 minutes & see if it creates a brief episode. There may be other circumstances in their environment that are even triggering this breathing behavior. The best approach is to make sure the environment is calm and reassuring.
There is an increased incidence of absence seizures in people with Alzheimer’s, but also for those suffering from prion disorders and some frontotemporal lobar degeneration syndromes. Those suffering from Parkinson’s (Lewy Body Dementia) do not tend to have seizures. Researchers speculate that the Hippocampus gets over-excited and may activate inhibitory cells that fuel the progression of neurodegenerative disorders.
Please stay tuned for a look at seizure medications and the implications for neglecting seizures in people with dementia.
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