During the many years I worked as a surgical nurse, I occasionally took care of patients with a history of seizures, usually grand mal seizures. I can remember being worried about their safety during seizures and trying to protect them from injury. I also remember being concerned during their postictal periods because they needed to be reoriented and to be monitored for other medical or surgical problems.

However, these experiences didn’t really prepare me for what I encountered when I began to work more closely with seizure patients as part of a team researching a new antiepileptic drug. This was an inpatient study in which EEG monitoring and closed-circuit television were used. I was unfamiliar with technology, but the range of seizure types that these patients had was even more unfamiliar to me.

I was not prepared to manage some of the unusual seizure behaviors that occurred as we began to take these patients off their seizure medications for the study. For example, we admitted a patient who typically wandered during his seizures and would become hostile when he was restrained. When I witnessed the beginning stages of one of his seizures, I was terrified because I could not predict what was going to happen next.

The patient ran out of the room with the EEG monitoring equipment still connecting him to the wall. When an observer tried to restrain him, he reacted physically with a wild look in his eyes. I knew enough to say to let him go and asked everyone else not to touch or restrain him. I quickly disconnected the electrode wire from the wall before he broke anything, while at the same time trying not to touch or aggravate him. As he ran down the hallway, my thoughts concerned his safety, the safety of other nearby personnel, and my responsibility to monitor his seizure activity for the study. I still didn’t know what to expect. I stayed with him, talked to him, and tried to redirect him. I had no idea how long this would last, how far I would have to follow him, or what I could do to protect him. Would he try to hurt me?

Suddenly, the patient turned around and returned to the research unit and tried to open a locked door. That scared me. Was he going to break the door down or, worse, hurt himself? Then, when he lay down in the middle of the hallway, I breathed a sigh of relief and thought that now he would be unresponsive with postictal confusion. I tried to administer intravenous seizure medication, but to my surprise he awoke and looked at me wildly. I was fearful of him because I thought he might misunderstand my intentions and hurt me. As his nurse, I felt helpless during this phase of his seizure. To me, this patient’s seizures were more dramatic, frightening, and unpredictable than any of the grand mal seizures I had ever witnessed. Fortunately, the patient did eventually become postictal.

Since then, I have been very conscious of patient safety at all times. I worry that I can’t always protect patients from harm while they are hospitalized, even with all the precautions that are taken.

The first instance in which a patient injured himself in my presence (while I was observing his seizure) took me completely by surprise. When the seizure began, the patient was in a chair next to the bed. He stared and became unresponsive. At this point he was still connected to the EEG monitoring equipment and I was waiting for him to become alert enough for me to assist him into bed. I knew not to touch him because in the postictal state he, too, could act in a hostile manner. So I only stood there and observed him. And waited. Then, without any warning, he catapulted forward off the chair head first and hit his forehead on the hard floor! This happened so quickly that I couldn’t help or protect him. The next thing I saw was that he was in the midst of a grand mal seizure. Other staff nurses helped me pad the floor under him until the convulsing stopped. His face turned blue and then the seizure seemed to end.

All this seemed to last an eternity but actually went on for only 2 to 4 minutes. I felt helpless because there wasn’t much that I could do, and terrible because my patient had hit his head and I couldn’t have prevented it. I was worried that he had suffered a skull fracture from hitting the floor so hard. I applied and held ice to his forehead while he was postictal and unresponsive, and saw that he had also bitten his tongue. Later, when he was alert, I discussed the seizure with him. I was struck by his calm attitude about the whole thing. What amazed me even more was that he said his head didn’t hurt that much. That made me feel better, especially after it became clear that his injury was not serious.

Why do I find some seizures frightening? I think it has to do with not being able to control the situation or anticipate what will happen next, along with being unable to completely protect the patient from injury. That uncertainly is unsettling for me and also, I suspect, for other people who observe seizures.

The Brainstorms Healer: Epilepsy In Our Experience edited by Steven C. Schachter, M.D. and A. James Rowan, M.D., Raven Press, 1998, Lippincott Williams & Wilkins