McGill

Seizures

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Seizures are caused by an abnormal focus of electrical activity within the brain. The causes of seizures are quite varied and include:

  • a tumour or blood in the brain
  • scarring within the brain from surgery or radiotherapy
  • high fevers
  • dehydration
  • some medications or drug withdrawal
  • head trauma

There are many different types of seizures with a range of signs and symptoms. In general, seizures may be divided into 2 types:

  1. Focal seizures are due to an abnormal electrical impulse that is confined to a small area of the brain. Focal seizures can produce abnormal sensations, such as numbness or tingling; involuntary movement of a limb or twitching in the face; or transient inability to speak. The symptoms experienced by the person having the seizure relate to the location within the brain of the abnormal impulse. Therefore, a focal seizure tends to be experienced in the same way each time a person has one.
  2. Generalized seizures occur when the abnormal impulse is transmitted across a larger area of the brain. Consciousness is affected, and there may be convulsions and/or loss of bowel and bladder control. Often there is little or no memory of the seizure once it ends.

Seizures tend to last only 30 to 60 seconds. Focal seizures may evolve into generalized seizures.

Vocational implications

Seizures are managed with antiepileptic drugs that reduce the frequency and severity of seizures, but may not eliminate them completely. Many people affected by seizures continue to work. There may be some restrictions on work activities. For example, there are legal implications regarding driving for those who have had a seizure or who stop taking seizure medications. Special precautions may need to be in place if patients operate heavy machinery, climb ladders, work on rooftops, cycle, scuba dive or perform other activities that could be dangerous if they have a seizure.

See also this information about driving restrictions.

What patients can do

Tell your patient whether they are at risk for seizures and, if so, how they can be prevented (see below). If the patient has had a seizure, consider recommending seizure medication. Even patients who take seizure medication may still be at risk for seizures, and sometimes people need to be on more than one seizure medication.

Precautions to prevent seizures:

  1. Inform the healthcare team if taking any new medications. Drug interactions are common and can make seizure medications less effective.
  2. Avoid physiologic stress, e.g., from dehydration or skipped meals.
  3. Avoid intense temperatures, e.g., saunas.
  4. Get enough rest and good sleep, as being overtired can provoke seizures.
  5. Avoid serious injury in case a seizure occurs. For example, wear a helmet when cycling; swim or hike with a buddy, not alone; take showers, not baths.
  6. Teach family members and work colleagues what to do when they observe a seizure.
  7. Read the First Aid for Seizures pamphlet (PDF) from Epilepsy Ontario.
  8. Know the signs of seizure medication toxicity, including slurred speech, visual changes, nausea and imbalance. Seek medical attention if experiencing any of these problems, as the medication dose may need to be changed.

Job accommodations

There are several ways that jobs can be modified to accommodate seizures:

Modify work tasks:

  1. Identify situations at high risk for injury (e.g., working at heights or with heavy equipment).
  2. Request alternative tasks that reduce injury risk to the employee and others in case of a seizure.
  3. Reduce injury risk with safety equipment when possible (e.g., harnesses).
  4. If the patient works alone or in an isolated area, consider an auto-alert lifeline that will contact emergency services in case of a fall.
  5. Identify any seizure triggers and eliminate or reduce them (e.g., high level of stress, over-fatigue, flickering lights).

Modify work schedules:

  1. Avoid fluctuating shifts.
  2. Ask for a shift change to prevent over-fatigue (e.g., day shifts only).

Modify the work environment:

  1. Tell the supervisor or the workplace occupational health advisor what steps to take if the patient has a seizure.
  2. If the patient is comfortable disclosing the possibility of seizures to co-workers, tell them what to do if the patient has a seizure.

It is not unusual for people who have seizures to have changes in their memory. See cognitive challenges for tips on dealing with these concerns.

To know: Driving restrictions related to seizures vary provincially and should be reviewed within your home province.

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