Seizure disorders, or seizures, are characterized by explosive episodes of uncontrolled and excessive electrical activity in the brain and results in a sudden change in behavior and level of consciousness. The event is described as a lightning storm in the brain. A seizure may be subtle and consist of abnormal sensations, or it may produce overt involuntary repetitive movements and loss of consciousness.
Two main types of seizures are partial and generalized.
- Partial seizures represent 60% of cases. Seizure activity is limited to a single area of the brain, and the person does not lose consciousness. However, the person often exhibits a lack of awareness, not knowing where he or she is or how much time has passed.
- Generalized seizures are seen in approximately 30% of cases and involve a more diffuse area of the brain.
Two types of generalized seizures are absence and tonic–clonic.
- Absence seizures (petit mal) involve a brief loss of awareness and often some transient facial movements lasting for up to 10 seconds. The previous activity is then resumed, and the person has no memory of what occurred during the seizure.
- Tonic–clonic seizures (grand mal) produce an intermittent contract-and-relax pattern in muscles and are associated with a loss of consciousness. These seizure types are often preceded by peculiar visual or auditory sensations, called auras, occurring minutes before the seizure begins. Tonic–clonic seizures are induced deliberately in electroconvulsive therapy (ECT), also known as shock therapy.
The other 10% of seizures are unclassified.
Most often, the underlying cause of seizures is unknown (65% of cases). Some cases are acquired and have been linked to head trauma, brain tumors, infections, high fever, cerebrovascular disturbances, chemical imbalances, withdrawal from certain drugs (medications and recreational drugs) or alcohol, and even stress.
Symptoms depend on which type of seizure is experienced. A partial seizure may be associated with repeated non-purposeful automatic movements such as turning the head from side to side, lip smacking, leg twitching, and picking at clothing, or with sensations such as tinnitus or ringing in the ears, sensations of light, or tingling beginning in one area and spreading.
Absence seizures are often accompanied by transient facial movements such as eye twitching or blinking, the person may have a blank stare while being spoken to, or the person may just stare into space for a moment.
Tonic–clonic seizures are the most intense. During the tonic phase, general tone increases and muscular contraction begins. If the person is standing, the seizure will often cause him or her to fall to the ground. A cry may be heard as the thoracic and abdominal muscles contract, forcing air out of the lungs. This phase lasts approximately 10 seconds. The clonic phase is the classic manifestation of alternating contraction and relaxation of muscles. The person may have increased salivation (foaming of the mouth); bowel and bladder incontinence may occur. These contractions gradually subside in several minutes; the person is then confused, weak, and drowsy and has no memory of the event. The post-seizure period is called the postictal state and can last from several minutes to several hours.
Massage & Seizure Disorders – If a client has a history of seizure disorders, ask about any known triggers and avoid them during the session. Contrasting light/dark patterns and flashing or patterned lights may trigger a seizure in clients who are photosensitive; ceiling fans may need to be switched off. Certain odors can trigger a seizure; therefore, aromatherapy may be contraindicated. Avoid the following essential oils: rosemary, fennel, sage, eucalyptus, hyssop, camphor, and spike lavender (ES, 2019).
Include hand and foot reflexology in the session and consider teaching and encouraging family/ caregivers to administer reflexology to the client at regular intervals. This may help reduce seizure frequency and reduce pain.
Clients with seizure disorders are more likely to have a seizure if they stop taking their prescribed anticonvulsant medications. As reminder, if your client has a first-ever seizure, this requires a referral to the client’s primary care provider (PCP) for medical evaluation.
Check out this blog for a list of appropriate first aid measures for clients experiencing a seizure (more specifically, tonic–clonic seizures).
Research. Caregiver-delivered reflexology improved pain management and quality of life among individuals with uncontrolled (intractable) epilepsy (Dalal et al, 2010). Family-delivered hand and foot reflexology combined with antiepileptic drugs reduced seizure frequency and improved quality of life in individuals with uncontrolled epilepsy (Dalal et al, 2013). Steenkamp et al (2012) conducted a literature review and found evidence supporting the use of reflexology to reduce the frequency of seizures in patients with uncontrolled epilepsy.
Black J: Medical-surgical nursing: clinical management for positive outcomes, 8e, St Louis, 2009, Saunders
Dalal, K., Devarajan, E., Pandey, R.M., Subbiah, V., Tripathi, M. (2013). Role of reflexology and antiepileptic drugs in managing intractable epilepsy–a randomized controlled trial. Forsch Komplementmed, 20(2), 104-111
Dalal, K., Maran, V.B., Elanchezhiyan, D., Srivastava, A., Dey, A.B., Tripathi, M. (2010). Efficacy of reflexology in managing chronic pain and difficulty in lower limb movement involving intractable epilepsy. 2010 International Conference on Systems in Medicine and Biology Systems in Medicine and Biology (ICSMB), 2010 International Conference, Dec, 2010, 187-192.
Epilepsy Society. (2019). Complementary therapies. Retrieved from https://www.epilepsysociety.org.uk/complementary-therapies
Steenkamp, E., Scrooby, B., van der Walt, C. (2012). Facilitating nurses’ knowledge of the utilisation of reflexology in adults with chronic diseases to enable informed health education during comprehensive nursing care. Health SA Gesondheid, 17(1), 1-12.
Dr. Susan Salvo is a massage practitioner, author, educator, researcher, explorer, and perpetual student. To learn more about Susan, check out the “About Susan” tab. You can contact Susan at firstname.lastname@example.org.