Drug Induced Seizures – newly updated
(from BP Issue 9 with recent updates as of Nov 2015)
Many BP readers will have already witnessed the distressing sight of someone having a seizure, or you may have even experienced one yourself. It can be frightening to watch, exhausting to go through and unfortunately, people can often make the situation worse by not knowing how to deal with seizures properly, leaving everyone concerned thoroughly freaked out.
Most people associate seizures with having epilepsy and while it is certainly true to say that seizures (there are over 40 different types) are a symptom of having epilepsy, you don’t have to have epilepsy, to have a seizure. Anyone who has seen someone have a cocaine or alcohol induced seizure can attest to that.
For those of us who use drugs, particularly those of us who binge use or use to excess, seizures are known to occur for a few reasons. Sometimes they happen just before or as someone is overdosing, (i.e a seizure occurring just in the minutes before someone actually lapses into an overdose) or through withdrawing from a drug/s (i.e benzos, alcohol) or, they are a (rather intense) way of telling us that we have been pushing our bodies too hard for too long (i.e cocaine/stimulant related) and we can have a seizure which although is not an overdose -it is an overdose in the sense that you have reached the threshold in what your body can tolerate -and it is telling you -“Enough! My body has now gone into toxic overload!”. Basically, seizures occur when our systems have reached this point of toxicity or overload, even if the culprit drug is ecstasy, acid or heroin -when we tend to think of the most common culprits as stimulants and alcohol and benzodiazepines and barbituates.
Know Your Limit
Everyone however, has what is called a ‘seizure threshold’, a certain sensitivity to seizures which means that anyone can experience one given the right conditions – such as excess use of alcohol, drug withdrawal, toxicity, dramatic metabolism changes etc. With 1 in 20 people having experienced a seizure at some stage in their lives, amongst drug users that rate increases rather dramatically, so its important that we learn something about seizures, their ‘triggers’ as well as their treatment.
It can be all too common to put the odd re-occurring seizure down to ‘the drugs I’m taking’ or to find that our medical investigations have not been followed up due to the pressures of everyday life and the difficulty embarking on consistent/stable medical care when you have other things on your mind like survival. But it’s important to remember that seizures can be very serious, they are hard work for the body and the brain in particular and, depending on where you are when you have your seizure, or if you end up having multiple seizures, you can be left in a dangerous or vulnerable situation.
If you are affected by seizures, if you have had more than 2 at once or 2 or more during the last year, or if it takes you more than a day to recover, or if your seizures start to occur regularly, it is essential you seek medical advice – at least to rule out any underlying causes such as infection, virus’s, tumors etc. You might have developed epilepsy in which you need medication, or there may be an underlying medical condition that has nothing to do with your drug use. You need to know these answers so you can take the right action.
Types of Seizure -or -Do I have Epilepsy?
There are two main types of epileptic seizures; petit mal (minor epilepsy where a person may momentarily lapse into inattention/ daydreaming without losing consciousness) and Grand Mal ( Major epilepsy) which is more serious with muscular spasms and convulsions and a short loss of consciousness. People who are epileptic may often carry an orange ID card or wear a warning bracelet. With drug use, it is the major type of seizure that occurs most often. This is usually from long term (or heavy bingeing) benzo or barbiturate use; A person may miss taking their pills for a day and find themselves fitting. However, seizures can occur alongside an overdose on most drugs, indeed they occur from too much alcohol, heroin, cocaine, ecstasy, antidepressants and many others. Interestingly, everyone has what is known as a ‘seizure threshold’ meaning that anyone can experience one given the right conditions.
It is certain that stress increases the possibility of seizures, as does menstrual changes, vitamin or mineral deficiencies, metabolic changes (including blood pressure that is too low or drug/alcohol use), virus activity and other things, such as trauma to the head area, with seizures more likely to re-occur if someone has had them in the past.
It is important to get to know what ‘trigger’ your seizures as it appears that the more you get them, the more susceptible you become to getting them (see below). Thus if you can find ways to reduce the likelihood of getting a seizure, either through using certain neuroleptic drugs and / or improving your lifestyle, you have more chance of getting rid of them for good. Most people do stop or ‘grow out’ of seizures, but they can come back when your body is struggling from one thing or another.
Many of us have experienced seizures starting through too much benzodiazepines use (or rather, from stopping them too quickly). Seizures can still happen up to a few years after benzo/barbiturate use has stopped. (see warning signs).
How do seizures affect the brain?
It is helpful to understand how seizures work in the brain and to do this one needs to have a little knowledge of your grey matter – a bit about how the brain is constructed. Normal brain function is made possible by millions of tiny electrical charges passing information between nerve cells in the brain to all parts of the body.
A typical brain like yours has about 10 billion (10,000,000,000) cells called “neurons.” These neurons are all bunched up side-by-side, and communicate with each other with electrical charges.
Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical activity. Certain chemicals in your brain help put brakes on all of this electrical activity but a seizure occurs when these neurons generate uncoordinated electrical discharges that spread throughout the brain. Normal activity gets interrupted by brain cells ‘firing’ much faster than usual. These ‘storms’ (intermittent bursts of activity) affect the delicate systems in the brain and can cause disruption, leading to a seizure.
In a seizure, when this “short circuit” occurs, during which the neurons keep firing, the neurons are still in control of your muscles, so the muscles keep firing. This stiffening or jerking of your muscles is what everyone sees and calls a seizure. Sometimes, in ‘petite mal’ seizures, your body might just go into a staring spell, but it’s due to the same kind of short circuit.
Interestingly, certain areas of the brain are much more likely than others to be the source of a seizure. These include the motor cortex (responsible for the initiation of body movement) and the temporal lobes (including a special deep area called the hippocampus, which is involved in memory). This is also why memory and muscle coordination are affected during a seizure. The reason for this may be that the nerve cells in these areas are particularly sensitive to situations that can provoke abnormal electrical transmission such as; sensitivity to a decrease in oxygen levels (such as when you have a large ‘hit’ of a drug), metabolic changes and infection, any of which may cause a seizure.
Despite dramatic scientific advances, there are many unanswered questions about why seizures begin; why trauma (such as head injury) can produce seizures years after the event, how genetic factors influence seizures, what factors make brain cells susceptible and why some people get them from some drugs, while others don’t.
Know your ‘Triggers’
After having a seizure, your sensitivity to them will have increased. Some people find that seizures will come in ‘pairs’, another occurring a week or month after the last. Many people, after many fits, often come to know when a seizure is about to happen, some sense a strange smell or taste, or some feel an ‘aura’ or a wave of anxiety or fear surround them. It is usually very subtle although nowadays there are dogs that are specially trained to sense when their owner is about to have a seizure and will encourage the person through signals or crying, to sit down or get help, helpful for those with more uncontrollable seizures or epilepsy.
However, for a seizure that is brought on by drugs, you often won’t get any warnings but you may be able to understand what makes you more vulnerable to having one – what drugs tend to ‘push you over the edge’, whether it is more likely to occur when you’ve drunk a lot of alcohol or been banging up coke solid for 2 days with no sleep. At BP, a few of us experience seizures through long term drug related issues, and although it has taken us some years to begin to understand how our seizures affect us as individuals, we were able to feel more confident about the situation by writing down in a diary, the date the seizure occurred, what was going on in the days and weeks beforehand.
Although epilepsy drugs have generally been difficult to take due to their side effects, they have recently been a whole new group of epilepsy drugs that are more easily tolerated, with less side effects and many people are able to discontinue treatment after a few years on medication. People can go into ‘remission’ with no seizures occurring for many years and others will find their seizures stop or lessen when certain factors in their life change, such as their drug use, (including alcohol) stress levels, food intake, sleeping patterns etc. And, when you have occaisional seizures, you may not need any drugs at all, and by locating what your ‘triggers’ are, you will be much better placed to start avoiding those vulnerable times. There are also doctors who recommend taking a clonazepam around the times you feel fragile or vulnerable in an effort to ‘head it off at the pass’ so to speak. This can be a really effective way of dealing with occaisional drug related seizures, as long as you only take such pills occaionally as regular or daily use can actually cause seizures. (see benzo withdrawals)
- Subsequent management:
- For short and ‘normal’ crises with a trigger factor (fever, drug withdrawal, photosensitivity, tiredness, toxicities…): non-urgent neurological consultation. Hospitalisation is not needed every time.
- For a series of crises or a grand mal state, the patient must be seen quickly by his/her usual neurologist or neuro-paediatrician to review his treatment.
Many drug users may have experienced a seizure at one time or another –and you don’t have to be an epileptic to have a seizure.
[Epileptic] seizures can be very frightening to experience and to witness and although many ‘committed’ drug users/drinkers will have experienced a seizure at some point in our lives, there are still many myths that concern how to deal with a person who is fitting and a general lack of understanding as to what triggers ones seizure, or how to deal with it when it occurs. (look at OD Myths’ in Black Poppy 2).
When someone has a seizure…
It is ESSENTIAL to remain calm when a person has a seizure -as they can often become very frightened and confused when regaining consciousness and may not recognize their surroundings. There is often no indication prior to someone having a fit, perhaps the person may get an odd taste or smell or a type of ‘aura’ surrounding their mood or body. A person will usually just suddenly lose consciousness, sometimes letting out a strange cry, or will just pass into unconsciousness and then begin fitting.
The casualty will become rigid for a few seconds and may cease breathing with their mouth and lips turning blue. There will be congestion around the face and neck. The muscles then relax and the convulsions begin. They consist of contraction and relaxation of alternate groups of muscles. These convulsions can be frightening to witness as they can be very intense. During this period which will only last a few minutes, the person may froth about the mouth and breathing can become noisy and difficult. You may see blood coming from their mouth but this will probably be the result of a bitten tongue. Your pal may sometimes lose control of their bladder or bowels.
After the convulsions finish (usually 5 minutes at most) the person will remain unconscious for a few more minutes or more, breathing will become normal and they will slowly ‘come around’ feeling dazed, confused and often scared. When a person has a seizure:
What can you do to help?
1) You can protect them from injury by holding them gently but firmly enough so they don’t hurt themselves whilst convulsing, but never hold them unnecessarily, you could do damage or you may get hurt.
2) Don’t move or lift them unless they are in danger and NEVER put anything in their mouth or try to open it. Spoons to stop people swallowing tongues are a MYTH, DONT DO IT!
3) When the convulsions cease, put them in the recovery position (see fig 6). Stay with them until they awake properly, speak calmly and reassuringly to them and try to make sure the first person they see is a loved one or friend rather than a stranger. Don’t give them anything to drink until they are fully awake. Leave them to rest as long as they need to in a quiet room. It is extremely exhausting for the body. You may need to comence mouth to mouth if their breathing hasn’t returned to normal from their overdose.
Call an ambulance if:
It is the persons first seizure,
Or it accompanies an overdose,
Or the person has two or three fits without regaining consciousness between them,
Or they take longer than 15 minutes to regain consciousness
It is always important however, they advise their doctor about the seizure, at least to rule out any other causes such as a virus, tumor or other problem.