A seizure is a temporary disruption of brain activity, causing changes in awareness, behavior, or movement. While breathing can be affected and may appear to cease during a seizure, it is usually not a complete or prolonged cessation. The specific impact varies by seizure type.
Impact on Breathing During Seizures
Breathing patterns can change significantly during different types of seizures. During a generalized tonic-clonic seizure, breathing is often impacted in two distinct phases. In the tonic phase, muscles stiffen, forcing air out of the lungs and sometimes causing a cry or moan. This stiffness temporarily restricts airflow.
The clonic phase involves rhythmic jerking movements. Breathing may be irregular or noisy, with temporary breath-holding, shallow breathing, or gasping. The person’s face might appear bluish or gray due to reduced oxygen flow, a condition known as cyanosis. Breathing typically normalizes once the seizure concludes.
In focal seizures, which originate in a specific area of the brain, the effect on breathing depends on the brain region involved. Breathing might be mildly irregular or barely noticeable, with some partial seizures leading to prominent drops in oxygen saturation. Absence seizures, characterized by brief periods of staring or unresponsiveness, have little to no noticeable effect on breathing.
Physiological Reasons for Altered Breathing
Changes in breathing during a seizure stem from abnormal electrical activity in the brain. The brainstem, which regulates automatic processes like breathing, can be disrupted by seizure activity. This disruption can lead to diminished central drive, temporarily impairing the brain’s signals to breathe.
Intense muscle contractions and rigidity can physically restrict the chest muscles and diaphragm. This physical restriction makes it difficult to inhale or exhale, leading to temporary breath-holding or reduced airflow. Additionally, the airway can become partially obstructed if the tongue falls back or due to the accumulation of saliva, which can contribute to noisy or labored breathing.
While breathing may be affected, severe oxygen deprivation is not typical for most seizures as the body usually recovers normal breathing shortly after. However, temporary drops in blood oxygen levels can occur, sometimes falling below 90% saturation. These temporary drops can cause the skin to appear bluish (cyanosis) and are a consequence of the altered breathing patterns during the seizure.
First Aid for Breathing During Seizures
The immediate priority when someone is having a seizure is to ensure their safety and protect them from injury. Clear the area around the person of any hard or sharp objects. Gently cushion their head to prevent injury, using something soft like a jacket or pillow.
Once the convulsive movements have stopped, or if it is safe to do so during the seizure, gently roll the person onto their side into the recovery position. This position helps keep the airway open by allowing saliva and any fluid to drain from the mouth, preventing it from blocking the airway. It is important to loosen any tight clothing around their neck to further assist with breathing.
Do not attempt to hold the person down or restrict their movements, as this can cause injury. Never put anything into their mouth; they cannot swallow their tongue during a seizure, and objects can cause injury to their teeth or jaw. Stay with the person, observe their breathing, and time the seizure. Call for emergency medical help if:
- The seizure lasts longer than 5 minutes.
- Breathing does not resume or becomes difficult after the seizure.
- It is the person’s first seizure.
- They are injured, pregnant, or have other medical conditions.
Understanding SUDEP
Sudden Unexpected Death in Epilepsy (SUDEP) is a rare complication where a person with epilepsy dies suddenly and unexpectedly, and no other cause of death is found upon autopsy. While the exact cause is not fully understood, breathing problems are considered a major contributing factor. Post-seizure respiratory depression, where breathing becomes shallow or stops after the seizure, is thought to play a role.
Research suggests that disruptions in breathing during and after seizures can lead to an imbalance of carbon dioxide and oxygen in the body. This can happen if the brain’s signals to breathe are suppressed or if the airway is obstructed, potentially leading to a lack of oxygen to the heart and brain. Frequent generalized tonic-clonic seizures are identified as the most significant risk factor for SUDEP.
Other factors that can increase the risk include not taking seizure medications as prescribed, and seizures occurring during sleep. SUDEP affects about 1 in 1,000 people with epilepsy each year. Individuals with epilepsy and their caregivers should discuss SUDEP and strategies to minimize risk with their healthcare providers.