Violent Postictal

[DebraN]

My 21 year old nephew had his first grand mal seizure 20 months ago. Since then he has had over 8, one required him to be sedated and intubated and in icu for several days. He uses ativan a lot to try and spell off seizures. He is on a lot of meds, sorry I do not know all their names my sister certainly does, she is an awesome mom! And my nephew is an awesome young man, however his violence after seizures are getting more severe and he beat his mom pretty bad last night. We are awaiting more testing. The neurologist went from being optimistic that we will get this under control to you should be happy it has been six weeks since his last seizure. I am at a loss as how to help them. The medical system seems to be taking their time and I don't know how much more my sister can take. My nephew has no other supports other than his mom, me and his grandparents, and his grandparents are both very ill themselves.
Does any one have any suggestions on how I can advocate for them? How to help my nephew with his violent postictal period? I am so concerned that he will hurt his mom to the point of hospitalization or worse and then he will have no one, as he will not talk to me during this time. Once he is out of this, about three weeks, he is back to himself and all is good. We are a loving family with little support. He always feels so bad once he is back to himself. Thanks for reading.

 

[Nakamova]

Hi Debra, welcome to CWE!

I'm not sure there's a simple way to prevent your nephew's post-ictal violence other than preventing the seizures altogether. To that end, you should encourage your sister to be "pushy" with your nephew's neurologist about finding the right combo of meds. It is often a matter of trial-and-error, and it sounds like the current set-up just isn't working. If his neurologist isn't easily available, there's nothing wrong with getting a second or even third opinion.

You should encourage your nephew to keep a journal that tracks the seizures and the medications along with other aspects of his lifestyle. The journal can potentially help identify secondary physiological, physical, emotional or environmental triggers that may play a role in his seizures, and can also give a sense if particular meds are helping or making things worse. Some good information about identifying triggers can be found here: http://www.coping-with-epilepsy.com/forums/f22/proactive-prescription-epilepsy-1254/ In addition, your nephew might be interested in pursing alternative or complementary therapies. More info here: http://www.coping-with-epilepsy.com/index.php?p=alternative-treatments

Your nephew and his mother might want to visit with the local police or EMTs to brief them on the particulars of his situation in case they are called to the scene when he is violent. It might also help for both of them to see a therapist -- separately or together -- to help cope with the ramifications of the post-ictal violence. Three weeks is a long time for him to be "out of it", and a therapist might be able to help in reducing that interval. His neurologist or regular doctor should be able to provide a referral.

I hope this helps. It's terrific that you are standing by your sister and your nephew.

Best,
Nakamova

 

[gymrat827]

does he take AED meds..??

how many grand mals so far?

 

[DebraN]

Thank you so much for your reply and suggestions. I will look into what you have suggested and I am most grateful for your words regarding police and EMTs. My sister is hesitant in calling police but I think if we can take a proactive stance they might prove helpful. Thank you again. She is so scared for his future, we all are. This is a great community and resource. <3

 

[Nakamova]

Debra,

Might be worth asking the neuro about:
1. Short-term use of anti-psychotics to prevent the periods of post-ictal violence from escalating. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265810/
2. Certain anti-seizure meds are more likely than others to exacerbate or minimize post-ictal psychosis. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175608/

 

[marika853]

Hi Debra,
Just a heads up. If you can avoid it, Do Not Call Police! The last thing you want is for him to get involved in the criminal justice system. Definitely, pursue the medical aspect to get this under control.
Good Luck!
M