NEURAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 187

tion recover quickly and completely, and another 10 percent improve somewhat over a few
weeks or months.
A typical feature of Bell's palsy is involvement of muscles of the forehead along with
the other facial muscles. If forehead involvement is not present, the individual should be
evaluated byaphysician toensure stroke oratumor isnotthe cause ofthe paralysis. Evac-
uation is unnecessary for Bell's palsy.
Seizures (Convulsions)
Seizures may be a sign of disease of the nervous system but also occur with diseases
that only affect the brain indirectly. Many seizures, particularly in young people, are solit-
ary events for which no cause can be established and which never recur.
Epilepsy is a condition with which a person suffers repeated seizures. (Seizures asso-
ciated with high fevers in young children are not considered epilepsy.) Most epilepsy can
be controlled with medications, and seizures rarely recur as long as the prescribed treat-
ment is diligently followed. Aperson with epilepsy need not refrain from wilderness activ-
ities, including ascents to high altitude, if the disorder is controlled and the individual is
conscientious about taking prescribed medications. Outing partners should be informed of
the condition so they can learn the measures to take should a seizure occur. However, the
stigma once attached to epilepsy is completely unwarranted.
The onset of a seizure is usually sudden and may be marked by a sound of some
kind.Thepersoncharacteristically losesconsciousness andfallstothegroundtwisting and
writhing, the limbs twitching, jerking, or flailing about. The jaw may be involved, and the
personmaybitethetongue.Salivationmaybeprofuseandurinationanddefecationuncon-
trollable. The eyes are usually open.
In any single convulsive episode, all or none of these features may be present. Some-
times onlyslight twitching oftheextremities ispresent. Apersonwhoisunconscious from
a head injury may exhibit only a series of jerking movements that gradually increase in in-
tensity and then subside. Limbs paralyzed by injury do not move.
Nothing can shorten or terminate the convulsive episode. The only helpful measure is
to protect the person from self-injury. Arms and legs should be restrained only enough to
preventstrikingnearbyobjectsastheindividualflailsabout.Attemptstoholdtheextremit-
ies absolutely still may produce muscular or tendinous injuries. Clothing around the neck
should be loosened to prevent strangulation.
Seizures usually last only one or two minutes but can persist for five minutes or even
longer.Aperiodofunconsciousnessalmostalwaysfollowsandcanlastfromafewminutes
toseveralhours.Thecomamaybesodeeptheindividualiscompletelyunresponsive,even
to painful stimuli, and requires the same care as any comatose person, particularly main-
tenance of an open airway. The person should be permitted to awaken without stimulation
and allowed to rest until strength has returned and recovery appears complete. The indi-