Correctional nurses can get jaded about treating inmate seizure disorders. After all, many perks can be claimed by those diagnosed with the condition including a coveted lower bunk and some real nifty medications. So, it would be easy to think that any inmate coming in with a history of inmate seizures or appearing with seizure activity is merely faking it.
Inmates Have More Seizures
Around 1% of the US adult population will be diagnosed with a seizure disorder (1 in 100). In contrast, 4% of the US inmate population has a seizure disorder (1 in 25). That is a huge disparity and gives greater understanding to the frequency of seizure history or activity in our patient population. This patient community has several risk factors which increase the likelihood of seizure activities.
The incarcerated have a background with greater violence and traumatic injury than the general population. In fact, recent studies indicate that 25-87% of inmates report having experienced a head injury or traumatic brain injury (TBI) as compared to 8.5% in a general population reporting a history of TBI. Head trauma increases the potential for seizure disorders.
Drug and Alcohol Withdrawal
Drug and especially alcohol withdrawal can lead to seizures. These seizures are not chronic in nature and require a specific treatment regimen. Seizure activity in withdrawal can be intensified if the inmate already has a background of epilepsy or TBI. Alcohol withdrawal can increase inmate seizure activity, especially in jails. The Federal Bureau of Prisons recently released revised Detoxification Guidelines.
Domestic, Child and Sexual Abuse
Past traumatic psychological stresses such as domestic, child or sexual abuse can produce a seizure disorder known as psychogenic seizures. These seizures have been described as a physical manifestation of a psychological disturbance and have received increased attention recently. Up to 1/3rd of patients sent for EEG-video diagnostics for seizures are diagnosed with the disorder. These seizures are of psychologic rather than physical origin; however, they are not being faked. Like other stress-induced conditions such as stuttering or fainting, psychogenic seizures are a physical response with only minor controllability from the individual. Psychogenic seizures do not respond well to epileptic medications, but rather to counseling and other psychotropics.
Treat all Seizures as Real
As healthcare professionals, correctional nurses must treat all seizures as valid until proven otherwise. If a witnessed event seems questionable, there are a few easy maneuvers to take in the post-seizure period including raising a arm over the chest and letting it drop (The non-seizing person will guard/the true seizing person will not) or using smelling salts (not effective for true seizing person). It is not recommended to do a sterna rub as this can cause unnecessary injury.
What are your experiences with inmate seizures and how does your facility deal with them? Post a response in the comments section.