Friday, 27 July 2012

NEURO FIRST AID: Seizures

This is the second in a series of posts on what to do during neurological emergencies. Today, seizures.

Seizures

On the grand scale of scary things, watching someone go through a full-blown, tonic-clonic seizure has got to be near the top. That said, even though seizures can kill, they’re less immediately life-threatening than a stroke (see this post for stroke first aid). Also, despite how scary seizures look, seizure first aid is surprisingly easy. It’s more about what not to do than what to do.


WHAT IS IT?

A seizure happens when there’s too much electrical activity in the brain. Specifically, too much of a type of activity that neuroscientists call excitatory. The total electrical activity in your brain is a sum of excitatory messages (“do this!”) and inhibitory messages (“don’t do this!”). Although 100% of your brain is always active (not 10%, see this post), most of that activity is inhibitory. This is because your brain spends a lot of its time filtering out unnecessary information or actions. But if your brain flips from mostly inhibition to mostly excitation, the result is a seizure.

This image shows excitatory electrical activity (red) spreading through the brain of someone having a seizure. This is if you were looking down on the brain from the top. Starting from the upper left and moving right, each image is a few seconds apart. From http://pet.radiology.uiowa.edu/webpage/research/casestudies/epilepsy%20test.


WHO IS AT RISK?

Everyone. I’m not saying this to scare you. It’s extremely unlikely that you’re going to have a seizure while walking down the street tomorrow afternoon. My point is that, given the right situation (like a high fever or exposure to certain toxic chemicals), anyone can have a seizure. It’s especially likely in people who have epilepsy, which is a brain disorder where people have repeated seizures.


WHAT DOES IT LOOK LIKE?

There’s two types of seizures, absence and tonic-clonic. I’ll talk about them separately.

Absence:
It’s in the name. Someone having an absence seizure looks absent. They space out. You might not even know they’re having a seizure, unless you try and talk to them and they don’t respond. Some people can have hundreds of them in a day, which is problematic to say the least, but they’re less dangerous than tonic-clonic seizures. They’re brief, usually lasting only about 20 seconds. These used to be called "petit mal."

Tonic-clonic:
Also known as "grand mal," if you want to be outdated and so last century. This is what you think of when you think of seizures. Violent uncontrolled muscle contractions of the entire body, lasting for several minutes. Because tonic-clonic seizures are both dangerous and easy to recognize, they’re the ones I’ll focus on for the rest of the post.


WHAT TO DO IF SOMEONE HAS A TONIC-CLONIC SEIZURE:

Remember, this is more about what not to do than what to do. But I’m going to start with a “do.”

  • DO remove anything that they might hit their head on. People who die during seizures don’t always die because of the seizure itself. Sometimes, it’s because they hit their head. I know this too well. I lost a friend this way. I’m telling you that to point out how important it is to remove anything that a person might hit their head on, like furniture. If you can’t move the furniture because it’s, you know, furniture and therefore heavy, grab pillows and blankets and place them around the person. You can also use pillows as shields – put them against the furniture, so that if the person does hit the furniture, the impact isn’t as hard.

  • DO NOT try to restrain the person. The person is going to be having very violent muscular contractions, and I mean violent. If you try to restrain them, they’ll probably punch or kick you, and that just adds a whole level of un-fun to an already un-fun situation. (A person is technically unconscious during a seizure. They did not mean to whack you. It was an accident.) Protect yourself. Remember, the pillows will keep the person safe. 

  • DO NOT put ANYTHING in their mouth.There’s a weird rumor that’s been going around for years, that you have to put something in the mouth of a seizing person, otherwise they’ll swallow their tongue and choke on it. It’s all over pop culture, and it’s wrong. So very wrong. I’m gonna bust this myth right now. It is physically impossible to swallow your own tongue. It can’t happen. Not a chance. EVER. (If you don't believe me, open your mouth and lift up your tongue. See the membrane running from the base of your tongue to your lower jaw? That's called the frenulum, and it's what stops you from swallowing your tongue.) But what’s going to happen if you put something in the mouth of a seizing person – someone who’s having extremely strong, violent muscle contractions, including the muscles of the jaw? Stick a wooden stick in there (the “recommended” option), and they’ll bite it, possibly breaking their jaw and swallowing splinters. Stick your finger in there (also “recommended”), and they’ll bite you, which is going to hurt. So unless you think a seizure isn’t bad enough and more problems would be a good thing, NEVER EVER stick something in the mouth of a seizing person. 

  • DO NOT leave the person alone. You need to keep both eyes on them. Make sure they keep breathing. Remember everything that happens, so that you can tell the paramedics.

That’s it. Move stuff, grab some pillows, arrange them, and then sit back and pay attention. Resist the urge to interfere – you could make the situation a lot worse.


WHEN DO I CALL THE PARAMEDICS?

Not all seizures require an immediate 911 call (US/Canada, 999 in UK, or the emergency number for your country). Here’s when you should call the paramedics:

  • If the person stops breathing. Grab that phone and dial! Now!
  • If the person does not have a history of seizures. If an epileptic has a seizure, you don’t need to rush for the phone. But if you don’t know if the person is epileptic, or if you know they’ve never had a seizure before, it’s time to call.
  • If the seizure lasts more than 10 minutes. If a seizure lasts this long, you’re in emergency territory. They need to go to the hospital. 911 time.
  • If the person hits their head on the furniture. This isn’t what’s officially taught in first aid courses, but I’m making a call and adding it in. Personal history, and all.
What this adds up to is, if an epileptic has a four minute seizure, you don’t need to call the paramedics. Otherwise, call. If in doubt, remember that paramedics would rather be called and not needed, than needed and not called.


WHAT DO I DO AFTER THE SEIZURE IS OVER?

Seizures usually end on their own after 3-4 minutes. When it’s done, check to make sure the person is breathing, awake, and aware. They’ll probably be drowsy and confused and have a banger of a headache. They might even be sleeping. Roll them on their side if you can, then stick around until they wake up. Don’t leave them alone until you’re sure they’re okay. If you called the paramedics, stick around at least until they arrive. Sometimes people come out of seizures feeling embarrassed. If they want privacy, be considerate and give it to them.


Like I said, seizures are scary to watch. But keep cool, keep an eye on the person, and protect their head. Keep that phone handy, and call 911 if necessary. Follow these instructions, and you could save a life.

Thursday, 19 July 2012

NEURO FIRST AID: Stroke

Occasionally, as a result of injury or disease, something can happen to the brain that is immediately life threatening. It's possible that, at some point, you will witness someone having a stroke or a seizure. Recognizing the signs and calling 911 (999 in the UK, or the emergency number for your country) can be the difference between life and death. It's not always obvious, and it's normal to be frightened and unsure of what to do. So here at The Brain Geek, I'm going to teach you how to recognize the signs of a life-threatening neurological problem, so that you can call the paramedics. I'm also going to tell you some basic first aid that you can use in the few minutes before the paramedics arrive. These instructions are simple, easy to follow, and require no special training. If you're not sure what to do, remember this: Paramedics would always rather be called and not needed, than needed and not called. If you follow these steps and call the paramedics, you could save a life.

Strokes

Excluding mechanical injury like a car crash, a stroke is arguably the most immediately life threatening thing that can happen to the brain. In a stroke, minutes matter. What happens in the first hour can determine not only whether someone survives, but their quality of life after the stroke. But it’s not always easy to recognize. Familiarize yourself with the signs now, so you know what to do if you ever witness a stroke.


WHAT IS IT?
Strokes happen when blood flow in the brain is disrupted. There are two types. Ischemic strokes happen when a blood clot blocks a blood vessel. The neurons can’t get oxygen, and they die. Hemorrhagic stroke happens when a blood vessel bursts and blood flows into the brain. This also kills neurons. Strokes are immediately life threatening, and must be dealt with right away.




WHO IS AT RISK?
  • People with high blood pressure
  • Obese people
  • People with a history of cigarette smoking, alcoholism, or drug use
  • Older people
  • People with diabetes
  • People with certain heart conditions
Just because someone isn’t on this list, don’t assume they can’t have a stroke. If you see the signs, assume the worst, and call the paramedics.


WHAT ARE THE SIGNS?
  • Paralysis or weakness on one half of the face. Ask them to smile. If only one side of the face moves, they might be having a stroke.
  • Paralysis or weakness on one half of the body. Ask them to lift both their arms. If they can’t lift one arm very high, maybe it’s a stroke.
  • Slurred speech. Ask them to say, “my dog has fleas,” and check to see if they slur, especially their s’s.
  • Confusion. If a normally sharp person suddenly becomes confused and disoriented, they might be having a stroke.
  • Sudden problems with sight.
  • Sudden problems with balance.
  • Severe headache.
From New York State Department of Health
Remember, not all people having a stroke will show all of these signs. Sometimes, the paralysis/weakness will be on both halves, not just one half. IF IN DOUBT, CALL 911 (or the emergency number for your country)!!


WHAT TO DO:
  • Call the paramedics. I really can’t stress that enough.
  • Keep the person calm. Tell them you’ve called for help. People having strokes may have difficulty communicating. They’ll be scared. While waiting for the paramedics, the best thing you can do is keep them calm and let them know that help is coming.
  • Keep the person talking. This does two things. First, it tells you that the person is still awake and with it. Also, it gives you a chance to get important information. Ask them what they’re feeling. Do they have any other medical problems? If they can’t talk, just keep talking to them and reassuring them. But if they can talk, remember as much as you can and tell the paramedics. Which takes us to…
  • Tell the paramedics everything. They need this information, especially if the person passes out. Which side was paralyzed? What parts couldn’t they move? Even just this much info tells the paramedics where in the brain the stroke has happened.

This may sound scary. It will be scary. But if you stay calm, recognize the signs, and call the emergency number, you can save a life.

Tuesday, 10 July 2012

This song smells blue

            If someone said to you, "Here, have a brain disorder!" you'd probably say, "No thanks," and run in the opposite direction. Not me. I'd say, "Sure! Give me synesthesia!" (say: sin-uhs-thee-zhuh). Synesthesia sounds fantastic. Of all the weird mix-ups and mess-ups that can happen with the brain, this is by far the coolest, and the only one I can think of that is actually desirable.
            Synesthesia means "sensing together". Imagine if every time you heard a certain musical tone, you saw blue.
Or if every time you saw red, you smelled strawberries. Or if every time you heard certain words, you tasted chocolate. Synesthesia is awesome. People with synesthesia experience the world at a level of vividness and beauty that I can't even imagine. (Disclaimer: it isn't always awesome. There's one poor woman who smells rotting flesh when she hears music. I don't want that synesthesia.)
A synesthete might see letters and numbers like this. (from Wikipedia)
            Somewhere between one in 20 and one in 200 people has synesthesia, so chances are, you've met a synesthete (that's what they're called). But the synesthete might not know they’re a synesthete. People can make it to their teenage years and beyond without realizing that not everyone thinks the number nine is green. You can tell the real synesthetes from the fakers because real synesthetes are consistent. If an A-minor chord looks purple one year, it'll still look purple two years later (97% of the time). It also tends to run in families.
            What causes it? No one really knows. The best guess right now is a mix-up in the thalamus. The thalamus is the great relay station of your brain. All information from your body must pass through the thalamus before reaching the rest of the brain. The thalamus filters out unimportant information, and sends important information to the correct processing centers. It ensures that sight information goes to the occipital lobe, and that sound information goes to the temporal lobe. (If these terms are unfamiliar to you, see the post on the parts of the brain.) In synesthetes however, the thalamus appears to be over-wired, so that information from, for example, the eyes, ends up in both the occipital lobes and the temporal lobes. In this example, visual information is going both to the brain area which processes vision (like it's supposed to), and to the brain area which processes sound. The person would hear sounds when seeing things, so trees might sound like bells. Keep in mind that this is all happening at the level of the brain. People who see blue when they hear a musical note aren't actually seeing blue with their eyes. They're seeing blue with their brain, and since the brain controls perception, they interpret it as "that sound looks blue."
            I wonder if anyone reading this blog is a synesthete. If so, please share it with us! What's your synesthesia?
            I’ll close with a couple quotes from Carol Steen, who is an artist and a synesthete:

            “I came back from college on a semester break, and was sitting with my family around the dinner table, and -- I don't know why I said it -- but I said, "The number five is yellow." There was a pause, and my father said, "No, it's yellow-ochre." And my mother and my brother looked at us like, 'this is a new game, would you share the rules with us?'
            “And I was dumbfounded. So I thought, "Well." At that time in my life I was having trouble deciding whether the number two was green and the number six blue, or just the other way around. And I said to my father, "Is the number two green?" and he said, "Yes, definitely. It's green." And then he took a long look at my mother and my brother and became very quiet.
            “Thirty years after that, he came to my loft in Manhattan and he said, "you know, the number four *is* red, and the number zero is white. And," he said, "the number nine is green." I said, "Well, I agree with you about the four and the zero, but nine is definitely not green!"

Here’s another one:

            “One example of synesthesia being distinctly unpleasant: I was at the dentist, and he was drilling. And I don't like the sound of the drill -- but the color orange that completely flooded my vision, I couldn't shut my eyes, because they were already shut! [laughs]
            "Except that I'm able to use it diagnostically. I had to have a root canal done once (not my favorite game) but you know, sometimes when you have a tooth pain you're not quite sure which tooth it is? He said, "I can't really say that you need a root canal in this tooth." I said, "This tooth is orange; please do it." And he hesitated. I said, "Look. If I'm wrong, this tooth will *never* need a root canal." So he went ahead and he did it.”

(quotes are from http://web.mit.edu/synesthesia/www/carol.html)


Wednesday, 4 July 2012

BRAIN MYTH-BUSTING: You only use 10% of your brain

Some of what we think we know about the brain is flat-out wrong. When the truth is so mind-bogglingly awesome, there's no need to cling to myths! So here at The Brain Geek, I'm going to devote some time to debunking the nonsense that's out there. Here it is: Brain Myth-Busting!
           

            "You only use 10% of your brain." Heard that before? I have. Loads of times. It’s such a popular idea, it’s even in the movies. A typical plot might be: "Here, Joe Nobody. Take this pill! It will allow you to use the full 100% of your brain! Wow! Now you're psychic and can move things with your mind! Amazing!" ...or.... "That girl is a genius because she had radioactive accident which changed her DNA and now she can use more than 10% of her brain. And she's psychic and can move things with her mind!" According to pop culture, the fast track to superpowers is using the full 100% capacity of your brain. Now, I'm the first person to say that sci-fi/fantasy is awesome, but this is just nonsense! Why? Because we already use 100% of our brains. Last time I checked, I couldn’t move things with my mind. If I could, my breakfast would be cooking itself right now.
            It's not true. If you only used 10% of your brain, you'd be dead. Unless that 10% was your brainstem, in which case, you'd be a vegetable (see the parts of the brain post). Why this myth is so popular is no mystery. Most people want to be smarter, and who wouldn't want to move things with their minds? (must...make...breakfast....) How it got started in the first place is a more interesting question.
            About 100 years ago, when scientists first started looking at brains under microscopes, they saw neurons. They soon figured out that neurons are important for processing information, making you conscious, allowing you to move your muscles, and all the other things neurons do. But most of the cells the scientists saw weren’t neurons, and these cells didn’t seem to do anything important. They named these cells glia, which means "glue." They looked at their slides and thought, "Wow, only 10% of the cells are neurons. The other 90% of the brain is glue. People only use 10% of their brains!"
Neurons. From wikipedia
Glia. From wikipedia

            They were wrong. Glia are much more than glue. There are lots of different kinds of glia, each with an important job to do. Some form the blood brain barrier, which stops toxins in your blood from reaching your brain. Others make the cerebrospinal fluid which cushions your brain from injury (see this post for a fun CSF activity where you get to smash eggs). Still others keep the amounts of ions and neurotransmitters in your brain at the right levels, so that neurons can send electrical and chemical signals (for discussions on how neurons use ions and neurotransmitters to talk to each other, see this post and this post). Some insulate your neurons, allowing electrical signals to travel faster, just like the insulated rubber covering around an electrical wire. Others are part of the immune system, zipping around the brain eating up bacteria and dead neurons so that the rest of the brain stays healthy.
Neurons and glia. The neuron is yellow. Astrocytes (red) are glia that keep ion and neurotransmitter amounts normal, and help make the blood brain barrier. Oligodendrocytes (blue) are glia that insulate neurons so signals can travel faster. From myroadtomedicalschool.blogspot,com
            An interesting factoid about glia is that the more neurologically complex an animal is, the more glia they have. Humans have more glia than any other animal. And Einstein – widely regarded as one of the smartest humans ever - had more glia in his brain than any other person we've looked at. Glia don't do any thinking - that's the job of the neurons - but having lots of glia around to keep the brain a clean and healthy place might be part of the reason why human neurons are so good at thinking.
            The myth started because so little of our brain is actually neuron. The rest is glia. But does that mean we only use 10% of our brain? No! We use those glia. They keep the brain healthy and moving quickly. We use 100% of our brains, all the time. And if we increased the percentage of neurons, so that it was more than 10% (which would make glia less than 90%), would that make us smarter? No! Because you needs lots of glia to have a smart brain. So next time someone says to you, "You're interested in the brain, right? Is it true we only use 10%?", feel free to show off just how much of your brain you're using, and tell them all about glia.