Scary Movements Seizures in the Wilderness

2023, Winter Adirondac

Seizures, although rarely serious emergencies, are very frightening to those unaccustomed to them. A seizure developing in the backcountry setting would be even more terrifying.

Seizures (convulsions, “fits”) are triggered by chaotic electrical activity in the brain, which results in uncontrolled movements. Although they occur in many types, the most common result is a rhythmic contraction of muscles, giving the appearance of jerks or spasms. Persons experiencing seizures are usually unaware and unresponsive during the episode, often exhibiting abnormal facial and eye movements. In most cases, seizures are self-limited; patients typically experience a period of confusion following resolution of the seizure. “Seizure” refers to a single event. An individual who is susceptible to recurrent seizures is said to have a “seizure disorder” or “epilepsy.”

First aid for a person experiencing a seizure is straightforward; the old medical axiom “first, do no harm” is a particularly good principle here. The patient should be helped into a safe location and eased to the ground on their side (the “recovery position” as taught in CPR). Obviously, packs and other constricting material should be removed or loosened. Ancient teaching recommended stuffing items in the mouth to prevent biting or “swallowing” the tongue (whatever that means!). Such maneuvers should be avoided, as they clearly risk more damage than they prevent. Time seems to move slowly when someone is observing a seizure. Keeping an accurate record of the length of the seizure may be helpful to the physician ultimately caring for the patient.

Once the seizure has stopped and the patient has regained consciousness, the next step in backcountry first aid is assessing the cause and making definitive plans. The most important determination when a seizure is observed in the wilderness is whether it represented an entirely new phenomenon or if the individual already had a history of seizures. This one determination will drive the next steps.

Seizures in individuals with previously known and controlled seizure disorders on a wilderness trek will almost invariably be caused by disruption in their medication administration; changes in their sleep and meal times may also play a role. Modern therapy for epilepsy is quite effective, thanks to a broad array of medications. Control of seizures requires precise levels of these medications in the body. Because of this, unlike the case with some other prescription drugs for which precise timing is not always necessary, anti-seizure medications need to be taken at predictable times daily. Some of these medications also have requirements of timing in regard to meals. So, if an individual with a seizure disorder has a “breakthrough” seizure on a trek, carefully review the medication, meal, and sleep times and adjust if needed. I would also suggest adjusting the trek goals, and even consider terminating it early.

A new onset of seizures in a backcountry traveler is much more serious, and is likely a medical emergency. Some of the possible explanations include recent head trauma, an infection of the brain or nervous system, or a disturbance in the body’s fluids and electrolytes. None of these can be diagnosed or treated outside a hospital setting, so immediate evacuation is needed. Under most circumstances, unless the group is highly experienced and well equipped, this will entail mobilizing outside help.

Is it even safe for individuals with known seizure disorders to participate in wilderness activities? Professional societies have not weighed in on this question directly. The Epilepsy Foundation ( 1 summer-camp) has a lot of suggestions and information regarding children participating in summer camps but does not directly address trekking. The British Columbia Epilepsy Society, while not taking an official position on the subject, has published a terrific post by an individual with epilepsy who is an avid, serious backpacker ( epilepsy-in-the -wild-tips-on-hiking-and-epilepsy). This post contains a host of valuable suggestions that certainly seem reasonable. Certainly, a multi-day expedition should not be the first trek for an individual with a known seizure disorder. Rather, a “training process” beginning with day hikes and progressing through brief overnights close to trailheads, accompanied by a capable partner, seems like a prudent way to prepare.

Tom Welch, MD, is a physician at Upstate Medical University in Syracuse and an active member of the Wilderness Medical Society. He is a licensed professional guide, a certifying instructor for the Wilderness Education Association, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available at his website and blog, Luis Mejico, MD, chair of the department of neurology at Upstate Medical University in Syracuse, reviewed this column and provided very helpful suggestions.

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Topics: General First Aid