Seizure Rescue Breath

Seizure Rescue Breath (SRB) is a breath technique that may be used to stop seizures taking place, or to prevent a seizure from occurring ^[1].

The breath technique may be applied for a number of types of seizure, for example: febrile convulsions; myoclonic; absence; partial and tonic clonic seizures or during status epilepticus. 

Consult Your Medical Team: 
It is important to note that the information provided here is not medical advice. 
Always check with your medical team before applying the technique. You may show your medical team the information and references here.

Potential Advantages

The Seizure Rescue Breath technique may be applied in clinical, home or school settings. It is free and simple to apply, with low risk of any contraindications. SRB may prevent or reduce the need to benzodiazepine seizure drugs, including diazepam, lorazepam, clonazepam, and midazolam. This may have particular benefits in developing countries or underserved communities with barriers to accessing seizure recovery medications.

Seizure Rescue Breath may be applied to an individual experiencing a seizure, or prior to a seizure occurring if an individual can sense seizure onset, in order to stop or reduce seizure activity. The breath technique may be implemented into Emergency Care Plans, without impacting on standard or personalised seizure emergency care procedures.

The Seizure Rescue Breath seizure recovery method may offer carers, parents and individuals with an alternative option to prevent or stop seizures in their tracks. SRB is a very versatile option as the recovery technique could to be used in any setting, for instance in schools, on trips or at home.

Prolonged seizures that don’t stop naturally are called status epilepticus. These seizure are dangerous, due to risk of injury, brain damage or death. SRB may offer an additional option to stopping seizures in action, or preventing seizures from occurring.

Consult with your epilepsy medical care team to discuss options to include SRB into your individual seizure care plan.

Seizure Rescue Breath (SRB) Technique

Seizure Rescue Breath is applied by breathing a gentle, consistent outward breath into the mouth or nose of a person experiencing a seizure, or about to.

Exhaled breath contains carbon dioxide (CO2) gas.

Increasing carbon dioxide levels in the body slightly may have the ability to shut down seizure activity taking place or about to occur ^[2]. The brain responds to elevated CO2 levels, to shut down seizure activity ^[3].

Instructions

Trialling this technique on a CPR approved training manikin may be beneficial before applying the technique in an emergency situation.

A resuscitation mask can be worn for hygiene purposes.

NOTE: Always follow your individual or standard approved seizure emergency care plan.

These are the instructions used by caregivers and families trialling SRB:

1. Prepare to implement the breath as soon as early as possible when the person you are caring for is having a seizure, or prior to the seizure occurring if the individual can sense a seizure is imminent.
   
2. Place your mouth over the nose of the person having a seizure, and hold the chin with your hand.
   
3. Breathe exhaled air into the nostrils: the exhaled breath should be gentle and consistent.
   
   IMPORTANT NOTES:
   For children and infants the breath should be very gentle and shorter in length.
   
   A resuscitation (CPR) mask may be warn for hygiene purposes. This may be a requirement in school or care settings.
   
4. The breath can be applied in a variety of positions, for example whilst the person is lying on their side, or sitting.
   
5. Time your exhaled breath with the person’s inhalation ‘in breath’. 
   You may watch the chest rise and fall, or feel their ribs moving in and out. 
   
6. Leave a short gap of five seconds between giving each separate breath.
   Continue the breath technique for several breaths, or until the seizure stops or alternative actions are required as per your individual seizure emergency care plan.
   

Pathophysiology

Studies dating back several decades indicate that increasing carbon dioxide levels in the body slightly may have the ability to shut down seizure activity taking place or about to occur ^[2]. Several clinical trials have studied the application of carbogen and the mechanisms that may stop seizures using this pathway,^[8][9] including clinical trials with children experiencing febrile seizures in home settings.^[10]

Recent research identifies the areas and mechanisms within the brain that respond to elevate CO2 levels, to shut down the seizure activity ^[3]

Studies have shown that inhalation of carbon dioxide (CO2) at 5% gas dilution has the ability to alter the body PH levels, reducing pH levels and increasing acidity in the brain^[6].

Researchers at the University of Iowa found that recently discovered acid activated ion channel ASIC1a shut down seizure activity in the presence of increased acidity in the brain.^[5][7]

Trials are taking place in hospital settings within the UK, involving applying carbon dioxide mixed gas to patients in status epilepticus seizures (seizures lasting over 5 minutes). These clinical trials will further investigate the mechanisms and applications of stopping seizures with slightly raised levels of carbon dioxide within the body.

SRB Technique Application

Seizure Rescue Breath provides another approach to stopping seizures, with no equipment, or easily accessible face masks. The method can be added within a seizure emergency care plan, for example while waiting for an ambulance or before rescue medication is applied (often medication is delivered at 5 minutes seizure duration).

SRB may be an effective option for stopping different seizures types:

• febrile convulsions
• myoclonus
• partial
• absence
• tonic clonic seizures

Status epilepticus

Status epilepticus is a single seizure lasting more than 5 minutes or 2 or more seizures within a 5-minute period without the person returning to normal between them.^[2]3] Previous definitions used a 30-minute time limit.^[4] The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures.^[3] Status epilepticus is a life-threatening medical emergency, particularly if treatment is delayed.^[3] Hospital emergency departments stop status seizures with strong medications, moving on to different types of drugs if the seizure activity does not cease, and it is sometimes necessary to admit the patient to intensive care units under a full anaesthetic. Seizure Rescue Breath may provide an alternative approach to stopping seizures due to the effects of increasing carbon dioxide levels within the body.

Exhaled breath, containing carbon dioxide gas, is applied to a patient suffering a seizure by breathing exhaled air into the person’s nose or mouth. Breathing in carbon dioxide has the ability to stop seizure activity.^[5]. Consult your individual medical team for advice on when to apply the SRB technique.

References

1. ^ Herbertson G, Liu J, McDonnell C (September 2019), “The Effect of Exchange Breathing Method First Aid on Status Epilepticus Seizures”, Frontiers, 10, doi:10.3389/conf.fneur.2019.62.00020
2. Drislane, Frank (19 March 2020). Garcia, Paul; Edlow, Jonathan (eds.). “Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis”. UpToDate. Wolters Kluwer. 34.2217.
3. Al-Mufti, F; Claassen, J (Oct 2014). “Neurocritical Care: Status Epilepticus Review”. Critical Care Clinics. 30 (4): 751–764. doi:10.1016/j.ccc.2014.06.006. PMID 25257739.
4. ^ Trinka, E; Höfler, J; Zerbs, A (September 2012). “Causes of status epilepticus”. Epilepsia. 53 Suppl 4: 127–38. doi:10.1111/j.1528-1167.2012.03622.x. PMID 22946730. S2CID 5294771.
5. ^ Jump up to:
   ^a b Eliner GI, Filatov PP (1978). “Carbon dioxide gas provoking and stopping an epileptic seizure”. Zh Nevropatol Psikhiatr Im S S Korsakova (in Russian). 78 (8): 1159–69. PMID 696105.
6. ^ Miller JW (July 2011). “Stopping seizures with carbon dioxide”. Epilepsy Curr. 11 (4): 114–5. doi:10.5698/1535-7511-11.4.114. PMC 3152150. PMID 21852882.
7. ^ Ziemann A (June 2008), “Study identifies brain pathway that shuts down seizures”, MedicalXpress
8. ^ Schuchmann S, Schmitz D, Grüters-Kieslich A, Vanhatolo S, Kaila K: Suppression of complex febrile seizures by elevating respiratory CO2 using a rebreathing technique – two case reports. Epilepsia. 2009, 50 (Suppl): 245-
9. ^ Tolner, E.A., Hochman, D.W., Hassinen, P., Otáhal, J., Gaily, E., Haglund, M.M., Kubová, H., Schuchmann, S., Vanhatalo, S. and Kaila, K. (2011), “Five percent CO2 is a potent, fast-acting inhalation anticonvulsant“. Epilepsia, 52: 104-114.
10. ^ Ohlraun S, Wollersheim T, Weiß C, Martus P, Weber-Carstens S, Schmitz D, Schuelke M. CARbon DIoxide for the treatment of Febrile seizures: rationale, feasibility, and design of the CARDIF-study. J Transl Med. 2013 Jun 27;11:157. doi: 10.1186/1479-5876-11-157. PMID 23806032; PMC PMC3700755

Contact

The Leafie team are keen to hear from you if you are interested in researching or trialling this technique:
[email protected]