Health Committee on Feb. 16th, 2012

[Voices]

Oh, oh!

[Patrick Brown, Conservative, Barrie, ON]

No. I just want to say that I think this is a great initiative. You mentioned the young girl in your riding. I know that in every city in every riding in the country there are young Canadians for whom this bill will make a big difference. Thanks for the great initiative.

I have no hard or pressing questions because I think you're going to find universal support from your colleagues on what is a positive initiative.

[The Chair, Conservative, Joy Smith]

Thank you.

Go ahead, Mr. Strahl.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you, Geoff, for the bill. I am a Vancouver Canucks fan, and even though you are a Boston Bruins fan, I will be voting in favour of the bill. Quite by accident, I did wear a purple tie today; I think there's even some lavender in there too, so my version of the tie is bilingual.

I have a friend who has epilepsy. He underwent surgery after many years. It was experimental surgery at the time and it greatly relieved the symptoms he faced. He spoke about his time in high school when he was on medication. He had just enough energy to get through to the end of the day and then he would go home to sleep, because the side effect was severe drowsiness, I assume to try to keep things under control. This was 20 years ago.

Have there been any improvements in the pharmaceuticals available for people with epilepsy, or are they the same treatments that have been around for a number of years?

[Sarah Ward]

There have been some improvements. Some of the newer drugs have fewer side effects, but most of them still do have at least some side effects. Phenytoin, or Dilantin, isn't a newer drug, but it's one of the more common drugs. It doesn't cause the person to be drowsy, but it causes a lot of other side effects. It can cause facial hair growth in women and it can cause pretty severe gum overgrowth. I don't know all the medications, but I know there has been some improvement. With more research, there will be more improvement.

[Geoff Regan, Liberal, Halifax West, NS]

Madam Chair, if I'm not mistaken, some epilepsy drugs have been among the drugs for which there have been shortages. You've probably looked at this issue as a committee, or heard about it. When a drug suddenly goes out of production for a period of time, from what I've heard--and I'm sure you have heard it as well--it can have a great impact on patients, who normally would need time to shift gradually from one drug to another but don't have time to do that in the case of a sudden shortage.

[The Chair, Conservative, Joy Smith]

Mr. Strahl, is that the end of your questions?

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

I'm good. Thank you.

[The Chair, Conservative, Joy Smith]

Before we go into the second round, with the permission of the committee, there's just one question I have.

Like you, Mr. Regan, I had a student in grade 9 who had three seizures a day, and if I remember correctly, they were called grand mal. I'm wondering if someone on the committee could describe that type of seizure. You described how someone looks into space or picks at their clothes or whatever, but can you also describe, first of all, what a seizure looks like? Some people have not seen a seizure, and it's very scary when you first see one, especially if it's a grand mal seizure. As well, can you describe what to do? I remember that as a teacher I was told by someone, “Oh, Mrs. Smith, grab a belt and put it between his teeth.” I didn't think that was very good, so I didn't do it; I just cleared the way around him. That was before I had information about what I really should do; fortunately, it wasn't too far from what I really should have done.

Could you go into that a little bit? Let's say that while walking home or whatever, you see someone who is having a seizure. What does it look like and what should you do? I ask because many well-intentioned people injure people they're trying to help.

Who would like to respond? Okay, Ms. Therrien, go ahead.

[Aurore Therrien]

You can also ask Ms. Iris Elliott that question, because she wanted to say something about it too.

There are different kinds of seizures. There is the family of generalized seizures, the first of which is called the absence seizure. Absence seizures are not really visible; they are characterized by small losses of consciousness, of which there can be many in the course of a day. They may not disturb people close by, but this kind of seizure can be a great disruption to the life of a child or an adult.

There are also simple partial and complex partial seizures. Simple partial seizures have involuntary movements, as you mentioned earlier. So the person can move, do common actions like getting up and walking around, but there is no context. So they can pull at their clothes and move around. In a simple partial seizure, the person is conscious, whereas in a complex partial seizure, the person is completely unconscious. A complex partial seizure can become more generalized. It can be the beginning of a seizure called the aura. Lastly, I think that everyone knows about the convulsive seizure, which can take different forms. The person suddenly loses consciousness, falls to the ground and goes into convulsions. For people who have complex partial seizures—the ones you were talking about—I think…

[The Chair, Conservative, Joy Smith]

I'm talking more about the complex ones. What should people do? This is where people seem to make mistakes.

[Aurore Therrien]

You should not try to restrict the person's movements. You have to follow them. If the seizure happens in a room, good. But if the seizure happens outside, it is different. We have seen a young woman get up and walk quickly outside. It's rare, but it happens. Someone must be at the person's side to make sure that they don't hurt themselves by falling down a staircase or anything like that. Seizures are very short. You should not try to restrain the person or sit them down. You must follow them, make sure they are safe and talk to them, because that is how you can tell when the person is no longer unconscious.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Elliott, did you want to make a comment?

[Iris Elliott]

Yes. I'd just like to describe what it looks like when somebody has what you referred to as a grand mal seizure. We actually call them tonic-clonic seizures these days.

What happens is that the seizure is happening all over the unconscious person's brain. They become rigid. They become unconscious. They fall down. They begin to shake. Every muscle in their body is clenching and unclenching, clenching and unclenching. This can go on for a long time, but most seizures last less than five minutes. Of course, if it does go on longer, you call the ambulance.

That's basically what it looks like: the person's lying on the ground, totally unconscious, and they're unclenching and clenching their muscles and moving in a very spasmodic way. That would be the kind of seizure you're mentioning. It used to be called a grand mal seizure.

[The Chair, Conservative, Joy Smith]

Well, it's been a while since I've been in the classroom; it was grand mal when I was in the classroom.

Go ahead, Mr. Regan.

[Geoff Regan, Liberal, Halifax West, NS]

Madam Chair, I would like to add something to what Mrs. Therrien said.

It is good for one or two people to be present when someone is having a seizure, but it is not desirable for a lot of people to be very close, as Ms. Fry described earlier. Just imagine the person seeing all kinds of people crowding around when the seizure is over. The space around the person must be kept clear.

[The Chair, Conservative, Joy Smith]

Thank you. I think that might be helpful.

Ms. Ward, did you want to make a comment?

[Sarah Ward]

Yes. I have something to add that hasn't been mentioned yet.

Commonly after grand mal and other types of seizures, there's a post-ictal phase. There's commonly vomiting, and they're still half unconscious. An important part of the first aid is to make sure they're in the recovery position, on their side, so they don't aspirate and choke.

[The Chair, Conservative, Joy Smith]

I think this would be helpful to the general public if they ever saw something like that, and especially in schools, where children are unaware.

We'll now go to the second round. Ms. Quach has five minutes--Ms. Fry?

[Hedy Fry, Liberal, Vancouver Centre, BC]

I'm sorry. Very quickly, the symptoms you present with depend on what part of your brain is affected. If it's a part of your brain that has to do with movement, your large limbs, you will get the tonic-clonic seizure

The term “woolgathering”—this is just a piece of trivia—comes from that. Sometimes you'd see people doing picking at their clothes, and it came to be known as woolgathering. Now when we see someone lost in thought, we say they're woolgathering, but there was a different reason for calling it that.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Fry.

Please go ahead, Ms. Quach.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you, Madam Chair.

I would like to thank Mr. Regan for introducing this bill. I would also like to thank all the witnesses. You have taught me a lot about this.

You say that people crowd around a person having a seizure. That is true. I experienced that as a teacher. Someone had a seizure in the classroom. Children have all kinds of reactions. But most of them are curious. They want to see what is going on, but when they do see, they become very afraid and they turn away. It's very traumatic for everyone. Some kids start crying; others ask what is going on, whether the person is going to die.

I would very much like to know what is happening neurologically. What are the physical reactions, the physiological reactions, of someone having an epileptic seizure? You often hear that the person is exhausted afterwards because the seizure uses up a lot of energy, but I am not really aware of what is happening.

In terms of the awareness campaign, I was wondering, given that people do not know how to react, if you had also thought of presenting things like improvised sketches in public areas, in supermarkets, in the subway, in the street and on buses. The idea would be to make people aware of the fact that it can happen anywhere at any time, and of the proper way to react. You could then give out the cards. That could create awareness.

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

Ms. Ward, would you?

[Sarah Ward]

Yes?

[The Chair, Conservative, Joy Smith]

I have to warn you that you can't scratch your ear here without having to answer a question.