Lesson of the week: Tonic seizures are a particular risk factor for drowning in people with epilepsy

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Abstract
Case report A 14 year old boy who had had epilepsy from 7 years of age drowned in a lake on a school outing. His early development was normal. The seizures were all of a similar form: his head and eyes deviated up and to the right; his trunk could either be flexed or straight; he was blue around the mouth; facial twitching was followed by twitching or jerking of the limbs. His parents commented that because he was so rigid it sometimes needed three people to lift him off the floor. He had been treated with sodium valproate and carbamazepine. He stopped taking carbamazepine three months before he died and had had only two seizures during that period. These seizures followed the form already described. He had always previously been accompanied by his parents when he went swimming. On this occasion he went on an unplanned swim in a lake with 10 or 11 other children and about 15 teachers. He was observed playing happily with the other children, throwing water about. He then disappeared from sight. The teachers did not suspect that he had drowned until the party was about to leave. Divers were called and they found him in about 1.5 m of water. There was a small cut above one eye but no other sign of trauma. His arms were crossed over his chest, as had previously been observed by his parents when he had a tonic seizure. The coroner's verdict was death by drowning secondary to epilepsy. His parents contacted the British Epilepsy Association and were informed that swimming is good for people with epilepsy and should be encouraged but should be supervised. They asked the question: “What does this mean?” His parents said, “The supervision should be one-to-one. He should have had someone in water with him. There was no chance for anyone to save him. I think we were blissfully ignorant. I know now he could have had a seizure in the water and I would have been totally unprepared for it. I'm not sure even now that I'd know what to do to resuscitate him. The whole business of epilepsy should be explained properly. You almost need someone to go through it with you.” His parents also commented that children with obvious physical disability tend to be better supervised than those who are able, like their son was.