rumaleptic seizure

A rumaleptic seizure is a seizure caused by hyperruemia. Most zeitgabberim undergo at least one, as it is part of the turning point. Zeitgabberim who became infected due to receiving Rumase under medical supervision usually do not undergo this seizure, as it is supposed to administered very carefully (rather than all at once with a bite or kiss) and thus usually avoids hyperruemia from occuring. It's not just the turning point that can trigger these seizures though, as hyperruemia is possible in a zeitgabber after the turning point. See the article on hyperruemia for more information.
Unlike most seizures, a rumaleptic seizure lasts between 10 and 20 minutes, with the mean being about 15. An epileptic seizure lasting this long would be reason to call for medical assistance, and indeed Licentia tries to medically supervise all turning points to ensure safety.
In rare cases, status epilepticus can occur in these seizures. Prognosis for those situations is far more grim.

Causes

The exact mechanism is unknown, but it is thought to involve an immune reaction to overwhelming presence of the Z-virus.
In rare scenarios, a rumaleptic seizure can occur at lower viral loads than what would technically be considered hyperruemia. It has been observed occurring at as low as 5,000 IU/mL in a patient who had a preexisting seizure disorder.

Symptoms

This kind of seizure has distinct phases, although people who have pre-existing hormonal or seizure disorders may have slightly different manifestations.

Hormonal Phase

The first phase is the sudden release of hormones associated with stress in the bloodstream. This often causes the patient to panic, and even those with nerves of steel will be deeply uncomfortable. Zeitgabberim who have already undergone the turning point before will find that this panic does not cause them fall into a RAASC.

Primary Clonic Phase

The patient will suddenly gasp or cry out during a brief, 5-30 second clonic seizure.

Myoclonic Phase

In this phase, the patient will "recover" somewhat as movements become less sustained. The patient will remain fully conscious, and sometimes even able to speak, in this phase. Interestingly, this phase can be extended by several minutes should the patient attempt to hold a conversation. It is thought that brain activity in Broca's Area can somehow delay the fourth stage.

Tonic-Clonic Phase

During this phrase the patient may or may not lose consciousness as their muscles tighten, then spasm again. Ictal bradycardia is common. This phase is the one that lasts the longest. Should the patient remain conscious, they will almost always dissociate. Hallucinations have also been reported.

Sleep Phase

In patients who lose consciousness during the previous phase, they will remain completely unconscious and in a state of bradycardia for anywhere from 30 seconds to 30 minutes after movements have stopped. The rare patients who retained consciousness sometimes skip this phase, but they, like those who undergo it and then "wake up," will be exhausted and confused.

Treatment

It should be noted that doctors outside of Licentia may use their own treatment plan. This article focuses on those used by Licentia.
Treatment is typically supportive. Although these seizures are grueling and hard to watch, they usually have a good prognosis. Monitoring these seizures allow intervention should heart failure occur. Even in the case of heart failure, doctors usually will not try to stop the seizure itself.
When it comes to status epilepticus on the other hand, the seizures must be stopped one way or another. Ultimately, doctors seeking to bring someone out of continuous rumaleptic seizures will want to lower viral load as fast possible, but that isn't a quick process. As such, the standard treatment plan developed by Licentia's doctors to at least pause the seizures is as follows, stopping at whatever step proves effective 1. Administer benzodiazepines 2. Administer anesthesia and wait for 8 hours 3. Put the patient in a medically-induced coma and wait 8 hours If the third step pauses the seizures, the doctor will proceed with a mass transfusion. If the third step fails to pause the seizures, the doctor will declare it super-refractory status epilepticus and proceed with a mass transfusion even as the seizure persists. It may seem odd that in either case, a mass transfusion will be performed, but research has shown that the seizures will usually begin again once the patient is brought out of the coma, as rumaleptic seizures are ultimately linked to viral load, and a coma doesn't affect viral load. Nevertheless steps 1 and 2 are given first as some patients need only them.

Mass Transfusion

In this procedure, a comatose patient is given a higher local concentration of oxygen to inhale. Once blood pressure, pulse, and dissolved oxygen has been established, some percentage of the patient's blood is drained. If the patient is a cachaemite, that percentage can be as high as 40% of total blood volume. If not, doctors will stop at at about 20%. At this point, transfusion with green florescent protein-tagged hemocleaved blood (see Hemocleave) completely free of the Z-virus begins, but doctors will continue to attempt to drain the body of non-GFP tagged blood as much as possible while maintaining overall blood volume. Once it is estimated that 80% of the diseased blood has been replaced, the patient will be brought out of the coma. This treatment has a high success rate, but in about half of patients, it isn't permanent and they will begin to develop hyperrumemia once again. Should that occur, the patient will begin a course of treatment known informally as pillguzzling.

Pillguzzling

Pillguzzling is noted to be quite unpleasant. It is an absolute last resort for those who have uncontrollable hyperrumemia or other bad reactions to the Z-virus. The patient is first purposely made trifected if they are not already in order to increase their chances of surviving the brutal treatment. They're also put on a course of potent antivirals. Next, their salivary glands are removed, as are the Z-virus associated scent glands in the armpits. The next step is being given chemotherapy with radiation to destroy their bone marrow as if they had leukemia. This is followed by an allogenic bone marrow transplant occurring immediately after another mass transfusion with the addition of white blood cells from an asymptote. Sometimes, if the patient's Z-virus associated hormones are well beyond normal levels, the adrenal glands are also removed, meaning the patient will need to be on hormonal medication for the rest of their life. Finally, the patient is given a cerebalspinal fluid transfusion from a zeitgabber who has baseline chronic hyperruemia. When all is said and done, this grueling experimental treatment usually succeeds. It is important to note that the recovery time is long and, if adrenal glands are removed, this treatment has life-long consequences.

Prognosis

Provided the seizures are under control and no injuries occur while convulsing, prognosis is good once the patient regains consciousness. Patients, regardless of being carriers or Cyclers, may wake up in a RAASC or wake up outside of one. Prognosis does not seem to correlate with what state they woke up in. If they are not in a RAASC, Confusion and disorientation are common, as is embarrassment, but the vast majority of patients are back to their normal selves in a day's time provided the seizure was not part of the turning point. If, on the other hand, it was their first rumaleptic seizure and their transition to a fully-fledged zeitgabber, their "usual selves" are gone forever, replaced with zeitgabber psychology in any of its myriad forms.

Prevention

Rumaleptic seizures seem to never happen to infected who are in a RAASC. There have been no confirmed cases of Romeros undergoing a rumaleptic seizure besides their first turning point seizure.

Type

Neurological

Parent

hyperruemia

Cycle

Short-term