Epilepsy is a neurological disorder affecting 1-2 % of the population in the world. People diagnosed with epilepsy are put at high risk of getting injured due to the unpredictable seizures caused by the disorder. Electroencephalography (EEG) in combination with machine learning can be used for prediction of an epileptic seizure. Therefore, a portable prediction device is of great interest with high emphasis for it to be user-friendly. One way to achieve this is by minimizing the number of electrodes placed on the scalp. This study examines the number of electrodes that provide sufficient information for prediction of a seizure. The highest prediction accuracy of 91 %, 97 % sensitivity and 85 % specificity was achieved with as few as 16 electrodes. Due to the limitation of the intracranial EEG recordings further testing must be performed on scalp EEG recordings to provide valid results.

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Prior studies have demonstrated that a sizeable percentage of children presenting to the epilepsy monitoring unit for evaluation of paroxysmal events (seizures) are found to have non-epileptic seizures (NES) (Asano et al., 2005). The importance of identifying NES cannot be overstated since misdiagnosis often leads to treatment with antiepileptic drugs, which may have side effects that may negatively impact cognition (Chen, Chow, & Lee, 2001) and perhaps even cognitive development. While studies in adults with epilepsy or NES have demonstrated impaired executive functioning and social outcome compared to healthy peers, less work is present among pediatric populations (Cragar, Berry, Fakhoury, Cibula, & Schmitt, 2002; Rantanen, Eriksson, & Nieminen, 2012). Furthermore, research is void of information regarding social skills between these pediatric groups. The aims of this study were to examine group differences between social skills and executive functioning between pediatric epileptic and NES patients, determine if social skills predict diagnostic classification, and examine correlations between executive functioning and social skill measures. This study was conducted on the epilepsy monitoring units (EMU) at Phoenix Children's Hospital and Primary Children's Medical Center. The parent/caregiver of patients admitted to the EMU for video-EEG diagnosis of seizures was approached regarding study participation. A total of 43 children and parent/caregiver participated in this study. The NES group consisted of15 participants (67% female; M age at testing = 12.62, SD = 3.33), and the epilepsy (ES) group consisted of 28 participants (50% female, M age at testing = 11.79, SD = 3.12). Both the parents and children completed brief questionnaires measuring executive functioning and social skills. These measures included The Behavior Rating Inventory of Executive Functioning, The Behavioral Assessment System for Children, Second Edition, and the Social Skills Improvement System Rating Scales. Binomial logistic regression analysis showed social skills did not significantly predict diagnostic group. No group differences were found between children with epilepsy and NES on measures of executive functioning or social skills. Parents of both groups rated their children as having below average social skills, while children rated their social skills in the average range compared to healthy peers. Both children and parents of both groups rated their executive functioning within the average range. Executive functioning scores and social skill scores significantly correlated and regression analyses indicated that the Behavioral Regulation Index on the BRIEF significantly predicted Social Skills on the SSIS. Interpretationof results, limitations, and future directions are discussed.

Στην παρούσα μεταπτυχιακή διπλωματική εργασία, η κυματιδιακή ανάλυση (Wavelet Analysis) εφαρμόζεται σε ηλεκτροεγκεφαλικές καταγραφές ασθενών που πάσχουν από επιληψία και σε προκλητά δυναμικά ασθενών που πάσχουν από σχιζοφρένεια και αλκοολισμό, με σκοπό την ανάδειξη παθολογικών προτύπων. Συγκεκριμένα, χρησιμοποιείται ο Διακριτός Κυματιδιακός Μετασχηματισμός (Discrete Wavelet Transform) για την εκτίμηση της Εντροπίας (Entropy) τωνηλεκτροεγκεφαλικών σημάτων. Η Εντροπία είναι ένα μέγεθος το οποίο εκφράζει το βαθμό τάξης ενός σήματος. Βιοσήματα με μεγάλο βαθμό οργάνωσης και περιορισμένο συχνοτικό περιεχόμενο -που θεωρείται ότι εκφράζουν πιο συντονισμένη εγκεφαλική λειτουργία- έχουν χαμηλές τιμές Εντροπίας. Αντίθετα, όσο πιο στοχαστικό είναι ένα σήμα τόσο μεγαλύτερη η τιμή της Εντροπίας του. Για τη μελέτη μας υλοποιήσαμε δύο διαφορετικά μεγέθη Εντροπίας, την Κυματιδιακή Εντροπία (Wavelet Entropy) και την Εντροπία Renyi (Renyi Entropy), τα οποία έχουν διαφορετικές σχέσεις ορισμού αλλά εκφράζουν και τα δύο το βαθμό τάξης των αναλυόμενων σημάτων. Τα αποτελέσματα της ανάλυσης αποκαλύπτουν ότι και τα δύο αυτά μεγέθη Εντροπίας κατορθώνουν να εντοπίσουν την επιληπτική κρίση, καθώς η τιμή τους διαφοροποιείται κατά τη διάρκειά της σε σχέση με την τιμή τους πριν από αυτή. Ακόμα, στατιστική ανάλυση των αποτελεσμάτων για προκλητά δυναμικά αποκαλύπτει ότι είναι δυνατός ο διαχωρισμός των παθολογικών καταγραφών (σχιζοφρενών ή αλκοολικών) από αυτές υγιών μαρτύρων, σε συγκεκριμένες περιοχές ενδιαφέροντος των σημάτων. / Wavelet Analysis of EEG during epileptic seizures and evoked potentials of patients suffering from schizophrenia and alcoholism was carried out in the present project. Discrete Wavelet Transform was used to estimate the Entropy of patients’ biosignals. Entropy is a measure of the degree of order of a signal -and subsequently of the system it represents- also reflecting the complexity of its power spectrum. An ordered activity, like a sinusoidal signal, is manifested as a narrow peak in the frequency domain which corresponds to a low entropy value. On the other extreme, a disordered activity (e.g. the one generated by pure noise or by a deterministic chaotic system) will have a wide band response, thus being reflected in higher entropies. In our research we used two differently defined Entropies, Wavelet Entropy and Renyi Entropy, both revealing the degree of order of the signal. Results show that both Entropy measures accomplish the goal they were used for. They manage to detect the epileptic seizure as their value clearly decreased during seizure compared to the pre-ictal value. Also, statistically significant differences were observed between entropy values of ERPs of healthy subjects and patients suffering from schizophrenia and alcoholism.

Introduction. La neurocysticercosis (NCC) est l'un des maladies helminthiques les plus courantes du SNC et elle cause de l'épilepsie symptomatique dans les régions pauvres. Il existe peu d'études communautaires sur cette zoonose et leurs comorbidités comme l'épilepsie et la NCC. Méthodologie. Dans la région nord du Pérou, trois études sur la communauté et une révision systématique ont été développés dont les objectifs étaient les suivants: a) évaluer la prévalence de la NCC asymptomatique, b) la prévalence de l'épilepsie associée à la cysticercose, c) la détermination de l'exposition à la cysticercose d) développer une intervention communautaire pour interrompre la transmission de la cysticercose. Résultats. 256 patients asymptomatiques qui avaient une tomodensitométrie (T) sans contraste, 48 (18%) avaient la NCC calcifiés. La prévalence de l'épilepsie trouvée était de 17.25 / 1000 habitants et la proportion de NCC en personnes atteintes d'épilepsie était de 39% (109/282). Le Western Blot (EITB-LLGP) pour la cysticercose a été positive dans le 40% des personnes atteintes d'épilepsie, et dans le 36,9% de la population générale. L'association entre la cysticercose et l'épilepsie avait un OR de 2,7 (95% CI 2.1 – 3.6, p <0,001). Le traitement massif avec niclosamide chez l'homme (n = 3), et plus la vaccination de la population porcine a été mis en oeuvre dans 107 communautés rurales de Tumbes. Aucun porc infecté avec la cysticercose n’a été trouvé en 105 des 107 communautés. Conclusions. (1) La NCC est un facteur contributeur de l'épilepsie, (2) La transmission de T. solium peut être réduite à échelle régionale. / Backgrounds. Neurocysticercosis is a parasitic infection of the brain and a common cause of epilepsy in poor regions. There are scarce community-based studies about its comorbidities as epilepsy and neurocysticercosis. Methods. In the northern region of Peru, we performed three community based-studies and one systematic review a) to assess the prevalence of asymptomatic NCC, b) the prevalence of epilepsy and epileptic seizures and NCC c) seroprevalence of cysticercosis (EITB-LLGP) and d) to perform a community intervention to interrupt the Taenia solium transmission. Results. Of the 256 residents who underwent CT scan, 48 (18.8%) had brain calcifications consistent with NCC. Lifetime prevalence of epilepsy was 17.25/1000, the proportion of NCC in people with epilepsy was 39% (109/282), and the seroprevalence of EITB-LLGP in individuals with epilepsy was 40% and between 23.4 to 36.9% in the general population. The association between CC and epilepsy had a OR of 2.7 (95% CI 2.1-3.6, p <0.001). Three rounds of mass treatment with niclosamida in humans and mass treatment and vaccination in pigs was implemented in 107 rural communities (n=81,170 people). No infected pigs with cysticercosis were found in 105 of 107 communities. Conclusion. NCC is a strong contributor of epilepsy and epileptic seizures. We showed that transmission of Taenia solium infection was interrupted on a regional scale in endemic regions in Peru / Introducción. La neurocisticercosis (NCC) es una de las enfermedades helmínticas más frecuentes del SNC y causa de epilepsia sintomática en regiones pobres. Hay escasos estudios basados en comunidad sobre esta zoonosis y sus comorbilidades la epilepsia y la NCC. Metodología. Se desarrollaron en la Región Norte del Perú tres estudios basados en la comunidad, y una revisión sistemática cuyos objetivos fueron: a) evaluar la prevalencia de NCC asintomática, b) la prevalencia de epilepsia asociada a cisticercosis, c) determinación de la exposición a cisticercosis y d) desarrollar una intervención comunitaria que interrumpa la transmisión de cisticercosis. Resultados. De 256 pacientes asintomáticos que tuvieron una tomografía axial computarizada (TAC) cerebral sin contraste, 48 (18%) tuvo una NCC calcificada. La prevalencia de epilepsia encontrada fue de 17.25/1000 habitantes y la proporción de NCC en personas con epilepsia fue de 39% (109/282). El Western Blot (EITB-LLGP) para cisticercosis fue positivo en el 40% de los individuos con epilepsia, y en el 36.9% de la población general. La asociación entre cisticercosis y epilepsia tuvo un OR de 2.7 (95% CI 2.1-3.6, p <0.001). El tratamiento masivo con niclosamida en humanos (n=3), y población porcina más vacunación fue implementada en 107 comunidades rurales de Tumbes; en 105 de 107 no hubo nuevos cerdos infectados con cisticercosis. Conclusiones. (1) La NCC es un factor contribuidor de epilepsia, (2) Se puede cortar la trasmisión de T. solium a escala regional.

Inledning: Funktionella anfall, anfall som inte är epilepsi utan tros ha en psykologisk orsak, kan mötas av oförståelse också inom sjukvården. För att förstå detta tillstånd behöver man en processinriktad biopsykosocial sjukdomsmodell där patientens egen sjukdomsförståelse är en viktig del. Frågeställningar: Hur upplever patienter med funktionella anfall sin sjukdom?Hur förstår patienter med funktionella anfall sin sjukdom? Metod: Fem fenomenologiska halvstrukturerade intervjuer har genomförts och med hjälp av tematisk analys kondenserats till fyra teman. Resultat: De fyra temana är upplevelsen av anfallen, egen förståelse av anfallen, konsekvenser av anfallen och vad hjälper mot anfallen. Stora skillnader framkommer i intervjupersonernas upplevelse och förståelse av sina anfall. Anfallen upplevs som en känsla av förändrad kontakt eller ingen kontakt mellan kropp och hjärna och de beskrivs både begränsa och berika livet. Sjukdomsförståelsen uttrycks i fysiologiska termer, i mer vaga psykologiska termer eller att det inte går att förstå. Det framkommer tveksamhet till om psykologisk behandling hjälper. Diskussion: Det diskuteras att de funktionella anfallen faktiskt går att förstå, ibland medvetet och ibland omedvetet som en försvarsmekanism enligt psykodynamisk modell. Korttids psykodynamisk terapi såsom ISTDP kan därför vara ett behandlingsalternativ när psykoedukation och KBT inte har varit tillräckligt. / Introduction: Functional seizures, seizures that are believed to have a psychological cause, may face misunderstanding also in health care. To understand this condition, one needs a process-oriented biopsychosocial model in which the patient's own experience of illness is an important part. Questions: How do patients with functional seizures experience their illness?How do patients with functional seizures understand their illness? Method: Five phenomenological semi-structured interviews have been conducted and condensed into four themes using thematic analysis. Results: The four themes are experience of the seizures, understanding of the seizures, consequences of the seizures and what helps against the seizures. Large differences emerge in the interviewees' experience and understanding of their seizures. The seizures are experienced as a feeling of altered contact or no contact between body and brain and they are described to both limit and enrich life. Understanding of illness is expressed in physiological terms, in more vague psychological terms or cannot be understood. There is some doubt as to whether psychological treatment will help. Discussion: It is discussed that the functional seizures can actually be understood, sometimes consciously and sometimes unconsciously as a defense mechanism according to the psychodynamic model. Therefore, short-term psychodynamic therapy such as ISTDP may be a treatment alternative when psychoeducation and CBT have not been sufficient.

The thesis titled Educational Specifics of Children with Epilepsy aims to find out what are the specifics of education of children with epilepsy. The theoretical part of the thesis defines the characteristics of epilepsy, contains information about epilepsy and epileptic seizure, it deals with etiology of epilepsy, classification of epileptic and non epileptic seizures. It deals with the provocative factors of epileptic seizure and informs about the possibilities of treating this disease. The diploma thesis further outlines the current topic of today, and this is the education of children with epilepsy in the family and especially at school. In the thesis one can read about the issues of family education and healthy siblings of a child with disabilities, as well as some prejudices that an individual with epilepsy can encounter today. The work highlights the educational specifics of the education of children with epilepsy and does not forget to mention the legislative framework and the possibilities of education. It explains the support measures and the concept of inclusion. In the practical part, it contains the questions and the objectives that have been answered by qualitative research. Four case studies of epilepsy children aged between 5 and 16 years, a semi-structured interview with the family...

Epilepsy is characterized by the hyperexcitability of individual neurons and hyper synchronization of groups of neurons (networks). The acquired changes that take place at molecular, cellular and network levels are important for the induction and maintenance of epileptic activity in the brain. Epileptic activity is known to alter the intrinsic properties and signaling of neurons. Understanding acquired changes that cause epilepsy may lead to innovative strategies to prevent or cure this neurological disorder. Advances in in vitro electrophysiological techniques together with experimental models of epilepsy are indispensible tools to understand molecular, cellular and network mechanisms that underlie epileptiform activity. The aim of the study was to investigate the epileptiform activity induced alterations in Ca2+ dynamics in apical dendrites of hippocampal subicular pyramidal neurons in slices and changes in network properties of cultured hippocampal neurons. We have also made attempts to develop an in vitro model of epilepsy using organotypic hippocampal slice cultures. In the first part of the present study, investigations on the basic properties of dendritic Ca2+ signaling in subicular pyramidal neurons during epileptiform activity are described. Subiculum, a part of the hippocampal formation is present, adjacent to the CA1 subfield. It acts as a transition zone between the hippocampus and entorhinal cortex. It receives inputs directly from the CA1 region, the entorhinal cortex, subcortical and other cortical areas. Several forms of evidences support the role of subiculum in temporal lobe epilepsy. Pronounced neuronal loss has been reported in various regions of the hippocampal formation (CA1 and CA3) leaving the subiculum generally intact in human epileptic tissue. It has been observed that epileptic activity is generated in subiculum in cases where the CA3 and CA1 regions are damaged or even absent. However, it is not clear how subicular neurons protect themselves from epileptic activity induced neuronal death. It is widely accepted that epileptiform activity induced neuronal damage is a result of an abnormally large influx of Ca2+ into neuronal compartments. In the present study, combined hippocampus / entorhinal cortical brain slices were exposed to zero Mg2+ + 4-amino pyridine artificial cerebrospinal fluid (ACSF) to generate spontaneous epileptiform discharges. Whole cell current-clamp recordings combined with Ca2+ imaging experiments (by incorporating Oregon green BAPTA-1 in the recording pipette) were performed on subicular pyramidal neurons to understand the changes in [Ca2+]i transients elicited in apical dendrites, in response to spontaneous epileptic discharges. To understand the changes occurring with respect to control, experiments were performed (in both control and in vitro epileptic conditions) where [Ca2+]i transients in dendrites were elicited by back propagating action potentials following somatic current injections. The results show clear distance-dependent changes in decay kinetics of [Ca2+]i transients (τdecay), without change in the amplitude of the [Ca2+]i transients, in distal parts (95–110 µm) compared to proximal segments (30–45 µm) of apical dendrites of subicular pyramidal neurons under in vitro epileptic condition, but not in control conditions. Pharmacological agents that block Ca2+ transporters viz. Na+/Ca2+ exchangers (Benzamil), plasma membrane Ca2+-ATPase pumps (Calmidazolium) and smooth endoplasmic reticulum Ca2+-ATPase pumps (Thapsigargin) were applied locally to the proximal and distal part of the apical dendrites in both experimental conditions to understand the molecular aspects of the Ca2+ extrusion mechanisms. The relative contribution of Na+/Ca2+ exchangers in Ca2+ extrusion was higher in the distal apical dendrite in in vitro epileptic condition. Using computer simulations with NEURON, biophysically realistic models were built to understand how faster decay of [Ca2+]i transients in the distal part of apical dendrite associated with [Ca2+]i extrusion mechanisms affect excitability of the neurons. With a linear increase in the density of Na+/Ca2+ exchangers along the apical dendrite, the decrease in τ decay values of [Ca2+]i transients in distal regions seen in experimental epileptic condition was reproduced in simulation. This linear increase in Na+/Ca2+ exchangers lowered the threshold for firing in response to consecutive synaptic inputs to the distal apical dendrite. Our results thus, show the existence of a novel neuroprotective mechanism in distal parts of the apical dendrite of subicular pyramidal neurons under in vitro epileptic condition with the Na+/Ca2+ exchangers being the major contributors to this mechanism. Although the enhanced contribution of Na+/Ca2+ exchangers helps the neuron in removing excess [Ca2+]i loads, it paradoxically makes the neuron hyperexcitable to synaptic inputs in the distal parts of the apical dendrites. Thus, the Na+/Ca2+ exchangers may actually protect subicular pyramidal neurons and at the same time contribute to the maintenance of epileptiform activity. In the second part of the study, neuronal network topologies and connectivity patterns were explored in control and glutamate injury induced epileptogenic hippocampal neuronal networks, cultured on planar multielectrode array (8×8) probes. Hyper synchronization of neuronal networks is the hallmark of epilepsy. To understand hyper synchronization and connectivity patterns of neuronal networks, electrical activity from multiple neurons were monitored simultaneously. The electrical activity recorded from a single electrode mainly consisted of randomly fired single spikes and bursts of spikes. Simultaneous measurement of electrical activity from all the 64 electrodes revealed network bursts. A network burst represents the period (lasting for 0.1–0.2 s) of synchronized activity in the network and, during this transient period, maximum numbers of neurons interact with each other. The network bursts were observed in both control and in vitro epileptic networks, but the frequency of network bursts was more in the latter, compared to former condition. Time stamps of individual spikes (from all 64 electrodes) during such time-aligned network burst were collected and stored in a matrix and used to construct the network topology. Connectivity maps were obtained by analyzing the spike trains using cross-covariance analysis and graph theory methods. Analysis of degree distribution, which is a measure of direct connections between electrodes in a neuronal network, showed exponential and Gaussian distributions in control and in vitro epileptic networks, respectively. Quantification of number of direct connections per electrode revealed that the in vitro epileptic networks showed much higher number of direct connections per electrode compared to control networks. Our results suggest that functional two-dimensional neuronal networks in vitro are not scale-free (not a power law degree distribution). After brief exposure to glutamate, normal hippocampal neuronal networks became hyperexcitable and fired a larger number of network bursts with altered network topology. Quantification of clustering coefficient and path length in these two types of networks revealed that the small-world network property was lost once the networks become epileptic and this was accompanied by a change from an exponential to a Gaussian network. In the last part of the study, we have explored if an excitotoxic glutamate injury (20 µM for 10 min) that produces spontaneous, recurrent, epileptiform discharges in cultured hippocampal neurons can induce epileptogenesis in hippocampal neurons of organotypic brain slice cultures. In vitro models of epilepsy are necessary to understand the mechanisms underlying seizures, the changes in brain structure and function that underlie epilepsy and are the best methods for developing new antiseizure and antiepileptogenic strategies. Glutamate receptor over-activation has been strongly associated with epileptogenesis. Recent studies have shown that brief exposure of dissociated hippocampal neurons in culture to glutamate (20 µM for 10 min) induces epileptogenesis in surviving neurons. Our aim was to extend the in vitro model of glutamate injury induced epilepsy to the slice preparations with intact brain circuits. Patch clamp technique in current-clamp mode was employed to monitor the expression of spontaneous epileptiform discharges from CA1 and CA3 neurons using several combinations of glutamate injury protocols. The results presented here represent preliminary efforts to standardize the glutamate injury protocol for inducing epileptogenesis in organotypic slice preparations. Our results indicate that glutamate injury protocols that induced epileptogenesis in dissociated hippocampal neurons in culture failed to turn CA1 and CA3 neurons of organotypic brain slice cultures epileptic. We also found that the CA1 and CA3 neurons of organotypic brain slice cultures are resilient to induction of epileptogenesis by glutamate injury protocols with 10 times higher concentrations of glutamate (200µM) than that used for neuronal cultures and long exposure periods (upto 30 min). These results clearly show that the factors involved in induction of epileptiform activity after glutamate injury in neuronal cultures and those involved in making the neurons in organotypic slices resilient to such insults are different, and understanding them could give vital clues about epileptogenesis and its control. The resilience of CA1 and CA3 neurons seen could be due to differences in homeostatic plasticity that operate in both these experimental systems. However, further studies are required to corroborate this hypothesis.

Tidigare forskning visar att ambulanssjuksköterskor upplever bristfällig utbildningsgrund samt känslor av bristande självförtroende och osäkerhet kopplat till vårdsituationer med den vuxna patienten med pågående krampanfall. Den forskning som finns etablerad omkring ambulanssjuksköterskors upplevelser av att möta den vuxna patienten med pågående kramp är dock begränsad. Ambulanssjuksköterskan har i sin yrkesutövning en förväntan på sig att inneha en handlingsberedskap för alla typer av patientärenden, så även för den vuxna patienten med pågående krampanfall. Krampanfall med tonisk-klonisk karaktär innebär ett komplext vårdmöte där ambulanssjuksköterskan måste ta ställning till multipla faktorer, både rörande en kritisk somatik samt patientens omvårdnadsmässiga behov. Studiens syfte är att beskriva ambulanssjuksköterskors upplevelse av att möta vuxna patienter med pågående epileptiskt anfall av tonisk-klonisk karaktär i prehospital miljö. Studien har genomförts som en kvalitativ, semistrukturerad intervjustudie med induktiv ansats. Genomförda intervjuer har analyserats utifrån en kvalitativ innehållsanalys och resulterade slutligen i huvudkategorin Ett vårdande som balanserar mellan trygghet och oförutsägbarhet, med efterföljande kategorier Mångbottnad upplevelse, Vårdrelationen och Prehospitalt vårdande. Resultatet visar på attambulanssjuksköterskor bär på en bred upplevelsegrund när det kommer till vårdmötet med denkrampande patienten, där känslor av osäkerhet och stress är vanlig förekommande. Ambulanssjuksköterskorna upplever även vårdmötet som utmanande i förhållande till faktorer som vårdmiljö, patientomhändertagande samt mötet med anhöriga. Ambulanssjuksköterskorna upplever att det i första hand är yrkeserfarenhet som utgör en trygghetsskapande grund i patientmötet. För att skapa förbättrade grundförutsättningar för vårdandet samt förstärka upplevelsen av trygghet för ambulanssjuksköterskor, bör ämnet lyftas tydligare inom utbildning och arbetsplatsrelaterad fortbildning. / Previous research shows that ambulance nurses experience a deficient educational basis as well as feelings of lack of self-confidence and uncertainty linked to care situations with the adult patient with ongoing seizures. However, the research that has been established about ambulance nurses' experiences of meeting the adult patient with ongoing convulsions is limited. In her professional practice, the ambulance nurse is expected to be ready to act for all types of patient matters, including for the adult patient with an ongoing seizure. Seizures with a tonic-clonic character involve a complex care encounter where the ambulance nurse must take a position on multiple factors, both concerning a critical somatic condition and the patient's nursing needs. The purpose of the study is to describe ambulance nurses' experience of meeting adult patients with ongoing epileptic seizures of tonic-clonic character in a prehospital environment. The study has been conducted as a qualitative, semi-structured interview study with an inductive approach. Conducted interviews have been analyzed based on a qualitative content analysis and finally resulted in the main category Care that balances between safety and unpredictability, with subsequent categories Multi-rooted experience, Care relationship and Pre-hospital care. The results show that ambulance nurses have a broad base of experience when it comes to the care meeting with the convulsing patient, where feelings of uncertainty and stress are common occurrences. The ambulance nurses also experience the care meeting as challenging in relation to factors such as the care environment, patient care and the meeting with relatives. The ambulance nurses feel that it is primarily professional experience that constitutes a security-creating basis in the patient encounter. In order to create improved basic conditions for care and strengthen the experience of security for ambulance nurses, the topic should be highlighted more clearly in education and workplace related continuing education.