There are several types of seizures that can cause baby to involuntarily 
bite at the breast - tonic and tonic-clonic.  Tonic seizures consist of 
tightening of all muscles in the body simultaneously.  Mom might do more 
damage than good if she tries to pull baby off the breast during the 
tonic phase of a tonic clonic seizure.  If baby is well attached to the 
breast and his tongue is over his lower two teeth, mom will just get 
clamped by the upper teeth on her breast, and baby will bite his tongue 
with his lower two teeth.  The tonic phase of a tonic-clonic seizure is 
very brief, but can do tremendous damage to the poor person's tongue.  
It is probably safest if he has a seizure during breastfeeding to just 
leave him in place until the tonic phase is over, and dislodge him 
rapidly as soon as the tonic phase ends and the clonic (rapid 
contraction-release of muscles phase) just begins.  This way she might 
have two puncture wounds on the breast, but will not likely have gashes 
from pulling the teeth along the breast. 

Any attempt to force the mouth open during a seizure can cause damage to 
the teeth and mouth, and is no longer taught or recommended.  One thing 
mom might be able to do is stick her finger in the angle of the jaw 
where there are no teeth as soon as she feels any stiffening, but her 
finger might be injured.  She can press right through the skin diagnally 
back from the corner of the mouth, so she doesn't waste any time trying 
to get inside the mouth.  This could prevent the mouth from completely 
closing before she can get her breast out.  My concern is that she could 
lose her grip before the nipple is completely out of the danger zone, 
and wind up with worse damage than if she had stayed put.

Another option is to have him re-evaluated by a comprehensive epilepsy 
center with a pediatric division, to make sure he is on the most 
effective treatment possible.  Some of the newer drugs (particularly 
topiramate and lamotrigine) are proving to be more effective than the 
old standbys.
It would be useful to know if the seizures are generalized (occurring 
throughout the whole brain at once) or secondarily generalized (starting 
in one area and spreading).  There are generally no warning signs for 
generalized seizures (except the baby might be cranky or out of sorts 
for a day or two before a seizure) but there are generally warning signs 
and sensations for a secondarily generalized seizure. Your suggestion to 
look for subtle warning signs is a good one.

Another good thing for mom to know is that if the baby has not had a 
seizure while bf in 10 mos, despite frequent seizures, it is unlikely 
that he will.  Seizures tend to be somewhat stereotyped as to 
situation.  I know one child who had one during soccer games, every 
single time he played.  He was ultimately cured by surgery-removal of 
one half of one hippocampus which had scar tissue from an in-utero stroke.
Hope some of this helps.
Catherine Watson Genna, IBCLC  NYC

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