Witnessing someone with epilepsy having a seizure can be truly frightening. But most seizures aren’t an emergency. They stop on their own with no permanent ill effects.
There isn’t much you can do to stop a seizure once it starts. But there are simple steps you can take to protect someone from harm during a seizure. It’s worth knowing some basic first aid — and when it’s time to call 999.
What can cause seizures?
Any of the following factors can cause seizures or anything that disturbs the blood flow to the brain: head injury, brain tumours, stroke, meningitis, malaria, eclampsia in pregnancy, poisoning, lack of oxygen, raised body temperature, epilepsy, drug and alcohol use and withdrawal, fainting, cardiac arrest and many more reasons.
Tonic-Clonic Seizures (“Grand Mal”)
Tonic-clonic seizures (older terms: grand mal seizures or convulsions) are the most recognized type of seizure. There are two parts to a tonic-clonic seizure: the tonic phase, which is the stiffening of the body and limbs; and the clonic phase, which is the jerking or convulsing of the body. A tonic-clonic seizure typically lasts 2 to 3 minutes. This seizure is sometimes confused with a heart attack or stroke.
During the seizure, a person may:
- Cry out and fall
- Go rigid
- Lose consciousness
- Begin shaking and rapidly jerk their muscles
- Have trouble breathing
- Bite their tongue or inside of their cheek
- Lose bladder or bowel control
After the seizure, the person:
- May not become fully conscious right away (if it takes more than 30 minutes, they may need to go to the ER)
- May appear confused, tired, or have a headache
- May sleep for several minutes or hours
- Breathes normally and eventually becomes fully conscious
First Aid for Tonic Clonic Seizures
DO –
- Stay calm
- Time the seizure
- Turn the person on their side to keep their airway clear, unless they have an injury
- Protect their head with your hands or a soft object
- Protect them from nearby hazards
- Loosen tight clothing around the neck like ties and collars
- Call an ambulance if the seizure lasts longer than 5 minutes, it is the person’s first seizure, the person is pregnant, or has diabetes
- Keep onlookers away and explain what is happening
- Stay with the person until the seizure is over and consciousness has fully returned
DON’T –
- Put any object in the mouth or try to hold the tongue
- Restrain the person or hold them down
- Give liquids or oral medications until conscious
- Use artificial respiration during the seizure
Absence (Petit Mal)
Absence seizures (older terms: petit mal seizures or staring spells) are a brief loss of awareness causing a person, most commonly children, to stare into space. The seizure usually lasts 5 to 10 seconds and can be easily missed. Absence seizures often happen many times during the day. This type of seizure may be confused with daydreaming or lack of attention.
During the seizure, a person may:
- Stare blankly
- Blink quickly
- Make chewing movements
- Have a glazed look on their face
- Not respond if they are called or touched
- Be unaware of what’s going on around them
- Other symptoms may include: hand gestures, eye fluttering, eye rolling, or a slight facial twitch
After the seizure, the person:
- Becomes fully conscious right away
First Aid for Absence Seizure
- No immediate first aid necessary
DO –
- Try to document duration of the seizure
- Give comfort and reassurance
- Try to document duration of the seizure
- Time the seizures if they begin to cluster
- Help the person reintegrate into the task they were just doing
- Time the seizures if they begin to cluster
Atonic Seizures (Drop Attacks)
Atonic seizures (older term: drop attacks) are a sudden loss of muscle tone, causing the person to fall to the ground or slump over in a chair. This seizure occurs suddenly and with no warning; and the person is not able to react, resulting in possible injuries to the head and face from a fall. The seizure usually lasts 10-60 seconds and is sometimes confused with being clumsy, poor walking skills, or being drunk.
During the seizure, a person may:
- Suddenly lose muscle control or suddenly fall
- Lose consciousness
After the seizure, the person:
- Becomes fully conscious
- Can stand and walk
- May be sore or injured from the fall and need first aid
First Aid for Absence Seizure
- No first aid needed unless the person is hurt during a fall
DO –
- Provide emotional support and reassurance
Myoclonic Seizures
Myoclonic seizures are sudden, brief, massive muscle jerks that may involve the whole body or parts of the body. The seizure lasts only a few seconds and the person maintains consciousness throughout. Myoclonic seizures can often occur in conjunction with various epilepsy syndromes. This seizure is sometimes confused with clumsiness or poor coordination.
During the seizure, a person may:
- Suddenly jerk their whole body or part of their body
- Spill a drink, drop an object, or fall off of a chair
- Maintain consciousnes
After the seizure, the person:
- May be sore or injured from the fall and need first aid
First Aid for Myoclonic Seizures
- No first aid needed unless injury occurs
DO –
- Provide emotional support and reassurance
Infantile Spasms
Infantile spasms are myoclonic seizures in young children 3 to 24 months old. This seizure is sometimes confused with the child asking to be held or colic.
The individual spasms last only 1 or 2 seconds. They often repeat in a series of 5 to 50 or more. A child may have many series per day.
During the seizure, a person may:
- Move their body suddenly
- Let their head and arms fall forward
- Fold up their knees and lift up their arms and head
First Aid for Infantile Spasms
- Take the baby to the doctor or emergency department if this is the first time
DO –
- Document the duration of the seizure
Febrile Seizures
Febrile seizures are seizures that occur as a result of a high fever. These typically occur in children under 5 years of age and generally last anywhere from a few seconds to a few minutes.
Febrile seizures are not necessarily indicative of a diagnosis of epilepsy, but they can be just as scary as epileptic seizures. If this is the first time your child is having a febrile seizure, they should be transported to an emergency room for evaluation; from there, the physician will provide instructions on how to move forward if your child experiences another febrile seizure.
Even though febrile seizures do not necessarily constitute a diagnosis of epilepsy, the first aid procedures are the same for tonic-clonic seizures.
Focal Without Altered Awareness, Focal Aware Seizures (Simple Partial)
Focal without altered awareness (older term: simple partial) seizures do not cause loss of awareness. The person is awake and alert but may not be able to speak or move until after the seizure is over. People may also refer to this type of seizure as an aura. They typically last 1 to 2 minutes and may progress to become a tonic-clonic seizure. This seizure is sometimes confused with acting out, hysteria, mental illness, mystical experiences, or psychosomatic illness.
During the seizure, a person may:
- Jerk their body, arm, leg, or face
- Experience a distorted environment
- See or hear things that aren’t there
- Feel scared, sad, angry, or happy for no reason
- Have nausea, sense odd smells, or have a funny feeling in the stomach
- Feel like vomiting or have a stomach ache
After the seizure, the person:
- May need to rest
First Aid for Focal Aware Seizures
DO –
- Stay calm
- Time the seizure
- Protect the person from harm
- Keep onlookers away and explain what is happening
- Stay with the person and support them when the seizure ends
- If the seizure becomes convulsive, then first aid is required as described for generalized tonic-clonic seizures above
Focal With Altered Awareness, Focal Impaired Awareness Seizures (Complex Partial)
Focal with altered awareness (older term: complex partial) seizures will change a person’s awareness. The seizure may start with a blank stare, followed by repeated movements (called automatisms). Once a pattern is established, the same set of actions usually occur with each seizure. These seizures typically last 1 to 2 minutes, but post-seizure confusion can last substantially longer. When it is over, the person will not remember what happened during the seizure. These seizures may progress to become a tonic-clonic seizure. This seizure is sometimes confused with drunkenness, drug use, mental illness, disorderly conduct, or acting out.
During the seizure, a person may:
- Stare blankly
- Make chewing movements
- Move their body in unusual ways
- Not answer questions
- Be unaware, seem dazed
- Pick at clothing or try to take off their clothes
- Seem scared or confused
- Run, pick up objects, or mumble Struggle or flail at restraint
After the seizure, the person:
- Is confused
- Can’t remember what happened
First Aid for Focal Impaired Awareness Seizures (FIAS)
DO –
- Stay calm
- Time the seizure
- Guide away from obvious hazards (like stairs or traffic)
- Speak calmly and reassuringly to person
- Keep onlookers away and explain what is happening
- Stay with the person and support them when it’s over
- If the seizure becomes convulsive, then first aid is required as described for generalized tonic-clonic seizures above
DON’T –
- Grab the person, unless there is sudden danger such as a cliff or an approaching car
- Try to restrain
- Shout
Psychogenic Non-Epileptic Seizures (PNES)
Psychogenic non-epileptic seizures (PNES) are sudden, disruptive changes in a person’s behavior which resemble epileptic seizures but no electrophysiological changes in the brain are seen.
These events may be related to physical illness, or a psychiatric or emotional disorder. They are sometimes referred to as “Pseudoseizures”.
While epilepstic seizures can occur at any time and any place, most psychogenic seizures occur only during the daytime with observers present.
Prolonged seizures are often common with psychogenic seizures, as are bizarre behaviors before, during, and after the seizure has occurred.
How a convulsive PNES seizure is different:
- Typically, there’s no tongue biting, or if there is, it’s usually the tip of the tongue rather than the side
- Incontinence is extremely uncommon
- Significant injury is extremely uncommon
How a non-convulsive PNES seizure is different:
- Eyes are typically fully closed, and person is resistant to passive eye opening
- Automatisms are typically absent
- Moaning and crying may occur
First Aid for PNES
- Same first aid protocol as epileptic seizures and should be treated as such in the moment
- Treatment methods outside of the seizure itself will vary, as psychogenic seizures do not typically respond to anti-epileptic drugs (AEDs) and other treatments that are typical for those diagnosed with epilepsy.
Other places where seizures can occur:
People can have a seizure when going out due to various triggers, most commonly in environments with flashing lights, such as clubs and or concerts. Other triggers include dehydration, lack of sleep, alcohol, and stress, which can occur at any social gathering or public place. Knowing personal triggers and planning ahead can help mitigate the risk.
In Water
Remove the person as quickly as possible, while supporting the body and keeping the head tilted. The head and face should stay above the surface. Once on dry land, examine the person and begin artificial respiration immediately if he/she isn’t breathing. The person should be taken to the emergency of a local hospital for a careful medical check-up, even if he/she appears to have fully recovered from the seizure. Inhaling water can cause heart or lung damage.
In Aeroplane
If possible, help the person lie across two or more seats with the head and body turned on one side. Once consciousness has been fully regained, help the person into a resting position in a single reclining seat.
If there aren’t any empty places, recline the person’s seat. Once the seizure’s rigidity phase has passed, turn the person gently in the seat so that he/she is leaning towards one side.
You can arrange pillow or blankets to protect the person’s head from hitting unpadded areas of the plane, but make sure the person is sitting at an angle that keeps the airway clear and breathing is unobstructed.
On a Bus
Lie the person across a double or triple seat, turn the person on the side and follow the same steps as indicated above. A person who has fully recovered from a seizure can stay on the bus until arriving at his/her destination.
First aid for people who use a wheelchair
- Put the brakes on, to stop the chair from moving
- Allow the person to remain seated in the chair during the seizure (unless care plan says to move them). Moving the person could possibly lead to injuries for the person having the seizure and the carer. There could be certain attachments or medical reasons for the person to remain within the chair.
- If the person has a seatbelt or harness on, leave it fastened
- If the person doesn’t have a seatbelt or harness, support them gently, so they don’t fall out of the chair
- Cushion the person’s head and support it gently
- Do not restrain
- Afterward, talk gently to the person, be comforting and reassuring and stay with them until they become re-oriented
If you use a wheelchair or any other mobility device, speak with your doctor about any specific treatment options or care packages they would like you to follow during or after a seizure.
- Don’t panic. Take deep breaths and remain calm.
- When possible, note the time the seizure began so you’ll know if it goes on too long (five minutes or more).
- If they’re sitting in a chair, gently guide them to the floor or try to prevent them from falling. Head injuries are common and usually result from the fall at the onset of the seizure.
- Move all heavy or sharp objects away from them. This includes tables, chairs, or any other hard furniture.
- Try placing something soft, like a jacket or blanket, beneath the person’s head to help prevent head injuries.
- Remove their eyeglasses if you can safely do so.
- If possible, roll them onto their side.
- While it may be helpful to loosen belts or ties to help them breathe easier, never hold somebody down during a seizure.
- Stay with them until the seizure is over, then be sensitive and provide support.
In Water
Remove the person as quickly as possible, while supporting the body and keeping the head tilted. The head and face should stay above the surface. Once on dry land, examine the person and begin artificial respiration immediately if he/she isn’t breathing. The person should be taken to the emergency of a local hospital for a careful medical check-up, even if he/she appears to have fully recovered from the seizure. Inhaling water can cause heart or lung damage.
In an Airplane
If possible, help the person lie across two or more seats with the head and body turned on one side. Once consciousness has been fully regained, help the person into a resting position in a single reclining seat.
If there aren’t any empty places, recline the person’s seat. Once the seizure’s rigidity phase has passed, turn the person gently in the seat so that he/she is leaning towards one side.
You can arrange pillow or blankets to protect the person’s head from hitting unpadded areas of the plane, but make sure the person is sitting at an angle that keeps the airway clear and breathing is unobstructed.
On a Bus
Lie the person across a double or triple seat, turn the person on the side and follow the same steps as indicated above. A person who has fully recovered from a seizure can stay on the bus until arriving at his/her destination.
First aid for people who use a wheelchair
- Put the brakes on, to stop the chair from moving
- Allow the person to remain seated in the chair during the seizure (unless care plan says to move them). Moving the person could possibly lead to injuries for the person having the seizure and the carer. There could be certain attachments or medical reasons for the person to remain within the chair.
- If the person has a seatbelt or harness on, leave it fastened
- If the person doesn’t have a seatbelt or harness, support them gently, so they don’t fall out of the chair
- Cushion the person’s head and support it gently
- Do not restrain
- Afterward, talk gently to the person, be comforting and reassuring and stay with them until they become re-oriented
If you use a wheelchair or any other mobility device, speak with your doctor about any specific treatment options or care packages they would like you to follow during or after a seizure.
- Don’t panic. Take deep breaths and remain calm.
- When possible, note the time the seizure began so you’ll know if it goes on too long (five minutes or more).
- If they’re sitting in a chair, gently guide them to the floor or try to prevent them from falling. Head injuries are common and usually result from the fall at the onset of the seizure.
- Move all heavy or sharp objects away from them. This includes tables, chairs, or any other hard furniture.
- Try placing something soft, like a jacket or blanket, beneath the person’s head to help prevent head injuries.
- Remove their eyeglasses if you can safely do so.
- If possible, roll them onto their side.
- While it may be helpful to loosen belts or ties to help them breathe easier, never hold somebody down during a seizure.
- Stay with them until the seizure is over, then be sensitive and provide support.