Seizure disorders take several forms, depending on where in the brain the malfunction takes place and how much of the total brain area is involved. Partial seizures affect only part of the brain. Partial seizures can be simple (during which a person remains awake and aware) or complex (during which a person’s awareness is clouded). Generalized seizures affect the whole brain.
Since seizure disorders are so different in their effects, they require different kinds of action from the public. First aid for epilepsy is basically very simple: it is to keep the person safe until the seizure stops naturally by itself. It is important for the public to know how to respond to all seizures, including the most noticeable kind — the generalized tonic clonic seizure, or convulsions. Some require no action at all. In all circumstances, please stay calm and remain with the person until they are fully awake, recovered and reoriented.
Types of seizures:
I. (Generalized) Tonic Clonic Seizures (Previously called Grand Mal Seizures)
These seizures are the ones most people generally think of when they hear “epilepsy”; they cause a person to undergo convulsions which usually last from 2 to 5 minutes, with complete loss of consciousness and muscle spasms.
Description: Sudden cry, fall, or rigidity, followed by muscle jerks, shallow breathing or temporarily suspended breathing, bluish skin, possible loss of bladder or bowel control; the seizures usually last a couple of minutes. Normal breathing then starts again. There may be some confusion and/or fatigue, followed by return to full consciousness.
What it is not: Heart attack or stroke
- Look for medical identification
- Protect from nearby hazards
- Loosen ties or shirt collars, remove glasses
- Protect head from injury by putting something soft and flat under the head
- Turn the person on their side to keep airway clear–unless an injury may exist
- Reassure the person as consciousness returns
- If a single seizure lasted less than 5 minutes, ask the person if a hospital evaluation is wanted
- If multiple seizures or if one seizure lasts longer than 5 minutes, call 911
- If person is pregnant, injured or diabetic, call for aid at once
What not to do:
- Don’t put anything in the person’s mouth
- Don’t try to hold the person’s tongue (It can’t be swallowed)
- Don’t try to give liquids during or just after a seizure
- Don’t use artificial respiration unless breathing is absent after muscle jerks subside or unless water has been inhaled
- Don’t restrain the person
II. (Generalized) Absence Seizures (Previously called Petit Mal Seizures)
These seizures take the form of a blank stare lasting a few seconds.
Description: A blank stare, beginning and ending abruptly, lasting only a few seconds, most common in children. May be accompanied by rapid blinking and/or chewing movements in the mouth. Person is unaware of what’s going on during the seizure, but they quickly return to full awareness once the seizure has stopped. May result in learning difficulties if not recognized and treated.
What it is not: Daydreaming, lack of attention or deliberate ignoring of adult instructions
- No first aid necessary, but if this is the first observation of the seizure(s), a medical evaluation is recommended
III. (Partial) Simple Partial Seizures
Partial seizures produce involuntary movements of the arm or leg, distorted sensations or a period of automatic movement in which awareness is blurred or completely absent.
Description: Jerking may begin in one area of the body, arm, leg or face. The jerking can’t be stopped, but the patient stays awake and aware. Jerking may proceed from one area of the body to another and sometimes spreads to become a convulsive seizure.
Partial sensory seizures may not be obvious to an onlooker. A patient experiences a distorted environment; they may see or hear things that aren’t there; they may feel unexplained fear, sadness, anger or joy; they may have nausea, experience odd smells or have a generally “funny feeling” in the stomach.
What it is not: Acting out, bizarre behavior, hysteria, mental illness, psychosomatic illness, parapsychological or mystical experience.
- No first aid is necessary unless the seizure becomes convulsive, then follow first aid instructions under Generalized Tonic Clonic Seizure
- No immediate action is needed other than reassurance and emotional support
- Medical evaluation is recommended
IV. (Partial) Complex Partial Seizures (Previously called Psychomotor or Temporal Lobe Seizures)
Description: Usually starts with a blank stare, followed by chewing, followed by a random activity; person appears unaware of surroundings, they may seem dazed and mumble; they may be unresponsive; their actions will be clumsy, not directed; they may pick at or fumble with their clothing, they may pick up objects or try to take their clothes off; they may wander or run; they may appear afraid; they may struggle or flail at restraint. Once a pattern is established, the same set of actions usually occurs with each seizure. The seizure lasts a few minutes, but post-seizure confusion can last substantially longer. There will be no memory of what happened during the seizure period.
What it is not: Drunkenness, intoxication on drugs, mental illness or disorderly conduct
- Speak calmly and reassuringly to the person
- Guide gently away from obvious hazards (ex: hot stove, stairs, traffic)
- Stay with the person until they are completely aware of their environment
- Offer to help the person in getting home
What not to do:
- Don’t grab hold of the person unless sudden danger (such as a cliff edge or approaching car) threatens
- Don’t try to restrain the person
- Don’t shout
- Don’t expect verbal instructions to be followed
V. (Generalized) Atonic Seizures (Also called Drop Attacks)
Description: A person suddenly collapses and falls. After 10 seconds to a minute, he recovers, regains consciousness and can stand and walk again.
What it is not: Clumsiness, normal childhood “stage”, lack of good walking skills (child), drunkenness or acute illness (adult)
- No first aid is needed, unless person hurt themselves as they fell
- Children should be given a thorough medical evaluation
VI. (Generalized) Myoclonic Seizures
Description: Sudden brief, massive muscle jerks that may involve the whole body or just parts of the body. These seizures may cause a person to drop what they were holding or fall off a chair.
What it is not: Clumsiness or poor coordination
- No first aid needed, but a thorough medical evaluation is recommended.
VII. (Generalized) Infantile Spasms
Description: These are clusters of quick, sudden movements that start between 3 months and 2 years of age. If a child is sitting up, their head will fall forward and their arms will flex forward. If a child is lying down, their knees will be drawn up, with their arms and head flexed forward as if they are reaching for support.
What it is not: Normal movements of the baby, colic
- No first aid needed but a doctor should be consulted
First Aid in Special Circumstances
A Seizure in Water
If a seizure occurs in water, the person should be supported in the water with the head tilted so his face and head stay above the surface. He or she should be removed from the water as quickly as possible with the head in this position. Once on dry land, he should be examined and, if he is not breathing, artificial respiration should be begun at once. Anyone who has a seizure in water should be taken to an emergency room for a careful medical checkup, even if he or she appears to be fully recovered afterwards. Heart or lung damage from ingestion of water is a possible hazard in such cases.
A Seizure on an Airplane
If the plane is not filled, and if the seat arms can be folded up, passengers to the left and/or right of the affected person may be reassigned to other seats, so that the person having the seizure can be helped to lie across two or more seats with head and body turned on one side.
Once consciousness has fully returned, the person can be helped into a resting position in a single reclining seat.
If there are no empty seats, the seat in which the person is sitting can be reclined, and, once the rigidity phase has passed, he can be turned gently while in the seat so that he is leaning towards one side.
Pillows or blankets can be arranged so that the head doesn’t hit unpadded areas of the plane. However, care should be taken that the angle at which the person is sitting is such that his airway stays clear and breathing is unobstructed.
A Seizure on a Bus
Ease the person across a double or triple seat. Turn him on his side, and follow the same steps as indicated above. If he wishes to do so, there is no reason why a person who has fully recovered from a seizure cannot stay on the bus until he arrives at his destination
Head Injury During a Seizure
If the person hits his or her head while falling, his or her post-seizure condition should be carefully monitored. Although sleepiness and confusion are natural consequences of a seizure, it should always be possible to rouse the person without difficulty. A person who fails to return to consciousness after a seizure needs further medical assessment. If head injury is a possibility, the person should be closely observed for the following signs:
- Difficulty in maintaining consciousness (an observer should try to waken the person at 20-minute intervals)
- Vision problems
- Excessive sleepiness two hours or more after the seizure (unless, of course, the seizure has occurred late in the day and the person’s usual bedtime is approaching)
If any of these signs are observed, or if the patient has a persistent headache after a rest period, unconsciousness with failure to respond, unequal pupil size or excessively dilated pupils, or weakness of the limbs, immediate medical attention is essential.
Is an Emergency Room Visit Needed?
An uncomplicated generalized tonic clonic (grand mal) seizure in someone who has epilepsy is not a medical emergency, even though it looks like one. It stops naturally after a few minutes without ill effects. The average person is able to continue about his business after a rest period, and may need only limited assistance, or no assistance at all, in getting home. In other circumstances, an ambulance should be called.
No Need to Call an Ambulance
- if medical I.D. jewelry or card says “epilepsy,” and
- if the seizure ends in under five minutes, and
- if consciousness returns without further incident, and
- if there are no signs of injury, physical distress, or pregnancy.
An Ambulance Should Be Called
- if the seizure has happened in water.
- if there’s no medical I.D., and no way of knowing whether the seizure is caused by epilepsy.
- if the person is pregnant, injured, or diabetic.
- if the seizure continues for more than five minutes.
- if a second seizure starts shortly after the first has ended.
- if consciousness does not start to return after the shaking has stopped.
If the ambulance arrives after consciousness has returned, the person should be asked whether the seizure was associated with epilepsy and whether emergency room care is wanted.