Seizure First Aid

(Note: In 2017 the International League Against Epilepsy has revised its classification of seizures. Please click <HERE> to read the new classification.)

SEIZURE FIRST AID

Generalized Tonic-Clonic (old term, Grand Mal)

Stay calm. Seeing someone who is having a seizure can be quite frightening. Some seizures are violent, but the individual may not need an ambulance.

  1. If required, help the person to the floor.
  2. Clear the area of furniture or other items that could be harmful.
  3. Cushion the person’s head. Loosen any tight clothing around the neck.
  4. Never put anything in the victim’s mouth.
  5. Record how long the seizure lasts and what symptoms occurred.
  6. Keep other people from gathering around too closely.
  7. Avoid holding the person down.
  8. Call 911 if the victim is a child, has multiple seizures, or has a seizure lasting more than 5 minutes.
  9. Stay with the person until the seizure ends. Lay the person on their side (during if possible) when the seizure is over.

Many patients with generalized tonic-clonic seizures have vision, taste, smell, or sensory changes, hallucinations, or dizziness before the seizure. This is called an aura. The seizures usually involve muscle rigidity, followed by violent muscle contractions, and loss of alertness (consciousness). Other symptoms that occur during the seizure may include:

  • Biting the cheek or tongue
  • Clenched teeth or jaw
  • Loss of urine or stool control (incontinence)
  • Stopped breathing or difficulty breathing
  • Blue skin color
  • After the seizure, the person may have:
  • Normal breathing
  • Sleepiness that lasts for 1 hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion
  • Weakness of one side of the body for a few minutes to a few hours following seizure (called Todd’s paralysis)

*** Be patient with the person and try to help him or her find a place to rest if he or she is tired or doesn’t feel well. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.

Non Convulsive Seizures (Focal) – NO FIRST AID IS USUALLY REQUIRED! 

Simple-Partial, not affecting awareness or memory. Complex-Partial, affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior. Absence, they may occur with other types of seizures, such as generalized tonic-clonic seizures (grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures). Most absence seizures last only a few seconds.

  1. Stay Calm and start timing the seizure.
  2. Do NOT restrain the person.
  3. Protect him or her by moving sharp or hot objects away.
  4. If wandering occurs, stay with the person and talk quietly. Do not agitate the person, speak calmly. As the person returns to full consciousness, help re-orient the person to surroundings.

Patients with simple partial seizures can have any of the symptoms below, depending on where in the brain the seizure starts. They will not lose consciousness and will be aware of and remember the events that occur at the time.

Patients with complex partial seizures may or may not remember any or all of the symptoms or events during the seizure.

  • Muscle contraction/relaxation (clonic activity) — common
  • Affects one side of the body (leg, part of the face, or other area)
  • Abnormal head movements
  • Forced turning of the head

Staring spells, with or without complex, repetitive movements (such as picking at clothes) – these are called automatisms

  • Abnormal mouth movements
  • Lip smacking
  • Behaviors that seem to be a habit
  • Chewing/swallowing without cause
  • Forced turning of the eyes

Abnormal sensations

  • Numbness, tingling, crawling sensation (like ants crawling on the skin
  • May occur in only one part of the body, or may spread
  • May occur with or without motor symptoms
  • Hallucinations
  • Abdominal pain or discomfort
  • Nausea
  • Sweating
  • Flushed face
  • Dilated pupils
  • Rapid heart rate/pulse

Other symptoms include:

  • Blackout spells — periods of time lost from memory
  • Changes in vision
  • Sensation of déjà vu
  • Changes in mood or emotion

Absence (old term, Petit Mal) – NO FIRST AID IS USUALLY REQUIRED!  

Most commonly they involve staring episodes or “absence spells.” The episodes may:

  • Occur many times a day
  • Occur for weeks to months before being noticed
  • Interfere with school and learning
  • Be mistaken for lack of attention or other misbehavior
  • Unexplained difficulties in school and learning difficulties may be the first sign of absence seizures. During the seizure, the person may:
  • Stop walking and start again a few seconds later
  • Stop talking in mid-sentence and start again a few seconds later
  • The person usually does not fall during the seizure. Immediately after the seizure, the person is usually:
  • Wide awake
  • Thinking clearly
  • Unaware of the seizure

Specific symptoms of typical absence seizures may include changes in muscle activity, such as:

  • No movement
  • Hand fumbling
  • Fluttering eyelids
  • Lip smacking
  • Chewing

Changes in alertness (consciousness), such as:

  • Staring episodes
  • Lack of awareness of surroundings
  • Sudden halt in movement, talking, and other awake activity
  • May be triggered by hyperventilation or flashing lights, in some cases typical absence seizures begin slower and last longer.
  • Symptoms are similar but muscle activity changes may be more noticeable.

***If you see someone having a non-convulsive seizure, remember that the person’s behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures.

A Seizure in Water

Support the person in the water with the head tilted so the face and head stay above the surface. The person should be removed from the water as quickly as possible with the head in this position. Once on dry land, the person should be examined and, if not breathing, artificial respiration should begin at once. Anyone who has a seizure in water should be taken to an emergency room for a careful exam, even if it appears that they are fully recovered after wards. Heart or lung damage from ingestion of water is a possible hazard in such cases.

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