What to Do and Not to Do in Case of a Seizure

By Eva Briggs, MD

3D illustration of a synapse part of a neuron or nerve cell. Stock photo.

Your brain’s nerve cells — neurons — communicate with one another via electrical impulses. If the electrical activity is temporarily disrupted, it causes a seizure.

When most people hear the word seizure, they imagine someone losing consciousness, falling over, stiffening and jerking. That is one kind of seizure called a tonic-clonic seizure. Tonic refers to stiffening and clonic refers to jerking movements.

But there are many kinds of seizures.

Seizures are broken down into three broad categories. Focal onset seizures begin in one group of neurons on one side of the brain. The patient may be awake and aware (focal aware seizure) or confused (focal impaired awareness seizure.) A second group of seizures are generalized seizures which start on both sides of the brain at once. This includes tonic-clonic seizures, absence seizures, atonic seizures and others. The third group of seizures is unknown onset when it is not known whether the seizure was focal or generalized at the start. This might happen if the person is alone and the seizure is unwitnessed or if the seizure starts at night while the patient is sleeping.

A seizure is a single event. Epilepsy is a condition where a person has recurrent unprovoked seizures. The following conditions may provoke a seizure: low blood sugar, high fever, infection, injury, sleep deprivation, stress, dehydration and exposure to flashing lights.

Unprovoked seizures don’t have an obvious link to a cause. They may be due to a neurologic disorder, genetics or metabolic disease.

So, what should you do if someone has a seizure?

Things Not to Do

• Don’t put anything into their mouth. People having a seizure will not swallow or choke on their own tongue. But putting something into their mouth could block the airway or injure the teeth or jaw.

• Don’t hold the person down. It will not stop or shorten the seizure but might cause injuries. It could confuse or frighten the person and even make them combative.

• Don’t offer water of food until the person is fully awake and alert. If they are not alert, they could choke and inhale food or water into the lungs.

Things You Should Do

• Check for a medical bracelet or other emergency information. If the person is at risk of falling, call for help and get the person down on the floor. If the person is lying down, gently turn them on their side with their mouth pointing down to help saliva drain away from the airway.

• Clear the area around the person to prevent them from injuring themselves on anything sharp or hard. Keep onlookers away because waking up to an audience might be confusing or embarrassing.

• Stay calm and comfort the person. This can help keep others calm and reassure the patient that he or she is safe. Offer to call a loved one.

Time the seizure. It’s helpful for medical personnel to know how long the seizure lasted from onset to the end. Also, time how long it took to recover and return to baseline.

Stay with the person until the seizure is over. Seizures can be unpredictable. Help them sit in a safe place.

When to Call 911

• A first seizure in someone who has never had a seizure before.

• The person having the seizure asks you to call 911.

• The seizure lasts more than five minutes.

• The person has trouble breathing or waking up after a seizure.

• The person has another seizure shortly after the seizure ends.

• The person is injured during the seizure.

• The seizure happened in water.

• The person has an underlying medical condition such as heart disease, diabetes or pregnancy.

Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.