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What to do when someone has a seizure

Knowing how to help someone during and after an epileptic seizure may help you, and them, feel more confident if a seizure happens. How you can help the person may depend on the type of seizures they have. If you know the person, they may have told you about their epilepsy and how you can help them if they have a seizure. If you don’t know about their epilepsy, this leaflet gives you some general guidance on how you can help if they have a seizure.

Epileptic seizures

The brain is made up of millions of nerve cells which control the way we think, move and feel. The nerve cells do this by passing electrical signals to each other. In some people, these signals may suddenly be interrupted, and this can cause an epileptic seizure (sometimes called a ‘fit’ or ‘attack’).

Are all epileptic seizures the same?

There are many different kinds of epileptic seizure. How epilepsy affects one person can be different to how it affects someone else.

• Some people have more than one type of seizure.
• Some people only have seizures when they are awake.
• Some people have nocturnal seizures. Nocturnal seizures happen when the person is sleeping. The term does not explain what type of seizures they are, only that they happen when the person is asleep.
• Some people have seizures when they are awake and when they are asleep.
• Most epileptic seizures happen suddenly, without warning, last a short time (a few seconds or minutes) and stop by themselves.
• Injuries can happen during a seizure, but most people do not hurt themselves and do not usually need to go to hospital or see a doctor.

Types of epileptic seizures and what to do

Epileptic seizures can be divided into two main types: partial seizures and generalised seizures. Seizures can vary from one person to another and how people are affected and how they recover after seizures also varies.
More information about seizure types

Partial seizures

In partial seizures the seizure starts in, and affects, just part of the brain. What happens during the seizure depends on where in the brain the seizure happens and what this part of the brain does.

Simple partial seizures
In a simple partial seizure (SPS) the person is conscious (awake) and aware of what is happening to them. A SPS could be twitching of one limb or part of a limb, an unusual smell or taste, a strange feeling such as a ‘rising’ sensation in the stomach or ‘pins and needles’ in part of the body or a sudden intense feeling of fear or joy.

What to do during the seizure:

• although the person is awake and aware, SPS can feel unsettling so giving gentle reassurance may be helpful.

Complex partial seizures
A complex partial seizure (CPS) affects a bigger part of the brain than SPS. In a CPS the person’s consciousness is affected and they may be confused. You might notice them wandering around or behaving strangely and they may not understand what they are doing. They may pick objects up for no reason, fiddle with their clothes or make chewing movements with their mouth. Afterwards, they may need to sleep; or they might be confused for some time. CPS may last from a few seconds to a few minutes.

What to do during the seizure:

• do not restrain them as this may upset or confuse them
• gently guide them away from dangerous situations (such as walking into the road)
• as they are likely to be confused, if you speak loudly or act forcefully this may confuse them further and they may mistake your help for being hostile, and respond in an upset or aggressive manner. Speak quietly and calmly so that they are not startled.

After the seizure stops:

• they may feel tired and need to sleep
• they may be confused and not fully aware of their surroundings so it may help to remind them where they are
• stay with them until they have recovered, and can safely return to what they were doing before the seizure.
  Some people recover quite quickly after their seizures, others may take longer to feel back to normal again.

Secondarily generalised seizures

For some people SPS and CPS develop into a generalised seizure (see below). When this happens the person becomes unconscious and will usually have a tonic clonic seizure. This is called a secondarily generalised seizure because it starts as a partial seizure and then becomes generalised. Some people call their partial seizure an ‘aura’ or ‘warning’ because it warns them that a generalised seizure may follow.

What to do during the seizure:

• if they are aware of an aura or warning, they may need help to make themselves safe before the generalised seizure happens.

Generalised seizures

Generalised seizures affect all of the brain at once. The person becomes unconscious and afterwards will not remember what happened during the seizure.

Absences (sometimes called petit mal)
During an absence a person becomes unconscious for a short amount of time, usually a few seconds. They may look blank and not respond to what is happening around them. For example, if they are walking they may continue to walk, but will not be aware of what they are doing during the absence. What to do during the seizure:

• stay with them, and if necessary, gently guide them away from any danger.

Tonic and atonic seizures
In a tonic seizure the person’s muscles suddenly become stiff. If they are standing they often fall backwards and may injure the back of their head. In an atonic seizure (sometimes called a drop attack) the person’s muscles suddenly relax, and they become floppy. If they are standing they often fall forwards and may injure their head. Tonic and atonic seizures tend to be very brief and happen without warning. People usually recover quickly.

What to do after the seizure:

• as they recover they may need reassurance. If they have been injured, they may need medical help.

Myoclonic seizures
Myoclonic seizures involve the jerking of a limb or part of a limb. They are brief and can happen in clusters with many happening close together in time. They often happen shortly after waking up from sleep. As they are so brief, there is nothing that needs to be done to help the person other than making sure they haven’t hurt themselves.

Tonic clonic (convulsive) seizures (sometimes called grand mal seizures)
When a person has a convulsive seizure they usually fall to the ground and make shaking or jerking movements. During the seizure their breathing might be affected and they may go blue, especially around their mouth. They may also bite their tongue.

Although this can be frightening to watch, these seizures are not usually a medical emergency. Usually, once the jerking has stopped, the person recovers and their breathing goes back to normal.

Partial seizures

Secondarily generalised seizures

Generalised seizures

Recording information about seizures

What do I need to know about somone's epilepsy?

ID cards and medical jewellery

Training in first aid for epilepsy

About pdfs

What to do during the seizure:

• try to stay calm
• note the time to check how long the seizure is going on (because there may be a risk of status epilepticus - see below)
• move objects, such as furniture away from the person if there is a risk of injury. Only move the person if they are in a dangerous place; for example, at the top of stairs or in the road (see photo)
• put something soft (like a jacket or cushion) under their head, or cup their head in your hands, to stop their head hitting the ground (see photo)
• do not restrain them, allow the seizure to happen
• do not put anything in their mouth - there is no danger of them swallowing their tongue during the seizure
• try to stop other people from crowding around.

What to do when the jerking (convulsing) has stopped (recovery):

• roll them on to their side into the recovery position
• wipe away any spit and if their breathing is difficult check their mouth to see that nothing is blocking their airway, like food
• try to minimise any embarrassment. If they have wet themselves deal with this as privately as possible
• stay with them, giving reassurance, until they have fully recovered.

Some people recover quickly after these seizures but more often the person will be very tired, may want to sleep and may not feel ‘back to normal’ for several hours or sometimes days.

How to put someone into the recovery position
(when they are lying on the floor)

• Place their arm nearest to you at a right angleangle to their body, with the palm facing upwards.
• Lift their other arm across their body putting the back of their hand against their cheek nearest you. Hold it there with your hand.
• Using your other hand, lift the knee furthest from you, and pull it upwards so that their leg is bent and their foot is flat on the floor.
• Keeping their hand against their cheek, pull the bent knee towards you. This will roll them onto their side. Keep the knee bent and position this leg at a right angle to their body.
• Make sure their airway is open by gently tilting their head back and lifting their chin. Check that nothing is blocking their throat that and they are breathing.
• If you are not happy with how they are recovering, call for help.

Status epilepticus

Most people's seizures last the same length of time each time they happen, and usually stop by themselves. However, sometimes seizures do not stop, or one seizure follows another without the person recovering in between. When a seizure goes on for 30 minutes or more it is called status epilepticus, or 'status' for short.

Status can occur in any type of seizure and the person may need to see a doctor. However, status in a tonic clonic (convulsive) seizure is a medical emergency. It is important to call for an ambulance before the seizure goes on too long. Do not wait until it has lasted 30 minutes before calling for help. See the information box above for when to call for an ambulance.

Some people who go into status are prescribed a form of emergency (or rescue) medication called diazepam to stop their seizures. Carers will need training on how to give rectal diazepam and it is important to have a written protocol for each individual, for the carer to follow.
For more information about medication for status, see medication for adults and medication for children.

How else can I help? - recording information about seizures

Because people are often not fully aware during their seizures they might not know what happens to them. Other people who have seen the seizures can often provide useful information for the GP or neurologist. An ‘eyewitness description’ like this may help to diagnose and identify what type of seizures a person is having.

If you see someone having a seizure, it can be helpful to note the following things.

• Where were they and what were they doing before the seizure?
• Did you notice their mood change - were they excited, anxious or quiet?
• Were there any triggers for the seizure – did they feel tired, hungry or unwell?
• Did they have any warning that the seizure was going to happen?
• Did they have any unusual sensations, such as an odd smell or taste?
• What made you notice the seizure (a noise, did they fall or did their eyes roll)?
• Did they appear to be ‘blank’ or stare into space?
• Did they lose consciousness or were they confused?
• Did they do anything unusual such as mumble, wander about or fiddle with their clothing?
• Did their colour change (become pale or flushed) and if so, where (face, lips, hands)?
• Did their breathing change (e.g. become noisy, or look difficult)?
• Did any part of their body move, jerk or twitch?
• Did they fall down, or go stiff or floppy?
• Did they wet themselves?
• Did they bite their tongue or cheek?
• How long did the seizure last?
• What were they like after the seizure? Did they need to sleep?
• How long was it before they were able to carry on as normal?
• Did you notice anything else?

What do I need to know about someone's epilepsy?

There are some things it can be useful to know about someone's epilepsy, so you can help them if they have a seizure.

• What types of seizures do they have? (for example complex partial seizures or absences).
• How long do their seizures normally last? Epileptic seizures usually stop by themselves. Although the length of seizures is different from person to person a seizure usually lasts the same length of time for each person.
• How often do they have seizures? Some people keep a note of when their seizures happen, in a seizure diary. Contact NSE on 01494 601 392 for a free seizure diary.
• Are their seizures usually triggered or 'brought on' by anything, such as stress or tiredness?
• Do they have a history of status? If so, do they need emergency medication?
• How long does it take them to fully recover after a seizure? Some people recover quickly, others may be confused for a while.
• Do they take anti-epileptic drugs? When do they usually take them?

ID cards and medical jewellery

ID cards and medical jewellery Some people with epilepsy wear or carry something that says they have epilepsy, such as an identity (ID) card or a bracelet or necklace. If they have a seizure the information carried on the ID card or jewellery lets other people know what is happening and how to help.

Order a free ID card in our online shop.
More about ID cards and medical jewellery

Training in first aid for epilepsy

The video 'Epileptic Seizures' contains footage of seizures and information about first aid. It is ideal for training purposes. Order it in the online shop.

Training is available from the NSE on epilepsy awareness, including management of seizures.
Information on NSE training services

UK Epilepsy Helpline: 01494 601400
Monday - Friday 10am - 4pm

© The National Society for Epilepsy
May 2007

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