Epilepsy/Seizures: What to do when someone has a seizure?

Seizures are sudden spikes in the brain's electrical activity that can lead to physical changes like uncontrolled movements, stiffness, changes in consciousness, or behavioral alterations. Epilepsy has got to be the most well cause of seizures, but other causes — sometimes as temporary as taking a certain medication — can also induce seizures. 

Why should you know what to do when someone has a seizure?

Watching someone having an epileptic attack or a seizure of any type is very frightening, so yes, everybody should know more about seizures and their symptoms. If a friend or a family member has epilepsy, you should know what to do in that situation.

If you recognize someone having a seizure you can help that person. Knowing what to do and what not to do when someone has a seizure is very important. In the majority of epileptic seizures, seizures last only a few minutes and do not require medical attention.

Seizures are paroxysmal episodes of sudden, involuntary muscle contractions and alterations in consciousness, behavior, sensation, and autonomic functioning. The episodes may be partial simple or complex or generalized absence, myoclonic, tonic, clonic, tonic-clonic and are labeled epilepsy if they are recurrent. [1]

Symptoms of a seizure

Help required during seizures depends on:

• The type of seizure
• How long the seizure lasts
• How the seizure affects the person's consciousness
• How severe it is. [1]

A person watching an epileptic attack should carefully note the nature of the seizure to tell the doctor. Symptoms of an epilepsy seizure can be:

• Motor
• Psychic 
• Sensory 

Motor symptoms of seizures include repetitive involuntary muscle contractions of one body part (face, finger, hand, or arm) that may spread to other or same-side body parts. This can manifest as violent shaking, as you've probably seen in movies, but also be much more subtle.

Psychic symptoms include a sensation of deja vu, complex hallucinations or illusions, unwarranted anger or fear, pupillary dilation and sweating. People can also have absence seizures, in which they may stare blankly into space and seem to be completely unaware of 

Sensory symptoms are auditory or visual hallucinations, paresthesias, and vertigo or dizziness. 

These kinds of seizures are also called focal seizures.

How to recognize when someone is having a seizure?

Seizures may occur several times a day to one every few years in people with epilepsy.

Seizures can occur during sleep or after stimulation, such as a blinking light or a sudden loud sound.

Most epileptic attacks are brief. They may affect the entire body or a small area. The muscles may contract and relax violently or only twitch slightly, if at all — not all seizures cause obvious, externally-observable, motor symptoms, and the only sign that someone with epilepsy is having a seizure may be that they appear to have lost conscious contact with their surroundings.

Mental confusion and tiredness can last for several minutes or hours or days. Petit mal attacks are marked by a loss of consciousness for several seconds and eye or muscle fluttering. Grand mal seizures are the classic muscle contractions involving the entire body, loss of consciousness, and often loss of bowel control. Drowsiness or confusion often follow seizures. Some seizures may require basic first aid.

• A person with generalized absence could have a temporary loss of consciousness, flickering of the eyelids or intermittent jerking of the hands.
• A person with myoclonic seizures may have rapid, jerky movements in extremities or over the entire body, which may cause a fall.
• Someone with tonic seizures could have a sudden abnormal dystonic posture, deviation of eyes and jerk their head to one side.
• A person with clonic seizures may have symmetric jerking of the extremities for several minutes with a loss of consciousness.
• A person with tonic-clonic may have an aura of epigastric discomfort, outcry, loss of consciousness, cyanosis, fall, tonic then clonic contractions, then limpness, sleep, headache, muscle soreness, confusion, and lethargy, and loss of bowel and bladder control. The person could also have irregular breathing and a blue tinge around the mouth.[2]

What should you do when someone is having a seizure?

1. During a seizure grand mal seizure, safety precautions can help prevent injury, and you should [3]:
   1. Loosen restrictive clothing and take any glasses the person is wearing off.
   2. Roll the person on one side to prevent aspiration.
   3. Place a small pillow (or even a sweater, for instance) under the head and ease them from a standing or sitting position to the floor.
   4. Don't move the person unless he or she is in immediate danger.
   5. Move furniture or any other objects that hat might injure the person during the seizure.
   6. If a person having an attack is standing, prevent him or her from falling if you can, or try to guide them to the floor gently.
   7. If the person with epilepsy is already on the ground, try to position the person on his or her side (recovery position) so that fluid can leak out of the mouth, preventing the patient from aspirating it. However, do not apply pressure to the individual's body because you may cause an injury.
   8. You shouldn’t place a finger or other object into the individual's mouth to protect or straighten the tongue — it is unnecessary and dangerous, having the potential to break their teeth or jaw and to cause choking, unless an object is obstructing the breathing pathway.
2. If the person having a seizure is unconscious, make sure nothing is blocking the nose or mouth. Put the person in the recovery position. Clear person's mouth if necessary. 
3. Don't perform artificial respiration during a seizure, even if the person is turning blue. Most seizures are very brief (up to 2 minutes) and over long before brain damage from lack of oxygen begins.
4. You should not try to hold the person still because you may injure the individual or yourself.
5. If the person has vomited, you should roll the person on his side so that any fluid can easily flow out of the mouth and not obstruct breathing.
6. If a person experience a seizure, they may not hear you. Nonetheless, you can say that you're there, you'll be staying with them until the seizure passes, and you're trying to help.
7. Don’t give the person anything to eat or drink until the person fully recovers.
8. Don't give the person medication by mouth until the seizure has stopped and he or she is completely awake and alert.
9. You should be calmly reassuring. When you are watching an epileptic attack, you should stay very calm and try not to panic, something that could induce panic in the person having the seizure as well.
10. Stay with the person until recovery is complete.
11. You should maintain a clear airway, note frequency, type, time, affected body parts, and length of seizure.
    Monitoring vital signs and neurologic status is critical.

What Should You Do When A Seizure Stops?

• After a minute or two, the seizure and jerking movements should stop.
• After the seizure, you should gently turn the person's head to the side to let the saliva flow out of the mouth.
• Let the person rest or sleep. After a seizure ends, many people sleep deeply and others will need time to recover, feeling fatigued. 
• Be reassuring and calm as awareness returns.
• When the person awakens, he or she may feel disoriented for a while. You should repeat any information the person has missed during the seizure. [3]
• If the person who had the seizure is a stranger to you, you could offer to call a relative or friend for them or get them a taxi home.

Complications may occur as a result of the onset of seizure activity and can include injury from a fall or jerking, as well as airway occlusion and aspiration. You could help and prevent these complications if you learn how.

You should know that a condition also known as status epilepticus, in which motor sensory or psychic seizures follow one another with no intervening periods of consciousness, is a medical emergency. Status epilepticus is usually convulsive. The seizures persist for 30 minutes or more. The airway occlusion and aspiration combined with muscular contractions during a seizure puts stress on the cardiovascular system. The lack of oxygen may lead to brain damage. If the person doesn’t get immediate treatment they may have hypoxia, hyperthermia, hypoglycemia, and acidosis. That may cause death. You could save someone’s life. [4] 

READ Epilepsy: Seizures when sleeping

When To Call A Doctor About A Seizure?  

Call a doctor if you know this is the person's first seizure.

If the person is injured during the seizure you should call a doctor. If the person is pregnant, has diabetes, or has high blood pressure you should find medical help. If the person has a seizure in water, call a doctor. [5]

When you help someone, you will feel better. When you know how to help, you should always help someone with a health problem.      

While epilepsy cannot be cured, for some people the seizures can be controlled with medication, diet, devices, and/or surgery. Once epilepsy is diagnosed, it is important to begin treatment as soon as possible.

In about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques.