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first aid for all seizures

These pages are currently being updated with the new International League Against Epilepsy (ILAE) seizure type classifications.

Epileptic seizures can be divided into two main types: focal seizures and generalised seizures. Seizures can vary from one person to another and how people are affected and how they recover after seizures varies. How you can best help someone during a seizure depends on what type of seizure they have and how it affects them.

Focal seizures

Focal seizures start in, and affect, part of the brain: either a large part or just one small area. What happens during the seizure depends on where in the brain the seizure happens and what this part of the brain normally does.

Simple focal seizures

In a simple focal seizure (SFS) a small part of the brain is affected. The person is conscious (aware and alert) and usually knows that the seizure is happening. A SFS could be an unusual smell or taste, a twitching of an arm or hand, a strange feeling such as a ‘rising’ feeling in the stomach or a sudden feeling of joy or fear.

How to help:

  • as the person might feel strange or be upset, reassuring them might be helpful.

Complex focal seizures

Complex focal seizures (CFS) affect more of the brain than simple focal seizures. The person’s consciousness is affected and they may be confused and not know what they are doing. They might wander around, behave strangely, pick up objects or make chewing movements with their mouth. Afterwards, they be confused for a while or need to sleep. CFS can last a few seconds or a few minutes.

How to help:

  • do not restrain the person as this may upset or confuse them
  • gently guide them away from any danger for example from walking into the road
  • speak gently and calmly as they may be confused. If you speak loudly or grab them they might not understand and get upset or respond aggressively.

After the seizure:

  • they may feel tired and want to sleep. It might be helpful to remind them where they are.
  • stay with them until they recover and can safely return to what they had been doing before. Some people recover quickly but others may take longer to feel back to normal again.

Secondarily generalised seizures

Sometimes a focal seizure spreads to affect both sides of the brain. This is called a secondarily generalised seizure as it starts as a focal seizure and then becomes generalised. Some people call these seizures ‘auras’ or ‘warnings’ as it warns them that another seizure may follow. When this happens the person will usually have a tonic clonic seizure.

How to help:

  • if the person is aware of a warning, they may need help to get to a safe place before the generalised seizure happens.

Generalised seizures

Generalised seizures affect both sides of the brain at once and happen without warning. The person usually becomes unconscious and will not remember the seizure afterwards.

Absences (sometimes called petit mal)

During an absence the person becomes unconscious for a short time. They may look blank and stare and will not respond to what is happening around them. If they are walking they may carry on walking, but will not be aware of what they are doing.

How to help:

  • stay with the person and 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 (or 'drop attack') the person’s muscles suddenly relax and become floppy. If they are standing they often fall forwards and may injure their face or head. Both seizures are brief and happen without warning. Most people usually recover quickly.

How to help:

  • reassuring them may be helpful
  • if they are injured they may need medical help.

Myoclonic seizures

Myoclonic means 'muscle jerk', and these seizures involve jerking of a limb or part of a limb. They often happen shortly after waking up, and are brief and can happen in clusters (many happening close together in time).

How to help:

  • you don't need to do anything to help during the seizure other than make sure that the person has not hurt themselves.

Tonic clonic and clonic (convulsive) seizures

During a tonic clonic seizure the person goes stiff ('tonic' phase), usually falls to the ground, and shakes or makes jerking movements (convulsions or 'clonic' phase). Their breathing may be affected and they may go pale or blue, particularly around their mouth. They may also bite their tongue. Some people have clonic seizures without going stiff to start with.

Although it can be frightening to see, this is not usually a medical emergency. Usually, once the convulsions have stopped, the person recovers and their breathing goes back to normal.

How to help:

  • try to stay calm
  • check the time to see how long the seizure goes on for (because there may be a risk of status epilepticus - see below)
  • only move the person is they are in a dangerous place, for example in the road. Instead, move any objects, such as furniture, away from them so that they don't hurt themselves
  • put something soft (such as a jumper) under their head, or cup their head in your hands, to stop it hitting the ground
  • do not restrain them or hold them down - allow the seizure to happen
  • do not put anything in their mouth - they will not swallow their tongue
  • try to stop other people crowding around.

How to help once the shaking stops:

  • roll them on to their side into the recovery position
  • if their breathing sounds difficult or noisy, gently open their mouth to check that nothing is blocking their airway
  • wipe away any spit from their mouth
  • try to minimise any embarrassment. If they have wet themselves deal with this as privately as possible (for example, put a coat over them).
  • stay with them until they have fully recovered. They may need some gentle reassurance.

Some people recover quickly from a tonic clonic seizure but often they will be very tired, want to sleep and may not feel back to normal for several hours or sometimes days.

Most people's seizures will stop on their own and the person will not need any medical help. However, if you are not sure whether someone is recovering from a seizure, they have hurt themselves during the seizure, or you have any concerns about them, you might want to think about when to call for an ambulance.

Some people might injure themselves during a seizure. Dental injuries can be common.

Status epilepticus

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

Status is not common, but can happen in any type of seizure and the person may need to see a doctor.

Status in a tonic clonic (convulsive) seizure is a medical emergency and the person will need urgent medical help. 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 an ambulance. See when to dial 999.

Some people are prescribed emergency medication, either buccal midazolam or rectal diazepam, to stop their seizures. Carers need training in giving emergency medication. It is important to have an individualised written protocol (plan) about when to give it, for the carer to follow.

How else can I help?

Checking the length of a seizure is essential in avoiding status (see above).  Another important reason to check the time and note the length of a seizure is so that you can pass this information on afterwards to the person who has had the seizure.  Many people keep a record of their seizures, and a description of the seizure and how long it lasted can be vital information for them to record, and pass on to their specialist.

More information about recording information about seizures.

 

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Further information

Taken from our First aid leaflet. Order this leaflet from our online shop as part of our 'first five free' offer.

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