First aid

An epileptic seizure is caused by a transient disturbance in the brain’s electrical activity. Seizure symptoms interfere with a person’s normal functioning. The type of symptoms that occur during a seizure depends on the location of the abnormal electrical discharge in the brain and how widely it spreads. There are many different types of seizures. The most common seizure types requiring immediate first aid are generalized tonic-clonic seizures and focal impaired awareness seizures.

Most seizures last a few minutes and stop spontaneously. If a seizure is prolonged or if seizures recur so frequently that the person does not recover between them, the person is in a life-threatening situation. In such cases, call the emergency number 112 and follow the instructions given by the emergency dispatcher.

Some individuals with epilepsy may experience warning signs prior to a seizure, such as increased anxiety or irritability. These symptoms alone usually do not require urgent action, and it is generally not necessary to call emergency services 112 because of them. Call 112 only if the actual seizure becomes prolonged or does not resolve as it normally would.

Generalized Tonic-Clonic Seizure (convulsive seizure)

During a generalized tonic-clonic seizure, the person loses consciousness, falls, and the body becomes stiff (tonic phase). The tongue or cheek may be caught between the teeth, which can cause bleeding from the mouth. The stiffening is followed by rhythmic jerking movements (clonic phase). Breathing may stop briefly for a few seconds, and saliva or foam may come from the mouth. The seizure may be followed by a period of postictal sleep, after which the person can be awakened.

A typical generalized tonic-clonic seizure lasts less than 2 minutes. A seizure is considered abnormally prolonged if it lasts continuously for more than 2 minutes or if seizures recur without the person regaining their usual level of consciousness in between.

First Aid Instructions

1. Stay calm.
2. Do not try to restrain the convulsive movements. Protect the person from injury, especially the head (place something soft under the head).
3. Do not put anything into the person’s mouth, as this may obstruct breathing.
4. Turn the person into the recovery (side-lying) position as soon as the convulsions decrease. This helps keep the airway open and allows secretions to drain from the mouth.
5. Make sure the person can breathe freely and that airflow is present.
6. After the seizure has ended, ensure that the person has not been injured and has fully recovered, can answer questions, and knows where they are going before leaving them unattended.

Call the emergency number 112 if:

• The person has difficulty breathing, does not recover, or has been injured during the seizure.
• A person with epilepsy has a prolonged seizure (convulsions last longer than 2 minutes) or the seizure recurs before recovery from the previous seizure.
• You do not know whether the person has epilepsy.

Focal Impaired Awareness Seizure

During a focal impaired awareness seizure, the person may appear confused and is not fully aware of their surroundings. They may perform repetitive, purposeless movements (automatisms), such as wandering aimlessly, rubbing their hands, picking at clothes, or lip-smacking. Awareness is impaired; the person does not understand what is happening and cannot respond appropriately to questions.

A typical focal impaired awareness seizure lasts a few minutes. A seizure is considered abnormally prolonged if it lasts continuously for more than 5 minutes or if seizures recur without the person recovering in between.

First Aid Instructions

1. Stay close to the person and, if necessary, gently guide them to prevent injury.
2. Do not try to restrain the person’s movements, as they are likely to resist.
3. Allow the seizure to resolve spontaneously.
4. After the seizure has ended, ensure that the person has fully recovered, can answer questions, and knows where they are going before leaving them unattended.

Call the emergency number 112 if:

• The seizure lasts longer than 5 minutes.
• The person is injured during the seizure or does not recover normally afterward.