Epilepsy and Seizure First Aid: What to Do and What Never to Do
Brain & Nerves

Epilepsy and Seizure First Aid: What to Do and What Never to Do

admin

Most people will witness a seizure at some point, and most will react in ways that are at best useless and at worst dangerous. The correct response is simple and worth knowing.

What a seizure is

A seizure is a burst of abnormal, synchronised electrical activity in the brain. Epilepsy is the condition of having a tendency to recurrent unprovoked seizures, usually defined as two or more at least 24 hours apart, or one seizure with a high risk of recurrence.

A single seizure is not epilepsy. Seizures can be provoked by fever in children, very low blood sugar, alcohol or benzodiazepine withdrawal, head injury, infection, electrolyte disturbance, lack of sleep or certain drugs.

Types

Focal seizures begin in one part of the brain. The person may stay aware, with twitching of one limb, an odd taste or smell, a rising sensation in the stomach, deja vu, or sudden fear. In focal impaired-awareness seizures the person appears blank, may lip-smack, pick at clothing or wander, and will not remember it.

Generalised seizures involve both hemispheres from the start. The best-known is the tonic-clonic seizure: sudden loss of consciousness, body stiffening, then rhythmic jerking, often with a cry, tongue biting and loss of bladder control, followed by confusion and deep tiredness.

Absence seizures, mostly in children, are brief blank stares lasting seconds, often mistaken for daydreaming or inattention at school.

Myoclonic seizures are sudden brief jerks, often of the arms, typically in the morning.

First aid for a convulsive seizure

  1. Stay calm and note the time. Duration is the most important thing you can report
  2. Protect the head. Put something soft underneath, and move away hard or sharp objects
  3. Loosen anything tight around the neck
  4. Do not restrain the person or try to stop the movements
  5. Do not put anything in the mouth. Nothing. Not fingers, not a spoon, not cloth. A person cannot swallow their tongue, and objects in the mouth cause broken teeth, injured jaws and choking
  6. Once the jerking stops, turn them onto their side in the recovery position so saliva and vomit can drain
  7. Stay with them until they are fully alert. Confusion for 10 to 30 minutes afterwards is normal
  8. Speak calmly and tell them what happened; they will be disoriented and may be frightened or embarrassed
  9. Give nothing to eat or drink until they are fully alert

For a focal seizure with altered awareness, simply guide the person gently away from danger and stay with them. Do not grab or shout.

Call emergency services if

  • The seizure lasts more than 5 minutes
  • A second seizure follows without full recovery between them
  • Breathing does not resume, or lips stay blue
  • The person is injured, or the seizure happened in water
  • It is a first-ever seizure
  • The person is pregnant, has diabetes, or has a high fever
  • Recovery is unusually slow or incomplete

Prolonged seizure activity, status epilepticus, is a medical emergency.

Common myths that cause harm

  • Putting a spoon in the mouth. Causes injury, achieves nothing
  • Holding the person down. Causes dislocations and fractures
  • Throwing water on the face, or making them smell an onion or a shoe. Useless and undignified
  • Treating it as possession or a curse. This belief still delays treatment in many families. Epilepsy is a brain condition and is treatable
  • Assuming people with epilepsy cannot work, marry or have children. They can, with appropriate management
  • Believing epilepsy is contagious. It is not

Diagnosis

Diagnosis is mainly clinical, built from a detailed description by the patient and, crucially, by a witness. A phone video of an event is genuinely valuable to the neurologist.

Investigations include an EEG, which can be normal between seizures and does not exclude epilepsy; MRI of the brain to look for a structural cause; and blood tests for provoking factors. An ECG is done because cardiac causes of collapse can mimic seizures.

Treatment

Antiseizure medication controls seizures in roughly two thirds of patients, often with a single drug. Choice depends on seizure type, age, sex, other conditions and planned pregnancy.

Key points for patients:

  • Take doses on time; missed doses are the most common cause of breakthrough seizures
  • Do not stop or change the dose without medical advice; abrupt withdrawal can trigger prolonged seizures
  • Tell your doctor about all other medicines, since interactions are common, including with hormonal contraception
  • Women planning pregnancy need pre-conception counselling and folic acid, and some drugs, especially valproate, carry significant risk to the fetus
  • Report any rash promptly
  • Sleep deprivation, alcohol and missed meals lower the seizure threshold

For drug-resistant epilepsy, options include epilepsy surgery, vagus nerve stimulation and ketogenic dietary therapy.

Living with epilepsy

Driving rules depend on seizure-free periods and must be followed. Swimming, bathing and cooking carry specific precautions, generally favouring showers over baths and never swimming alone. Most sports are permitted. Schools and workplaces should know what to do rather than exclude the person.

This is general information. Seizure diagnosis and medication must be managed by a doctor; never adjust antiseizure drugs on your own.