Seizures and Epilepsy:
Recognising and Providing First Aid for Seizures

Seizures, also known as fits, are sudden bursts of electrical activity in the brain that disrupt normal functioning. They can vary in intensity and duration, with some seizures being mild and others life-threatening. Epilepsy is a neurological condition that makes a person prone to recurrent seizures. Knowing how to respond to someone having a seizure can prevent injury and potentially save their life.

What is a Seizure?

A seizure occurs when there is abnormal electrical activity in the brain. This can lead to a variety of symptoms, from brief lapses in awareness to full-body convulsions. Not all seizures are related to epilepsy – seizures can also be triggered by high fever (febrile seizures), head injuries, low blood sugar, or alcohol withdrawal, among other causes.

Types of Seizures

There are different types of seizures, but the two most common categories are:

• Generalised Seizures: These affect both sides of the brain and often result in loss of consciousness. The most recognisable type is a tonic-clonic seizure (formerly known as a grand mal seizure), which involves stiffening of the body (tonic phase) followed by rhythmic jerking (clonic phase).
• Focal Seizures (Partial Seizures): These begin in one area of the brain and can either affect consciousness or not. Symptoms may include unusual sensations, changes in behaviour, or minor movements such as twitching of one part of the body.

Signs and Symptoms of a Seizure

The symptoms of a seizure depend on the type, but common signs include:

• Loss of Consciousness: The person may suddenly collapse or lose awareness.
• Uncontrollable Jerking Movements: The body may stiffen and then jerk rhythmically, often affecting the whole body.
• Foaming at the Mouth: Some people may foam at the mouth during a tonic-clonic seizure.
• Loss of Bladder or Bowel Control: Involuntary urination or defecation can occur during a seizure.
• Breathing Difficulties: The person may stop breathing temporarily or have difficulty breathing.
• Confusion or Drowsiness: After the seizure, the person may be confused, disoriented, or drowsy (known as the postictal phase).
• Absence Seizures: In these milder seizures, the person may seem to “zone out” or stare blankly for a few seconds.

First Aid for Seizures

For Generalised (Tonic-Clonic) Seizures:

1. Stay Calm and Protect the Person from Injury:
   • Move nearby objects (furniture, sharp items) out of the way to prevent injury. If possible, place something soft, like a jacket, under the person’s head to protect it from banging against the floor.
2. Do Not Restrain the Person:
   • Do not hold the person down or try to stop their movements. This can cause injury to both you and the person having the seizure.
3. Do Not Put Anything in Their Mouth:
   • Contrary to popular belief, you should never put anything in the person’s mouth during a seizure, as this could cause choking or damage to their teeth. They cannot swallow their tongue.
4. Time the Seizure:
   • Use a watch or phone to time how long the seizure lasts. Most seizures last between 1 to 3 minutes. If the seizure lasts longer than 5 minutes, or if one seizure follows another without the person regaining consciousness, call 999 immediately.
5. Place Them in the Recovery Position:
   • After the seizure stops, if the person is unconscious, roll them onto their side in the recovery position to help keep their airway clear and prevent choking. Ensure their head is tilted slightly back to open the airway.
6. Monitor Breathing:
   • Check that the person is breathing normally after the seizure. If they stop breathing or show signs of distress, be prepared to start CPR and call 999 for help.
7. Stay with the Person:
   • Stay with the person until they are fully awake and alert. After a seizure, the person may be confused, disoriented, or exhausted. Offer reassurance and help them to sit up gradually.

For Focal (Partial) Seizures:

1. Stay Calm and Provide Reassurance:
   • Focal seizures may not cause the person to lose consciousness, but they may behave unusually or appear confused. Gently guide them away from any danger, such as busy roads or sharp objects.
2. Do Not Restrain Them:
   • Do not try to restrain the person or forcibly stop any repetitive movements (such as lip-smacking or twitching). Simply stay with them and provide reassurance.
3. Monitor the Duration:
   • Time the seizure and observe the person’s behaviour. If the seizure lasts longer than 5 minutes or they become unresponsive, call 999.
4. After the Seizure:
   • Once the seizure ends, the person may feel confused or tired. Help them find a safe, quiet place to rest and monitor them until they are fully recovered.

When to Call 999

You should call for emergency help if:

• The seizure lasts longer than 5 minutes.
• The person has multiple seizures without regaining consciousness in between.
• It is the person’s first-ever seizure.
• The person has difficulty breathing or stops breathing.
• They suffer an injury during the seizure, such as a head injury from a fall.
• The person remains unconscious or unresponsive for several minutes after the seizure ends.
• The person is pregnant or has diabetes.

First Aid for Febrile Seizures in Children

Febrile seizures are seizures that occur in young children, often as a result of a high fever. If a child has a febrile seizure:

1. Stay Calm and Protect the Child from Injury:
   • Move objects out of the way and protect the child’s head by placing something soft underneath.
2. Do Not Restrain the Child:
   • Do not try to hold the child down or stop their movements.
3. Time the Seizure:
   • Most febrile seizures last a few minutes. If the seizure lasts longer than 5 minutes, call 999 immediately.
4. Cool the Child Down:
   • Once the seizure has stopped, cool the child by removing excess clothing and providing cool water to drink. Do not give medication until after the seizure.
5. Seek Medical Advice:
   • Even if the seizure is brief, it is important to seek medical advice to determine the cause of the fever and prevent further complications.

Epilepsy Management

For people with epilepsy, seizures may be a regular part of life, but there are steps they can take to manage their condition and reduce the risk of seizures:

• Medication: Taking anti-epileptic drugs (AEDs) as prescribed by a doctor is essential in controlling seizures.
• Lifestyle: Avoiding seizure triggers, such as stress, lack of sleep, alcohol, and flashing lights, can help prevent episodes.
• Medical ID: People with epilepsy should wear a medical ID bracelet or carry a card that informs others of their condition in case of an emergency.

Key Points to Remember

• Do not restrain someone having a seizure or put anything in their mouth.
• Protect the person from injury and place them in the recovery position after the seizure.
• Call 999 if the seizure lasts more than 5 minutes, is the first seizure, or if the person has difficulty breathing or multiple seizures.
• Stay with the person until they are fully conscious and offer reassurance as they recover.