Understanding Seizures: Types and Recognition

Seizures manifest in various forms, and recognizing the type can help provide appropriate assistance. The main categories include:

  • Generalized tonic-clonic seizures (formerly called grand mal): Involve loss of consciousness and muscle rigidity, followed by rhythmic jerking movements
  • Absence seizures (formerly called petit mal): Brief lapses in awareness, often appearing as staring spells
  • Focal seizures: Affect just one area of the brain and may cause unusual sensations, involuntary movements, or awareness changes
  • Atonic seizures: Cause sudden loss of muscle tone, often resulting in falls

Warning signs that may precede a seizure, known as auras, can include unusual smells, visual changes, dizziness, or a rising sensation in the stomach. Some people with epilepsy may recognize these warning signs, while others experience no warning before a seizure begins.

Understanding what a seizure looks like helps you respond appropriately. During a tonic-clonic seizure, a person may cry out, fall, experience muscle rigidity followed by jerking movements, have shallow breathing, drool, or experience incontinence. They may also appear confused upon regaining consciousness.

Not all seizures involve convulsions. Some may simply appear as brief staring spells, repetitive movements, or unusual sensory experiences. Learning to recognize different seizure types enables faster, more effective response.

Immediate Steps During an Active Seizure

When someone is having a seizure, your actions in those first moments matter greatly. Follow these steps to provide proper assistance:

  • Stay calm - Your composed presence helps both the person seizing and others nearby
  • Time the seizure - Note when it began, as seizures lasting over 5 minutes may require emergency medical attention
  • Clear the area - Remove dangerous objects and create space around the person
  • Protect the head - Place something soft beneath their head if possible
  • Turn them onto their side - The recovery position helps prevent choking if the person is unconscious

For generalized seizures where the person falls and experiences convulsions, gently guide them to the ground if you're present when it begins. Loosen any tight clothing around their neck, and clear away dangerous objects.

If the person is wearing eyeglasses, carefully remove them. Stay with the person until they are fully conscious and oriented. Speak calmly and reassuringly as they regain awareness, as they may feel confused or embarrassed.

For absence seizures or focal seizures without loss of consciousness, stay with the person and gently guide them away from dangerous situations if necessary. Even with milder seizures, the person may be temporarily confused and need reassurance.

What to Avoid During a Seizure

Knowing what not to do during a seizure is just as important as knowing the correct actions. Avoid these common mistakes that could cause harm:

  • Never restrain the person - Holding someone down during a seizure can cause muscle tears, joint injuries, or broken bones
  • Do not put anything in their mouth - Contrary to outdated advice, you should never place objects in someone's mouth during a seizure, including your fingers
  • Avoid moving them - Unless they're in immediate danger, don't try to move someone having a seizure
  • Don't give food, drink, or medication - Wait until they are fully alert and aware
  • Don't attempt CPR - During a seizure, breathing may appear irregular but typically resumes normally afterward

The myth about people swallowing their tongues during seizures has led to dangerous practices. The tongue cannot be swallowed, and forcing objects into the mouth risks broken teeth, injured gums, and blocked airways. The person may temporarily stop breathing during a seizure, but this usually resolves on its own.

Avoid crowding around the person or taking videos of the seizure, which can be distressing when they regain awareness. Maintain their dignity by creating privacy if possible, such as asking onlookers to step back or holding up a coat as a screen in public places.

After the seizure ends, don't rush the recovery process. Allow the person time to become fully oriented before helping them move or asking complex questions.

After the Seizure: Recovery and Observation

The period immediately following a seizure, known as the postictal phase, requires careful attention and support. During this time:

  • Stay present - Remain with the person until they are fully recovered
  • Position for safety - Keep them on their side if they remain unconscious
  • Speak calmly - Use a gentle, reassuring tone when they begin to regain awareness
  • Orient gradually - Tell them who you are, where they are, and what happened
  • Check for injuries - Look for any wounds that may have occurred during the seizure

The postictal phase can last from minutes to hours. During this time, the person may experience confusion, fatigue, headache, muscle soreness, or difficulty speaking. They may not remember the seizure or events immediately before it.

Offer comfort and reassurance as they recover. Help them find a quiet place to rest if possible. Once they're fully alert, offer water if they can swallow safely. Do not offer food until they are completely alert and ask for it.

Document what you observed during the seizure, including how long it lasted, the person's movements, any color changes, breathing patterns, and how long it took them to regain awareness. This information can be valuable for medical professionals.

If this was the person's first seizure, encourage them to seek medical evaluation, even if they feel fine afterward. First-time seizures should always be medically assessed to determine possible causes.

When to Call Emergency Services

While most seizures resolve on their own without emergency intervention, certain situations require immediate medical attention. Call emergency services (911 in the US) if:

  • The seizure lasts longer than 5 minutes
  • The person does not regain consciousness after the seizure ends
  • The person has another seizure shortly after the first one
  • The person is injured during the seizure
  • The person is pregnant or has diabetes
  • The seizure occurs in water
  • The person has difficulty breathing after the seizure
  • This is the person's first seizure

Status epilepticus—a condition where seizures last longer than 5 minutes or occur in succession without recovery between them—is a medical emergency requiring immediate treatment. Prolonged seizures can lead to brain damage or other life-threatening complications.

When calling emergency services, stay on the line and follow the dispatcher's instructions. Be prepared to provide information about the seizure, including when it started, what you observed, and any known medical conditions the person has.

If possible, have someone meet the emergency responders to guide them to your location. Continue monitoring the person and keep them in the recovery position until help arrives. If they have a known seizure disorder and carry emergency medication like nasal or rectal diazepam, administer it according to their prescription if you are trained to do so.