What Should You Do If Someone Has a Seizure, and When Is It Epilepsy?

If someone has a seizure, stay calm, note the time, move hard objects away, cushion their head, and turn them onto their side once the shaking stops. Do not put anything in their mouth. Call 911 for a first seizure, one lasting five minutes or longer, repeated seizures without recovery in between, trouble breathing, a seizure in water, a significant injury, or a seizure during pregnancy. A single seizure is not always epilepsy. This article covers first aid, emergency signs, and how epilepsy is diagnosed.

What to do if someone has a seizure: first aid steps

A seizure is a burst of abnormal electrical activity in the brain. The most recognizable type causes stiffening and jerking, but seizures can also look like staring, confusion, or repeated movements. MedlinePlus (NIH) describes seizures as a symptom with many possible causes, and epilepsy as one of them (MedlinePlus: Seizures).

For a convulsive seizure, these steps are the usual advice:

• Stay with them and note the time. How long the seizure lasts matters to the emergency team.
• Clear the area. Move furniture, hot drinks, and sharp objects away.
• Cushion the head. A folded jacket or sweater works.
• Loosen anything tight around the neck, such as a tie or scarf, and remove eyeglasses if you can do so easily.
• Turn them onto their side once the jerking stops, so saliva or vomit can drain from the mouth.
• Stay until they are fully alert. Speak calmly and tell them where they are.

What not to do

• Do not put anything in their mouth. A person cannot swallow their tongue during a seizure, and objects can break teeth or block the airway.
• Do not hold them down or try to stop the movements. Restraint can cause injury.
• Do not give food, drink, or pills until they are awake and alert.

Tongue biting, loss of bladder control, and heavy breathing afterward are common and do not by themselves mean something went wrong.

When a seizure needs 911

Many people with known epilepsy recover on their own, and their seizure action plan may not call for an ambulance each time. If the person has a prescribed rescue medicine, follow the plan and call 911 if the seizure continues past five minutes. If you do not know the person's history, treat the event as an emergency. The reasons to call 911 are listed in the box below. The 5-minute threshold is widely used in seizure first-aid advice and in status epilepticus guidelines, which treat a convulsive seizure lasting five minutes or longer as an emergency.

A first seizure always deserves urgent medical evaluation, even if the person seems fine afterward. Clinicians need to look for causes that can be dangerous, such as low blood sugar, infection, head injury, bleeding in the brain, stroke, or drug and alcohol effects. If the person also has face drooping, arm weakness, or speech trouble, treat it as a possible stroke and call 911; our article on stroke warning signs covers those signs.

Seizures that are easy to miss

Not every seizure involves falling or shaking. Focal seizures can cause a blank stare, lip smacking, picking at clothes, odd smells or tastes, a sudden sense of fear, or a short period of confusion. Reviews of emergency department patients have found that focal seizures without obvious movement can go unrecognized, particularly in younger people (Unrecognized Focal Nonmotor Seizures in Adolescents Presenting to Emergency Departments).

If you see someone who seems awake but unresponsive, gently guide them away from hazards such as stairs or traffic, speak calmly, and do not argue or restrain them. They may not remember the episode. Anyone who has an unexplained episode like this should tell a clinician.

Is a single seizure epilepsy?

Not necessarily. Epilepsy is generally diagnosed when a person has had more than one unprovoked seizure, or has one unprovoked seizure along with a high likelihood of more. A seizure with an immediate trigger, such as very low blood sugar, alcohol withdrawal, a head injury, or a severe infection, is often described as provoked. It may not lead to a diagnosis of epilepsy, although the underlying cause still needs treatment. MedlinePlus summarizes epilepsy as a brain disorder that causes repeated seizures (MedlinePlus: Epilepsy).

Several factors can contribute to epilepsy, and in many people no clear cause is found. Possible contributors include a prior brain injury, stroke, brain infection, a brain tumor, developmental or genetic conditions, and scarring in the brain. Brain tumors are a much less common cause than the other factors, and a seizure alone does not establish one.

How clinicians evaluate a possible seizure disorder

Clinicians combine history, examination, and testing. No single test confirms or rules out epilepsy in every person. Typical steps include:

• A detailed description of the event. What happened before, during, and after matters. A witness account is often among the most useful pieces of information, so write down what you saw, or record a video if it is safe and does not delay help.
• Blood tests to check blood sugar, electrolytes, and other possible triggers.
• Electroencephalogram (EEG), which records electrical activity in the brain. A normal EEG does not exclude epilepsy, and repeat or longer recordings are sometimes used.
• Brain imaging, usually MRI, to look for structural causes.
• An ECG, because some heart rhythm problems cause fainting that can look like a seizure.

Conditions that can mimic seizures include fainting, heart rhythm disorders, migraine with unusual symptoms, sleep disorders, and psychogenic nonepileptic events. Telling these apart is a specialist task.

Treatment and daily life after a seizure diagnosis

Treatment for epilepsy often involves antiseizure medicines, which can reduce seizure frequency for many people, though outcomes vary. Choice of medicine depends on seizure type, age, other health conditions, other medicines, and pregnancy plans. Drug labels for antiseizure medicines carry a warning about suicidal thoughts and behavior, and some carry boxed warnings (for example valproate in pregnancy, and serious rash with carbamazepine and lamotrigine). Read the label for the specific product and ask the prescriber or pharmacist about it. Do not skip, stop, or change the dose or timing of an antiseizure medicine on your own, because stopping suddenly can provoke seizures. If you miss a dose, call the prescriber or pharmacist for instructions.

Other options include epilepsy surgery, nerve stimulation devices, and dietary therapy for selected people. A neurologist can discuss which may suit a given situation.

Safety at home and on the road

• Showers are often considered safer than baths. Ask your clinician about individual precautions.
• Driving rules differ by state. Your clinician and your state motor vehicle agency can explain what applies to you.
• Sleep loss, missed doses, heavy alcohol use, and some other medicines or substances may make seizures more likely in some people.
• Some people use wearable seizure detection devices, though their availability and recommendations vary around the world (ILAE SUDEP Task Force report on wearable seizure detection devices).

Sudden unexpected death in epilepsy

Sudden unexpected death in epilepsy (SUDEP) is uncommon but is a recognized risk, particularly in people whose seizures are not well controlled. Reviews suggest that taking medicines as prescribed and working with a neurologist on seizure control are important parts of lowering that risk (Antiseizure Medications and Sudden Unexpected Death in Epilepsy: An Updated Review). This is a topic to raise with your neurologist so they can discuss it in the context of your own health.

Living with epilepsy: mood, memory, and sleep

Epilepsy is associated with higher rates of depression, anxiety, and sleep problems, and some people notice memory or concentration changes (Expert opinion on diagnosis and management of epilepsy-associated comorbidities). Tell your clinician about these symptoms so they can decide how to evaluate and treat them. If you or someone you know has thoughts of self-harm, call or text 988, the Suicide and Crisis Lifeline.

How to help afterward

After a seizure, a person may be sleepy, confused, embarrassed, or sore. Stay with them until they are alert, offer water once they are fully awake, and let them rest. Tell them what happened in plain words. If it was their first seizure, encourage them to be evaluated the same day, and help them get a ride rather than letting them drive.

When to Seek Medical Care