What To Do if and When a Seizure Occurs?

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Understanding Seizures: What Happens During a Seizure

A seizure occurs when there is a sudden, uncontrolled burst of electrical activity in the brain. This abnormal electrical activity disrupts the brain’s normal communication patterns, causing temporary changes in behaviour, movements, feelings, and levels of consciousness. Seizures can range from brief episodes of staring or subtle body twitching to full-body convulsions lasting several minutes. Understanding what to do if and when a seizure occurs is an essential component of first aid knowledge that everyone should possess.

Seizures affect approximately 1 in 100 Canadians, making them one of the most common neurological conditions in the country. Epilepsy, a condition characterized by recurrent seizures, affects over 300,000 Canadians. Seizures can also occur in people without epilepsy due to a variety of seizure triggers including high fever, head injuries, low blood sugar, drug or alcohol withdrawal, stroke, and other medical conditions. Seizures can lead to injuries such as cuts, bruises, or broken bones due to falls or convulsions, especially if they occur while a person is engaged in activities like driving or operating machinery. Regardless of the cause, knowing how to provide appropriate seizure first aid can prevent injury, reduce complications, and potentially save a life.

When someone has a seizure in a public place, bystander response in the first minutes makes a critical difference. Organizations like the Epilepsy Foundation recommend the “Three S’s” when responding to a seizure: Stay, Safe, and Side. Stay with the person, keep them Safe from harm, and roll them onto their Side when possible. This simple framework is the foundation of effective seizure first aid and applies to most types of epileptic seizures a bystander will encounter.

Types of Generalized Seizures and Focal Seizures You May Encounter

Not all seizures look the same. Understanding the different types of generalized seizures and focal seizures helps you recognize when a seizure is occurring and respond appropriately. Generalized onset seizures affect both sides of the brain from the onset, often resulting in loss of consciousness. Focal seizures start in one part of the brain and may or may not spread. Most seizures are brief and self-limiting, but knowing the type helps you communicate clearly with emergency dispatchers.

Generalized Tonic-Clonic Seizures (Grand Mal)

Tonic-clonic seizures, previously referred to as grand mal seizures, involve a loss of consciousness, body stiffening (tonic phase), and rhythmic jerking movements (clonic phase), typically lasting 1 to 3 minutes. These generalized seizures are followed by a postictal period of confusion and exhaustion. The person may make sounds, bite their tongue, lose bladder control, or temporarily lose muscle control during the seizure.

Absence Seizures (Petit Mal)

Absence seizures, also known as petit mal seizures, are brief episodes lasting 5 to 30 seconds where the person appears to stare blankly and may lose awareness. They may exhibit subtle movements like blinking or lip smacking and chewing movements. These seizures are most common in children and can be so subtle that they go unnoticed. The person typically resumes normal activity immediately afterward with no memory of the episode. Absence seizures are a type of generalized seizure that affect consciousness without convulsions.

Focal Seizures

Focal seizures begin in one specific area of the brain and may or may not affect consciousness, and seizure symptoms vary by seizure type. A simple partial seizure causes localized sensory symptoms such as twitching in one hand, tingling sensations, or visual disturbances while the person remains fully aware. Complex focal seizures alter consciousness and may cause repetitive purposeless movements such as lip smacking, hand rubbing, or wandering. These seizures can sometimes progress to generalized tonic-clonic seizures.

Myoclonic Seizures

Myoclonic seizures involve sudden, brief muscle jerks or twitches that typically affect the arms, legs, or upper body. They often occur in clusters, particularly shortly after waking. Myoclonic seizures usually last only a fraction of a second but can cause the person to drop objects or fall. They are associated with several epilepsy syndromes and may occur alongside other seizure disorders.

Atonic Seizures (Drop Seizures)

Atonic seizures, also called drop seizures, involve a sudden loss of muscle tone and muscle control that causes the person to collapse or drop to the ground without warning. They are brief, typically lasting fewer than 15 seconds, but the sudden fall can cause serious head injuries. People with frequent atonic seizures often wear protective headgear. These seizures are more common in people with certain neurological disorders.

Tonic Seizures

Tonic seizures involve a sudden stiffening of the muscles, typically in the arms, legs, or trunk. They usually occur during sleep and last 20 seconds or less. If a tonic seizure occurs while the person is standing, they may fall and sustain an injury. Tonic seizures differ from the tonic phase of a tonic-clonic seizure in that there are no subsequent clonic jerking movements.

Clonic Seizures

Clonic seizures consist of rhythmic, repetitive jerking movements of the muscles. They can affect one part of the body (focal clonic) or both sides simultaneously. Unlike tonic-clonic seizures, there is no preceding stiffening phase. Clonic seizures are relatively rare on their own but can occur as part of other seizure disorders.

Identifying the Different Types of Seizures

Recognizing the specific type of seizure is the first step in providing appropriate care. While many people only associate epileptic seizures with full-body convulsions, the various types of seizures can include subtle staring spells or localized muscle twitching. By understanding whether a seizure is generalized or focal, you can better describe the event to emergency dispatchers and ensure the person’s safety throughout the episode. Not all seizures involve convulsions, and not all seizures affect consciousness.

Seizure Triggers: What Causes Seizures?

Understanding seizure triggers is important for prevention and helps bystanders identify potential causes when a seizure happens suddenly without warning. Some people experience warning signs called an aura before a seizure begins, such as a strange smell, a feeling of déjà vu, or unusual sensory symptoms. Common seizure triggers include:

• Low blood sugar (hypoglycemia): a drop in blood glucose can trigger seizures in people with and without diabetes
• High fever: febrile seizures are common in young children
• Head injury: traumatic brain injury can cause immediate or delayed seizures
• Sleep deprivation: one of the most common triggers for people with epilepsy
• Alcohol or drug withdrawal: abrupt cessation can provoke severe seizures
• Flashing lights (photosensitivity): affects a small percentage of people with epilepsy
• Stress and illness: physical and emotional stress can lower the seizure threshold
• Missed antiseizure medications: one of the most preventable causes of breakthrough seizures
• Infection and fever: any illness that causes high fever increases seizure risk
• Brain stimulation abnormalities: including tumours, stroke, and other neurological disorders

Unprovoked seizures that occur without a clear identifiable trigger are the hallmark of epilepsy. A second unprovoked seizure after a first seizure significantly increases the probability of a seizure disorder diagnosis. People at risk should discuss risk factors and a prevention plan with their healthcare provider.

The Three S’s of Seizure First Aid: Stay, Safe, Side

The Epilepsy Foundation’s Three S’s provide a clear, memorable framework for responding when a seizure occurs:

Stay: Stay with the person for the entire duration of the seizure and through the recovery period. Never leave someone alone during or immediately after a seizure. Time the seizure from the moment the seizure begins, as this information is critical for medical professionals.

Safe: Keep the person Safe by clearing the area of hard, sharp, or hot objects that could cause injury during the convulsions. If the person is standing when the seizure begins, gently guide them to the ground to prevent a fall. Protect the person’s head by placing something soft underneath it, such as a folded jacket, towel, or your hands. Remove eyeglasses to prevent facial injuries. Loosen any tight clothing around the neck such as ties, scarves, or collars to help them breathe more easily.

Side: Once the jerking movements allow, gently roll the person onto their Side into the recovery position. This keeps the airway clear and allows any saliva, blood, or vomit to drain from the mouth rather than blocking the airway.

How to Help Someone Having a Seizure: Step by Step

What to Do If and When a Seizure Occurs: The Core Steps

Stay calm and stay with the person. Time the seizure from the moment you notice it begin. Clear the area around the person, moving away any hard, sharp, or hot objects. If the person is standing, gently guide them to the ground to prevent a fall. Protect the person’s head, remove their eyeglasses, and loosen tight clothing around the neck. Do not restrain them. Allow the seizure to run its course naturally. Standard First Aid with CPR C covers seizure response, the recovery position, and postictal care as part of the core curriculum.

The Recovery Position and Loss of Consciousness

Once the jerking movements allow, gently roll the person onto their side into the recovery position. This is one of the most important actions you can take during seizure first aid. It keeps the airway clear and allows fluids to drain. If the person loses consciousness during the seizure, the recovery position protects the airway until they regain awareness. Gently roll the person onto their side, supporting their head, bending the top knee for stability, and checking that the airway is open.

After the Seizure Stops: Postictal Care

Once the seizure stops, the person enters the postictal state. During this recovery period, which can last from a few minutes to several hours, they may experience confusion, drowsiness, headache, muscle soreness, difficulty speaking, and emotional distress. Stay with the person until they are fully alert and oriented. Speak calmly and reassuringly. After a seizure, the person may enter a postictal state characterized by confusion, drowsiness, and fatigue, and it is essential to provide reassurance and monitor them until they are fully alert. Check for any injuries that may have occurred, particularly to the head, tongue, or limbs.

What NOT to Do During a Seizure

Knowing what not to do is just as important as knowing what to do. The primary goals when witnessing a seizure are to keep the person safe, prevent injury, and allow the seizure to run its course.

Do not restrain the person. Attempting to hold someone down during a seizure will not stop it and can cause muscle tears, joint dislocations, or fractures. Allow the seizure to run its natural course.

Do not put anything in their mouth. The myth that people can swallow their tongue during a seizure is false. Do not insert objects into the person’s mouth to avoid choking or dental injuries. This includes fingers, wallets, spoons, or any other objects.

Do not offer food or water. After the seizure ends, the person may be confused and their swallowing reflex may not function normally. Wait until the person is fully alert before giving them anything to eat or drink.

Do not perform CPR during the seizure. The jerking movements are not the same as cardiac arrest. Only begin CPR if the person is not breathing after the seizure has completely stopped.

When to Call 911: Status Epilepticus and Other Emergencies

Most seizures end on their own within a few minutes and do not require emergency medical attention. However, certain situations require a call to 911 immediately.

Status Epilepticus: A Medical Emergency

Status epilepticus occurs when a seizure lasts longer than five minutes or when multiple seizures occur without the person regaining consciousness in between, posing a life-threatening risk of brain damage or death. If a seizure lasts longer than five minutes, call 911 immediately. This is a medical emergency requiring emergency room treatment. Do not wait to see if it stops on its own.

Call 911 in any of the following situations:

• The seizure lasts longer than 5 minutes
• The person has a second seizure without regaining consciousness in between
• The person is injured during the seizure
• The person has trouble breathing or difficulty breathing after the seizure ends
• This is the person’s first known seizure
• The person is pregnant
• The seizure occurred in water
• You are uncertain whether the person has a known seizure disorder
• The person does not regain consciousness within a reasonable time after the seizure stops

Seizure First Aid in Special Situations

Seizures in Water

A seizure occurring while someone is in a swimming pool, lake, or bathtub is a life-threatening emergency. Support the person’s head above water and move them to the edge of the pool or to shallow water as quickly as possible. Remove them from the water once it is safe to do so. Call 911 immediately, as water aspiration during a seizure can cause serious respiratory complications even if the person appears to recover. For aquatics staff and lifeguards, the Emergency Medical Responder program covers in-water seizure response as part of advanced training.

Seizures While Standing or in a Wheelchair

If someone has a seizure while standing, gently lower them to the ground to prevent a fall. If someone has a seizure while in a wheelchair, lock the wheels and leave the person seated, supporting their head and keeping them secure in the chair. Apply the same principles of protection and airway management regardless of the person’s position.

Seizures in Children

Febrile seizures in young children are triggered by high fever and are one of the most common types of seizures in children under 5. Most febrile seizures are brief and do not cause lasting harm. Place the child on a flat surface, protect their head, and time the seizure. Call 911 if the seizure lasts longer than 5 minutes, if the child is under 6 months old, or if this is the child’s first febrile seizure.

SUDEP: Sudden Unexpected Death in Epilepsy

Individuals with epilepsy face a higher risk of sudden unexpected death in epilepsy (SUDEP), particularly those with poorly controlled seizures or frequent tonic-clonic seizures. SUDEP is the sudden, unexpected, non-traumatic, and non-drowning death of a person with epilepsy, with or without evidence of a seizure. The exact mechanism is not fully understood but is thought to involve seizure-related disruptions to breathing and heart rhythm.

While SUDEP cannot always be prevented, the risk is significantly reduced through better seizure control with antiseizure medications, avoiding seizure triggers, and ensuring people with epilepsy are not sleeping alone when their seizures are poorly controlled. Bystanders who are present during a nocturnal tonic-clonic seizure can help reduce SUDEP risk by placing the person in the recovery position immediately after the seizure stops and ensuring they are breathing normally.

Living with Epilepsy: Managing Recurring Seizures

For people with a diagnosed seizure disorder, preventing seizures starts with consistent management. Antiseizure medications are the primary treatment for most forms of epilepsy and help manage seizures in approximately 70 percent of patients. Missing a dose is one of the most common triggers for breakthrough seizures. Other prevention strategies include maintaining regular sleep schedules, avoiding known seizure triggers, managing stress, and working closely with a neurologist.

For people with epilepsy who experience recurring seizures despite medication, other options include brain stimulation therapies, dietary approaches such as the ketogenic diet, and in some cases, surgery to remove the seizure focus in the brain. Seizures start to come under better control for most people with appropriate treatment. The goal is to achieve the best possible seizure control with the fewest side effects, allowing people with epilepsy or other seizure disorders to live full and active lives.

The Importance of First Aid and Aid Training for Seizure Emergencies

Training in first aid and CPR is essential for effectively responding to seizure emergencies, as it equips individuals with the knowledge and skills to provide immediate assistance and reduce the risk of injury during a seizure. Hands-on first aid training builds confidence and competence, enabling individuals to respond effectively to seizure emergencies and other medical situations when they arise.

Standard First Aid courses cover seizure management as part of a broader curriculum that includes emergency assessment, CPR and AED training, and management of various medical emergencies. For workplaces, schools, and community organizations, private group first aid training ensures that multiple people on site are prepared to respond to seizure emergencies and other medical crises. This collective preparedness creates safer environments for everyone, including the approximately 1 in 100 Canadians living with epilepsy.

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