Epilepsy seizure: what to do in an emergency

Tongue biting, thrashing limbs, eyes rolled in the back of the head -- witnessing someone with epilepsy having a convulsive seizure can be truly frightening. But most seizures aren't an emergency; they stop on their own, with no permanent ill effects.

There is little you can do to stop a seizure once it's started. But by learning a few tips, you can protect a person with epilepsy from harm during seizures. It's worth knowing some basic first aid for seizures -- and when it's time to head for Accident and Emergency (A&E).

Types of seizures, degrees of danger

Not all seizures are the same. Some seizures are more dangerous than others. The two main types are partial seizures and generalised seizures.

Partial seizures start in a single part of the brain. During simple partial seizures, a person with epilepsy is aware of what's happening. For example, a person's arm might start moving, or her face start twitching -- the person is awake and aware, but can't control it. This can be followed by decreased consciousness or staring as the seizure becomes complex. After the seizure the person has no recollection of the event.

Generalised seizures involve both sides of the brain at once. People are rarely aware of what's happening during generalised seizures.

Convulsive seizures are known as generalised tonic-clonic seizures (grand mal seizures). These are the most frightening seizures to watch, and can be an emergency. In a generalised tonic-clonic seizure:

• A person with epilepsy who is having a seizure often becomes unresponsive. Calling out to them brings no answer; waving your hand in their eyes or shaking them elicits no response. They may suddenly collapse.
• Seizures cause a person's muscles to clench, and they become rigid as a board (tonic phase). This lasts a few seconds.
• Next, a series of jerking movements convulse the person's body (clonic phase). The convulsions of a seizure can last for only seconds, or can go on for minutes.
• Eventually, the jerking stops and the person regains consciousness. Usually after a generalised seizure, a person is confused or disoriented for a short period of time.

Any generalised seizure can be dangerous, because the person becomes unaware of surroundings and can't protect themselves from harm, such as while driving. The uncontrollable thrashing movements during a generalised tonic-clonic seizure increase the risk of injury. Most seizures that result in trips to A&E are of this type.

If you witness someone with epilepsy having a generalised tonic-clonic seizure, remember that it's probably not an emergency, although it may look like one. Keep these first-aid tips in mind:

• Keep other people out of the way.
• Clear hard or sharp objects away from around the person.
• Don't try to hold the person down, or stop the movements.
• Place the person on his or her side, to help keep the airway clear.
• Look at your watch at the start of the seizure, to time its length.
• Don't put anything in the person's mouth. Contrary to a popular misconception, it is not possible for a person to swallow the tongue during a seizure. However, placing an object in the mouth of a person who is having a seizure may cause the patient harm or injury. The patient may experience a dental injury or you may harm yourself by having your finger bitten.

Milder seizures -- like brief periods of staring or shaking of the arms or legs -- are also not an emergency. You should, however, gently guide a person with epilepsy who is having a seizure away from any surrounding danger. They may be in a state similar to sleepwalking, and need protection from threats around them, like traffic or stairs.