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Epileptic seizures first aid, what to do and what not to do

Seizure first aid
  • Published: 10 Feb 2025

According to the World Health Organization (WHO)1, up to 1 in 10 people on average can experience an epileptic seizure during their lifetime. Epileptic seizures can be caused by various diseases and medical conditions2 and may also be influenced by specific genetic factors. The major cause is epilepsy – a chronic non-transmissible disease characterised by recurrent seizures – which is diagnosed when at least two such episodes occur in an uncontrolled manner. Other causes of a seizure may include high fever, an overdose of certain medications, a stroke or brain damage due to trauma, such as accidents, the existence of a tumour, certain inflammatory diseases, infections of the central nervous system, and other medical conditions2. Adopting appropriate lifestyles and scrupulously following the medical treatments prescribed by the doctor are absolutely essential in reducing the likelihood of suffering a seizure. Nevertheless, whenever such an instance occurs, it is  important to know how to help the affected person so as to reduce the risk of falls and other serious injuries that can rarely be fatal3.

 

How to recognize an epileptic seizure and its type4,5 

The first step in providing assistance is being able to recognize a seizure. Seizures are of very different kinds and are associated with various symptoms, which may not all be present at the same time and which are not always easy to identify.
In general, seizures can be divided into these two types, focal or generalized.

Focal (or partial) seizures are associated with abnormal activity in a small area of the brain that generally affect just one side of the body. These seizures can entail:

  • alterations in the way the person perceives the reality around them, in their emotions or in their behaviour
  • changes in their movements on one side of the body, with involuntary jerks, muscle contractions or spasms,
  • pins and needles
  • fixed staring
  • dizziness
  • seeing flashing lights.

Generalized seizures (previously called Generalised Tonic Clonic Seizures) involve activity in all areas of the brain. These seizures frequently cause:

  • brief or prolonged loss of consciousness
  • a loud shout or groan
  • increased muscle tone, leading to falls
  • tremors and shaking
  • body and eyelid contractions, spasms.

What to do during a seizure4,5

Once it is clear that a person is having a seizure, it is essential to act promptly and adopt the right measures. Here is what you should do:

  • keep calm
  • stay close to the person throughout the attack
  • if the person is lying down, turn them onto their side, with their mouth turned towards the floor, to prevent them choking on saliva or vomit (known as ‘The Recovery Position’)
  • monitor how long the seizure lasts and if it is more than 5 minutes, call for an ambulance and/or medical help
  • if it turns out to be the person’s first epileptic seizure, if they have hurt themselves during the seizure or had a second seizure shortly after the first then you should also call for assistance. Those who are pregnant or suffer from diabetes will also need extra help.

 

What not to do during a seizure4,5

  • Do not intervene by moving the person, unless it is to prevent them from injuring themselves (e.g. moving them away from obstacles or staircases)
  • Do not force their mouth open: the old-fashioned notion of ‘swallowing their tongue’ will be prevented by placement in the recovery position6
  • Do not perform mouth-to-mouth resuscitation
  • Do not administer any drugs or liquids unless you have been trained in this

 

After the seizure7

After an epileptic seizure, there is a phase be characterized by confusion, drowsiness, hypertension, headache and nausea. This is called the Postictal (i.e. post-seizure) State and can last from 5 to 30 minutes. Once the person has regained consciousness and is able to stand up, in their own time, it is a good idea to help them to sit down in a safe place. In view of the person’s sense of disorientation, it may be important to reassure them and explain what has happened.

 

Seizures first aid in specific situations

When the seizure occurs in public places or at work, it is important to follow the same procedure. Additionally, it may be helpful to call a family member or a friend to come and collect the person4. In particular settings such as schools, teachers and school staff should receive specific training8. In the case of a prolonged (more than 5 minutes) seizure or of multiple seizures repeated in a short period of time – in which the person does not recover between seizures (known as status epilepticus) – it is essential to call for an ambulance and/or medical help. These seizures are in fact associated with a greater risk of mortality and permanent brain damage, therefore prompt medical evaluation and management are necessary9.

 

Bibliography:

  1. WHO. Epilepsy. 7 February 2024
  2. Huff J.S., Murr N.I. “Seizure”. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430765
  3. Asadi-Pooya A.A., Hosseini S.A., Hashemizadeh Fard Haghighi L., Asadi-Pooya H., “Seizure first aid for people with epilepsy: opinions and knowledge of caregivers and healthcare professionals”, Seizure: European Journal of Epilepsy, Volume 102, 2022, Pages 1-5, ISSN 1059-1311, https://doi.org/10.1016/j.seizure.2022.09.007. (https://www.sciencedirect.com/science/article/pii/S1059131122001996)
  4. U.S. Centers for Disease Control and Prevention (CDC), “First aid for seizures”, 15 May 2024
  5. Istituto Superiore di Sanità (ISS), Epilessia, 30 January 2019 https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/e/epilessia
  6. Rossi K.C., Baumgartner A.J., Goldenholz S.R., Goldenholz D.M. “Recognizing and refuting the myth of tongue swallowing during a seizure”. Seizure. 2020 Dec;83:32-37. doi: 10.1016/j.seizure.2020.09.023. Epub 2020 Oct 5. PMID: 33080482.
  7. Abood W., Bandyopadhyay S., “Postictal Seizure State”. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526004/
  8. CDC, “Managing Epilepsy in schools”, 8 July 2024
  9. Wylie T., Sandhu D.S., Murr N.I., “Status Epilepticus”. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430686/

 

 

 

 

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