Seizure Recognition and First Aid

Seizure disorders take several forms, depending on where in the brain the malfunction takes place and how much of the total brain area is involved. Partial seizures affect only part of the brain. Partial seizures can be simple (during which a person remains awake and aware) or complex (during which a person's awareness is clouded). Generalized seizures affect the whole brain.

Since seizure disorders are so different in their effects, they require different kinds of action from the public. Some require no action at all. In all circumstances, please stay calm and remain with the person until they are fully awake, recovered and reoriented.

Types of seizures:

I. (Generalized) Tonic Clonic Seizures (Previously called Grand Mal Seizures) These seizures are the ones most people generally think of when they hear "epilepsy"; they cause a person to undergo convulsions which usually last from 2 to 5 minutes, with a complete loss of consciousness and muscle spasms.

Description: Sudden cry, fall, or rigidity, followed by muscle jerks, shallow breathing or temporarily suspended breathing, bluish skin, possible loss of bladder or bowel control; the seizures usually last a couple of minutes. Normal breathing then starts again. There may be some confusion and/or fatigue, followed by return to full consciousness.

What it is not: Heart attack or stroke

First Aid:

• Look for medical identification
• Protect from nearby hazards
• Loosen ties or shirt collars, remove glasses
• Protect head from injury by putting something soft and flat under the head
• Turn person on side to keep airway clear--unless injury exists
• Reassure as consciousness returns
• If a single seizure lasted less than 5 minutes, ask if hospital evaluation wanted
• If multiple seizures or if one seizure lasts longer than 5 minutes, call 911
• If person is pregnant, injured or diabetic, call for aid at once

What not to do:

• Don't put anything in the person's mouth
• Don't try to hold tongue (It can't be swallowed)
• Don't try to give liquids during or just after a seizure
• Don't use artificial respiration unless breathing is absent after muscle jerks subside or unless water has been inhaled
• Don't restrain

II. (Generalized) Absence Seizures (Previously called Petit Mal Seizures) These take the form of a blank stare lasting a few seconds.

Description: A blank stare, beginning and ending abruptly, lasting only a few seconds, most common in children. May be accompanied by rapid blinking and/or chewing movements in the mouth. Person is unaware of what's going on during the seizure, but they quickly return to full awareness once the seizure has stopped. May result in learning difficulties if not recognized and treated.

What it is not: Daydreaming, lack of attention or deliberate ignoring of adult instructions

First Aid:

• No first aid necessary, but if this is the first observation of the seizure(s), a medical evaluation should be recommended

III. (Partial) Simple Partial Seizures Partial seizures produce involuntary movements of the arm or leg, distorted sensations or a period of automatic movement in which awareness is blurred or completely absent.

Description: Jerking may begin in one area of the body, arm, leg or face. The jerking can't be stopped, but the patient stays awake and aware. Jerking may proceed from one area of the body to another and sometimes spreads to become a convulsive seizure.

Partial sensory seizures may not be obvious to an onlooker. A patient experiences a distorted environment; they may see or hear things that aren't there; they may feel unexplained fear, sadness, anger or joy; they may have nausea, experience odd smells or have a generally "funny feeling" in the stomach.

What it is not: Acting out, bizzare behavior, hysteria, mental illness, psychosomatic illness, parapsychological or mystical experience.

First Aid:

• No first aid necessary unless seizure becomes convulsive, then follow first aid instructions under Generalized Tonic Clonic Seizure
• No immediate action needed other than reassurance and emotional support
• Medical evaluation should be recommended

IV. (Partial) Complex Partial Seizures (Previously called Psychomotor or Temporal Lobe Seizures)

Description: Usually starts with a blank stare, followed by chewing, followed by a random activity; person appears unaware of surroundings, they may seem dazed and mumble; they may be unresponsive; their actions will be clumsy, not directed; they may pick at or fumble with their clothing, they may pick up objects or try to take their clothes off; they may wander or run; they may appear afraid; they may struggle or flail at restraint. Once a pattern is established, the same set of actions usually occurs with each seizure. The seizure lasts a few minutes, but post-seizure confusion can last substantially longer. There will be no memory of what happened during the seizure period.

What it is not: Drunkenness, intoxication on drugs, mental illness or disorderly conduct

First Aid:

• Speak calmly and reassuringly to patient and others
• Guide gently away from obvious hazards (ex: hot stove, stairs, traffic)
• Stay with person until completely aware of environment
• Offer to help getting home

What not to do:

• Don't grab hold unless sudden danger (such as a cliff edge or approaching car) threatens
• Don't try to restrain
• Don't shout
• Don't expect verbal instructions to be followed

V. (Generalized) Atonic Seizures (Also called Drop Attacks)

Description: A person suddenly collapses and falls. After 10 seconds to a minute, he recovers, regains consciousness and can stand and walk again.

What it is not: Clumsiness, normal childhood "stage", lack of good walking skills (child), drunkenness or acute illness (adult)

First Aid:

• No first aid needed, unless person hurt themself as they fell
• Child should be given a thorough medical evaluation

VI. (Generalized) Myoclonic Seizures

Description: Sudden brief, massive muscle jerks that may involve the whole body or just parts of the body. These seizures may cause a person to drop what they were holding or fall off a chair.

What it is not: Clumsiness or poor coordination

First Aid:

• No first aid needed, but a thorough medical evaluation should be given

VII. (Generalized) Infantile Spasms

Description: These are clusters of quick, sudden movements that start between 3 months and 2 years of age. If a child is sitting up, their head will fall forward and their arms will flex forward. If a child is lying down, their knees will be drawn up, with their arms and head flexed forward as if they are reaching for support.

What it is not: Normal movements of the baby, colic

First Aid:

• No first aid needed but a doctor should be consulted