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First aid for all seizures

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First aid for all seizures

Epileptic seizures can be divided into two main types: focal seizures and generalised seizures. The following information describes different types of seizures and what you can do to help.

Focal seizures

Focal seizures start in, and affect, part of the brain: either a large part or just one small area. What happens during the seizure depends on where in the brain the seizure happens and what that part of the brain normally does.

Focal aware seizures

During a focal aware seizure the person is conscious (aware and alert) and usually knows that the seizure is happening. A focal aware seizure could be an unusual smell or taste, a twitching of an arm or hand, a strange ‘rising’ feeling in the stomach, or a sudden feeling of intense joy or fear.
How to help

  • As the person might feel strange or be upset, reassuring them might be helpful.            

Focal impaired awareness seizures

Focal impaired awareness seizures affect more of the brain than focal aware seizures. The person’s consciousness is affected, and they may be confused and not know what they are doing. They may wander    around, behave strangely, pick up objects, or make chewing movements with their mouth. Afterwards they may be confused for a while, or need to sleep. These seizures can last a few seconds or a few minutes.
How to help

  • Do not restrain the person as this might upset or confuse them.
  • Gently guide them away from any danger, for example from walking into the road.    
  • Speak gently and calmly as they may be confused. If you speak loudly or grab them, they might not understand and may get upset or respond in an aggressive way.

After the seizure

  • They may feel tired and want to sleep. It might be helpful to remind them of where they are.
  • Stay with them until they fully recover and can safely return to what they had been doing before the seizure.
  • Some people recover quickly, but others may take longer to feel back to normal again.

Focal to bilateral tonic clonic seizures

Sometimes a focal seizure spreads to affect both sides of the brain. This is called a focal to bilateral tonic clonic seizure. Some people call the focal seizure an ‘aura’ or ‘warning’, as it warns them that a tonic clonic seizure may follow (see below). 
How to help

  • If you or the person is aware of the warning, they may need help to get to a safe place before the tonic clonic seizure happens.

Generalised seizures

Generalised seizures affect both sides of the brain at once and happen without warning. The person usually becomes unconscious and will not remember the seizure afterwards.

Absence seizures

During an absence seizure the person becomes unconscious for a short time. They may look blank and stare and will not respond to what is happening around them. If they are walking, they may carry on walking but will not be aware of what they are doing.
How to help

  • Stay with the person, and gently guide them away from any danger.

Tonic and atonic seizures

In a tonic seizure the person’s muscles suddenly become stiff. If they are standing, they often fall, usually backwards, and may injure the back of their head.

In an atonic seizure (or ‘drop attack’) the person’s muscles suddenly relax and become floppy. If they are standing, they often fall, usually forwards, and may injure their head or face.

Both seizures are brief and happen without warning. Most people usually recover quickly.
How to help

  • Reassuring them may be helpful. If they are injured, they may need medical help.

Myoclonic seizures

Myoclonic means ‘muscle jerk’, and these seizures involve jerking of a limb or part of a limb. They often happen shortly after waking up, are brief, and can happen in clusters (many happening close together 
in time). 
How to help

  • You don’t need to do anything to help during the seizure other than make sure that the person has not hurt themselves.      

Tonic clonic and clonic seizures

During a tonic clonic seizure the person goes stiff (‘tonic’ phase), usually falls to the ground, and shakes or has jerking movements (‘clonic’ phase). Their breathing may be affected, and they may go pale or blue, particularly around their mouth. They may also bite their tongue or cheek. 

Some people have clonic seizures without going stiff to start with. Although it can be frightening to see, this is not usually a medical emergency. Usually, once the movements have stopped, the person recovers and their breathing goes back to normal.
How to help        

  • Try to stay calm.
  • Check the time to see how long the seizure lasts (see our information on status epilepticus for why this is important).
  • Only move the person if they are in a dangerous place, for example in the road. Instead, move any objects (such as furniture) away from them so they don’t hurt themselves.
  • Put something soft (such as a jumper) under their head, or cup their head in your hands, to stop it hitting the ground.
  • Look for medical jewellery or an ID card for information about what to do.
  • Do not hold them down – allow the seizure to happen.
  • Do not put anything in their mouth – they will not swallow their tongue.
  • Try to stop other people crowding around.    

After the seizure

  • Gently roll them on to their side into the recovery position .
  • If their breathing sounds difficult or noisy, gently open their mouth to check that nothing is blocking their airway. 
  • Wipe away any spit from their mouth. 
  • Try to minimise any embarrassment. If they have wet themselves, deal with this as privately as possible (for example, put a coat over them).
  • Stay with them until they have completely recovered. They may need gentle reassurance.
  • Do not give them anything to eat or drink until you are sure that they have fully recovered. 

Epilepsy Society is grateful to Dr F J Rugg-Gunn Consultant Neurologist & Honorary Associate Professor, Clinical Lead, Chalfont Centre for Epilepsy, who reviewed this information.

Information updated: May 2024

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