What to do if someone has an epileptic seizure

Photo of a young man (Stockbyte / Stockbyte / Thinkstock) Most people aren't sure how to react if someone has an epileptic seizure. It's quite straightforward, though. Just a few rules can help.

There are different types of epileptic seizures. The best reaction will depend on the type and severity of the seizure, as well as the general situation. The main thing is to stay calm and protect the person having the seizure from harm. Most seizures aren't dangerous and pass within a few minutes.

Minor seizures and seizures that affect awareness

Some seizures only cause people to be mentally absent ("zone out") for a short time, or only cause muscles to twitch. These kinds of minor seizures are usually not dangerous. But people who have them are often unsettled or frightened afterwards, and they may feel unwell. So it can be important to comfort them and make them feel safe.

Some seizures have a major effect on awareness, and the person may then show especially unusual behavior. They might seem confused or lost. Then it's important to keep them from doing something dangerous like running out into the street. If possible, you should calmly try to lead them out of the situation without the use of unnecessary force. Panicking and treating the person roughly may provoke an unexpected response. It is better to provide support and let them know you are there for them. Just "being there" can be helpful. This is also important while they are recovering from a seizure.

Major seizures

If someone has a major seizure – in other words, if their whole body shakes, they fall down and lose consciousness – you can help by doing the following:

  • Prevent injury: It is especially important to prevent injury to their head. For instance, you could put a jacket or pillow under their head and move any dangerous objects out of the way. During the seizure, the person should under no circumstances be held or pushed against the ground. You should allow the seizure to run its course as much as possible.
  • Keep their airways free: Loosen any tight clothing around the person's neck. The person having the seizure may bite their tongue. But you should still not open their mouth during the seizure or put anything between their teeth. It is important to check that their airways are clear after the seizure.
  • Stay there: Don't leave the person alone, even to get help, unless it's absolutely necessary because the seizure goes on for too long.
  • Watch the time to see how long the seizure lasts: Seizures usually start suddenly and are over after one or two minutes. They rarely last longer than five minutes. If the seizure does, then it's an emergency and you need to call the emergency services (112 in Germany and most other European countries, 911 in the U.S.) for help.
  • After the seizure, stay and help: A person who has just had a seizure may need some time to recover from it. They may want something or need help figuring out where they are and what happened. Some people get very tired and would like to sleep right away. It's best to put them into the recovery position. It's also important to be sensitive to embarrassing situations and, for instance, keep people from forming a crowd if the seizure happens in public. The person might accidentally urinate (wet themselves) during the seizure. If that happens, you can cover them with a coat or blanket to avoid embarrassment and keep them warm.

Illustration: Recovery positionRecovery position

When do you need to call the emergency services?

You don't always have to call an ambulance when someone has a major seizure: If it's over quickly and the person comes around ("wakes up" again) soon after, you can talk to them about whether or not to call. It is only necessary in the following situations:

  • The seizure lasts longer than five minutes.
  • The person has several seizures in a row.
  • The person has breathing difficulties.
  • They have injuries.
  • You know that it's their first seizure.
  • The person doesn't "wake up."

Some people with epilepsy always have emergency medication on them. If they have a seizure that lasts longer than five minutes, people who are with them can then give them the medication to stop the seizure. Tablets can be put inside their cheek, and creams can be squeezed into their bottom through a thin tube. If you call an ambulance, the emergency responder can inject the medication into a vein.

It may be helpful to take note of exactly what happened during the seizure. Careful observations can help doctors later on when they're making a diagnosis.

But many people who have epilepsy recover fully within just a few minutes of having seizures. They can return to work or school activities without any medical attention.