Watching someone have a seizure can be unsettling, especially if you’re not sure what to do.
But a few simple steps can help protect the person until the seizure passes or medical help arrives.
The following tips can help prepare family members, friends, coworkers and bystanders so they can safely respond.
What is a seizure?
The brain is a massive circuit that normally sends electrical signals through different channels in an organized way.
A seizure is like an electrical storm that causes those signals to become chaotic or fire together in an abnormal way.
Not every person who has a seizure will be diagnosed with epilepsy. Epilepsy affects about 1% of the population and is defined by recurring, unprovoked seizures.
What can trigger seizures
Common seizure triggers include:
- Emotional stress
- Lack of sleep
- Missed doses of anti-seizure medication
- Overheating
- Overexertion
- Alcohol use
- Menstrual periods
- Flashing lights, in some people who have a form of photosensitive epilepsy
Triggers can pile up. For example, someone under stress who isn’t sleeping well and skips medication could be at even higher risk for a seizure.
If someone you’re with has a seizure, it’s unlikely that you did anything to cause it.
Signs that someone may be having a seizure
Seizures don’t always include full-body convulsions. They can happen anywhere in the brain, impacting the activities that portion of the brain controls.
Full-body, convulsive seizures involve falling, shaking, stiffening and loss of bladder control. A person having this type of seizure will likely stop breathing during the attack.
Signs of partial, or focal, seizures are significant changes in the person’s behavior or function. These changes are unintentional, come on suddenly and then pass.
They can vary widely and may include:
- Vision changes
- Staring
- Not responding when spoken to
- Lip smacking
- Unusual or repetitive movements or gestures
- Confusion
- Wandering or trying to leave
How to help when someone has convulsive seizure
- Call 911, especially if you are a bystander and don’t know the person’s seizure history.
- Stay with the person until help arrives.
- Time the seizure with a phone or watch. Seizures lasting longer than 5 minutes require urgent medical attention.
- Lower the person to the ground or the safest possible position if they are standing or sitting. This can prevent injuries caused by falling or sliding from a chair.
- Move hard, sharp or dangerous objects away from the person.
- Place something soft and flat under the head if possible.
- Gently turn the person onto their side when safe, especially as the seizure ends. This will help saliva or vomit drain from the mouth and prevent choking.
- Try to track any details emergency responders or EMS or doctors may need: How long did the seizure last? Did the head or eyes turn to one side? Did one arm or leg look different from the other? What happened afterward? Was the person breathing? How did the person recover?
- If the person is a loved one and has prescribed rescue medication, administer the medication as directed.
What not to do when someone has a convulsive seizure
- Don’t put anything in the person’s mouth. They cannot swallow their tongue, and objects or fingers can cause serious injury.
- Don’t try to hold the person down or stop their movements.
- Don’t try to give water, pills or food during the seizure or before they are fully alert and aware.
- Don’t attempt mouth-to-mouth breathing or CPR during the convulsive phase. The body may be too stiff, and the person will likely start breathing again after the seizure ends.
- Don’t pull on a stiff arm or use limbs as “handles” when trying to roll the person. This can injure joints or bones.
What to do when someone has a non-convulsive seizure
Focal seizures can also be serious and sometimes spread into bigger convulsive seizures.
If someone is exhibiting signs of a focal seizure:
- Call 911. Focal seizures can turn into convulsive seizures.
- Time the episode, stay nearby and track the person’s behaviors.
- Gently guide the person away from danger without restraining them and try to help them lie down.
- Use a calm voice and avoid grabbing or pushing the person. They may be confused and interpret this as a threat.
What to do after someone has a seizure
Recovery after a seizure can take 30 minutes to an hour or longer. Expect confusion, sleepiness, weakness or disorientation during this time.
- Stay with the person until they are awake, oriented and able to make a safe plan.
- Don’t give food, water or medication until the person is fully alert and able to swallow safely.
- If EMS has been called, share what you observed.
When to call 911 for a seizure
If you are a bystander, always call 911. A seizure can sometimes be the first visible sign of another urgent condition, such as an infection, stroke or brain tumor, so medical evaluation may be needed.
If you are a friend or family member and know the person’s history of seizure, always call 911 if the seizure lasts 5 minutes or longer. Prolonged seizures can become more dangerous and harder to treat.
Epilepsy treatment and prevention options
People with recurrent or hard-to-control spells may need evaluation by an epileptologist.
This evaluation may include a stay in an epilepsy monitoring unit, where brain scans and symptom monitoring can be recorded during active seizures. This helps doctors determine if seizures are epileptic, where in the brain they start and the most appropriate treatment.
Treatment is individualized and may include daily anti-seizure medication and, for some, prescribed rescue medication.
Bystanders should not give medication unless they are trained and authorized.
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