Seizure protocol differs depending on the type of seizure a person has, but it may include staying with the person, making their environment safe, and providing reassurance.

Seizures often occur as a symptom of epilepsy, which affects over 2 million people in the United States. A person will receive a diagnosis of epilepsy after experiencing two or more unprovoked seizures. An unprovoked seizure is one not caused by another condition, such as meningitis.

According to the Centers for Disease Control and Prevention (CDC), there are two categories of seizures:

  • Generalized seizures: These affect both sides of the brain.
  • Focal seizures: These are also known as partial seizures, and they begin in a specific area of the brain. Symptoms of a focal seizure depend on where in the brain the seizure occurs.

This article will outline the subtypes of seizures and what to do if people experience them. It will also discuss when to call an ambulance.

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The following sections outline what to do in the event of generalized seizures.

Tonic-clonic seizure

This is the most recognizable type of seizure. In a tonic-clonic seizure, a person usually loses consciousness, and their muscles twitch and jerk rapidly.

Tonic-clonic seizures are multistage seizures. They occur due to disturbances in both sides of a person’s brain. Someone about to experience a tonic-clonic seizure may experience an “aura” before the seizure starts. This may involve a subtle mood change or headache.

Tonic-clonic seizures, previously called grand mal seizures, may include:

  • In the tonic phase:
    • crying out
    • going stiff
  • In the clonic phase:
    • falling to the floor
    • experiencing muscle jerks or spasms

A person’s breathing may change, and they may turn pale or blue around the mouth. They may also bite the inside of their mouth.

The United Kingdom’s Epilepsy Society gives the following advice for dealing with a tonic-clonic seizure:

What to do during the seizure

  • Stay calm.
  • Start timing the seizure.
  • Move away any objects that may cause injury.
  • Only move the person if they are in an unsafe place.
  • Place something soft under the person’s head or cup their head to prevent it from hitting the ground.
  • Look for an identity card or medical jewelry for information about what to do.
  • Do not restrain the person. Allow the seizure to take its course.
  • Do not put anything in their mouth.
  • Try to stop people crowding around.

What to do when the shaking stops

  • Roll the person onto their side into the recovery position.
  • Check their breathing. If it sounds labored, open their mouth to check that their airway is clear.
  • Wipe away any spit from their mouth.
  • If they have wet themselves, cover them to minimize embarrassment.
  • Gently reassure them and stay with them until they have recovered.
  • Do not give them food or drink until they are fully alert.

A person often feels very tired following a seizure and may take several hours or days to recover fully.

Learn more about tonic-clonic seizures here.

Myoclonic seizure

In myoclonic seizures, people experience brief and involuntary muscle twitching, or “myoclonus.” They happen very quickly, often after waking up, and may even go unnoticed. They sometimes happen repeatedly.

Myoclonic seizures typically affect the neck, shoulders, or upper arms. Hiccups and the sudden jerk some people experience before falling asleep are forms of myoclonus.

What to do

If a person thinks they are experiencing a myoclonic seizure, they should stay still. The best way to help a person experiencing this type of seizure is to ensure that they do not hurt themselves.

A person should only seek medical attention if:

  • they are pregnant
  • they injure themselves as a result of the seizure
  • it is their first seizure

Learn more about myoclonic seizures here.

Tonic and atonic seizure

An atonic seizure presents as an instant loss in muscle tone as the muscles relax. A person’s body may fall limp, and they may fall forward, risking injury.

Tonic seizures cause muscles to stiffen, so the person’s body goes rigid. Other symptoms of a tonic stage include:

  • drooling or foaming at the mouth
  • falling to the ground, often backward
  • crying out involuntarily
  • losing consciousness

These seizures happen without warning and are brief. People usually recover quickly.

What to do

If a person notices someone having a tonic or atonic seizure, they should try:

  • rolling the person into the recovery position
  • seeking medical attention, if the seizure caused injury

If a person experiences a seizure alone and it is not their first, they can decide whether to seek medical attention once the seizure has stopped. If it is a person’s first seizure, they should seek medical attention.

Learn more about atonic seizures here.

Absence seizure

An absence seizure or petit mal typically occurs in children aged 4–12 years. They are brief seizures where a person loses awareness and stares blankly.

This type of seizure is extremely common with certain genetic conditions, such as Lennox-Gastaut syndrome.

What to do

To help someone having an absence seizure, a person should guide them away from danger and into a safe environment.

Learn more about absence seizures here.

The following sections outline what to do in the event of focal seizures.

Focal to bilateral tonic-clonic seizure

Focal onset seizures occur due to a specific region in the brain behaving abnormally. This typically involves the misfiring of electrical signals. Focal to bilateral seizures start in a specific site and quickly spread, involving both sides of the brain.

This differs from a generalized-onset tonic-clonic seizure, which starts on both sides of the brain. A person usually experiences a site-specific sign first, such as arm jerking.

What to do

If a person recognizes the initial focal signs of a seizure, they can try to reach a safe place before the tonic-clonic phases begin. This can help them avoid injury.

People nearby should follow the previous advice for tonic-clonic seizures.

Learn more about focal-onset seizures here.

Focal aware seizure

Focal aware seizures, previously called simple partial seizures, affect a specific brain region yet do not impair consciousness. People may be able to talk during the seizure. These seizures can present in different ways and may feel like:

  • an intense feeling, such as joy or fear
  • a rising feeling in the stomach
  • twitching in a limb
  • an unusual smell or taste

What to do

It may be helpful to reassure someone during and after a focal aware seizure. People should seek medical attention if it is their first seizure.

Focal impaired awareness seizure

Also called complex partial seizures, these seizures affect a specific part of the brain. When a seizure occurs, it causes impaired consciousness. Focal impaired awareness seizures usually last several minutes but may last up to 10 minutes.

A person may carry out automatisms during a seizure, which are repetitive movements such as moaning, chewing, or head-rolling.

What to do during the seizure

  • Do not restrain the person, as this may cause upset or confusion.
  • Guide them away from danger.
  • Speak calmly and gently. Being loud and forceful may cause confusion, leading them to respond aggressively or become upset.

What to do after the seizure

  • Be calm and reassuring, reminding them where they are.
  • Stay with them until they are alert and can return to their previous activity.

Some people recover quickly from this type of seizure, while others feel very tired and want to sleep.

According to the CDC, seizures do not often require medical attention.

However, if a seizure continues for 5 minutes or longer, doctors call it status epilepticus, or simply “status,” and it is a medical emergency. This is the case for any seizure and is most common in children.

Status can cause brain damage, so urgent medical care is necessary. It is important to time a person’s seizures and pass this information on to healthcare professionals.

If it is a person’s first seizure or they were injured during a seizure, they should also talk with a doctor.

Different types of seizures require different actions from people nearby. Seizures arise in different brain areas, cause different symptoms, and require different treatments. Most seizures end within a few minutes.

General advice for helping someone having a seizure includes:

  • staying with a person until they are fully alert and can understand what happened
  • being calm and reassuring
  • trying to make the environment safe for them
  • looking for a medical bracelet for information about what to do
  • ensuring the person gets home safely

If someone experiences a seizure for the first time or if they have epilepsy and experience a change in their seizures, they should talk with a doctor. If a person’s seizure lasts 5 minutes or more, a person should call 911.