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First Aid For Tonic-Clonic Seizures

A tonic-clonic seizure may appear dramatic and frightening to an observer. It is important to remember that the person affected normally feels no pain during the seizure, and they will probably have no memory of it afterwards. If you see a tonic-clonic seizure, keep calm and prevent others from acting rashly. You cannot stop a seizure once it has started. Let the seizure run its course and be ready to provide reassurance afterwards.

What to do

Note the time.
Clear a space around the person.
Cushion the head (e.g. with a rolled up jacket).
Loosen tight neckwear.
Remove glasses if worn
Check to see if the person is carrying an ID or wearing an SOS Talisman or any Medic Alert jewellery, as this may give information about the seizure type and medication.
As soon as the convulsions subside, turn the person onto his/her side into the recovery position to aid breathing.
Clear any frothy saliva from the mouth and check the airway.
Reassure the person during any period of confusion which may follow.

What not to do

DO NOT move the person while the seizure is in progress, unless he/she is in immediate danger (e.g. in a busy road, at the top of a flight of stairs, at the edge of water, or near a fire).
DO NOT restrict movements.
DO NOT attempt to lift the person up.
DO NOT force anything between the teeth.
DO NOT try to give anything by mouth.
DO NOT interfere unnecessarily with the person in the period immediately after the seizure. Let them recover in peace and quiet, but stay with them until any confusion has passed.

How to help other types of seizure

ABSENCES ('petit mal') - No action needs to be taken; absences are usually very brief and often pass unnoticed. If you witness an absence seizure, stay with the person for a while to make sure that no injury has been sustained or that further seizures do not occur.

COMPLEX PARTIAL SEIZURES ('psychomotor' or 'temporal lobe seizures') - Some people have seizures which put them temporarily into a state of altered consciousness. Behaviour may seem inappropriate (e.g. lip-smacking clutching at clothing, or wandering around purposelessly with a glazed expression). During this type of seizure, stay with the person and allow the seizure to run its natural course. Gently guide the person away from danger and offer reassurance afterwards.

Remember

Epilepsy symptoms vary from person to person.
Seizures may occur frequently or rarely.
Seizures may last for only a few seconds or several minutes (very rarely longer)
Seizures may be mild or severe.
There may be a partial or a total loss of consciousness.
There may be a slight movement of one part of the body or violent shaking of the whole body.
The same person can have more than one type of seizure.

When to get medical help

You should call an ambulance if :

The stiffening and jerking phase of a tonic-clonic seizure lasts longer than 5 minutes.
One major seizure follows another without full recovery in between.
The person hits their head during the seizure and there is no sign of consciousness being regained within 10 minutes of the convulsions ceasing. Unconsciousness could be due to concussion. (Remember that some people sleep after a seizure. A sleeping person responds when gently shaken; an unconscious person does not).
There is an injury you cannot deal with (e.g. if you cannot stop bleeding).
The person is very confused and disorientated for a long period after the seizure.
The seizure has occurred in water and it is suspected that water has been inhaled.
It is the first seizure the person has ever had.

Small Children

If you have no prior knowledge of a child's epilepsy, phone for medical assistance immediately.

Rectal Medication

Rectal medication (i.e. diazepam or paraldehyde) may be administered under prescription to stop a seizure in adults or children. The administration of rectal medication is straight forward first aid procedure which can be carried out by 'non-medical' people such as parents, carers, teachers or support workers, but only if they have received the relevant training. The diazepam or paraldehyde is administered rectally because this is the quickest way for the medication to reach the blood stream, and hence the brain.

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