Witnessing someone have a seizure can be frightening, but knowing what to do can make all the difference. Amanda Dendis, Neura Health Nurse Practitioner in General Neurology, shares essential guidance in our video to help you respond confidently and safely. 

The good news? Most seizures are self-limiting and last only one to two minutes. And with the right knowledge, you can respond confidently and help keep someone safe during a seizure.

Recognizing the signs of a seizure

Seizures can present in many different ways. Here are the key signs to watch for:

Physical manifestations

• Involuntary muscle movements, such as twitching, convulsions, or shaking.
• Temporary loss of consciousness or awareness.
• Staring spells.
• Confusion, difficulty speaking, or stumbling.

Sensory and perceptual changes

• Sensations of déjà vu (feeling of familiarity) or jamais vu (feeling of unfamiliarity).
• Experiencing unusual tastes or smells.
• Distortions in the perception of surroundings.

In infants and children

• Uncharacteristic irritability.
• Frequent, unexplained stomach pain.
• Changes in typical sleep patterns.
• Staring spells (known as absence seizures, which are very common in this age group).

Stay vigilant and pay close attention to these indicators!

‍

What to do during a seizure

When you see someone having a seizure, follow these steps:

Step 1: Ensure safety

Move all objects  away from the person, especially anything sharp or hard that could cause injury. As Amanda Dendis, NP emphasizes, your first priority is preventing the person from hitting their head or injuring themselves on nearby objects.

Step 2: Position the person safely

If the person isn't already on the ground, carefully help them down. Gently roll them onto their side with their mouth facing downward to keep their airway clear, reducing the risk of choking from vomit or secretions. If it's safe, place something soft like a jacket or a pillow under their head for added comfort. 

Loosen any tight clothing around their neck to help them breathe easier, being mindful of everyone's safety. If they're wearing glasses, kindly remove them to prevent any potential injury. Your thoughtful actions can make a big difference in their safety and comfort!

Step 3: What NOT to do

Never:

• Restrain their movements or hold down their arms and legs (this can injure you and them, as their muscles are extremely stiff during a seizure).
• Put anything in their mouth (this is a dangerous myth that can cause choking or aspiration).
• Give water, food, or medications until they are fully alert.
• Try to wake them or shake them.

Step 4: Monitor and support

• Stay calm and reassure others around you that the seizure will end soon.
• Time the seizure, this information is crucial for medical personnel.
• Stay with the person throughout the entire episode.

Understanding the post-ictal period

After a seizure ends, the person may be confused, disoriented, or even combative. This is called the post-ictal period, when the brain is recovering from the intense electrical activity. 

During this time:

You can guide them to a comfortable, safe space as they regain awareness. Gently reassure them and explain the situation, as they might be confused or not remember. Keep a watchful eye to ensure they don’t inadvertently wander into danger. Monitor their breathing and recovery closely, and take notes on the seizure’s duration and details for later reference. Remember, they might feel disoriented and combative, so prioritize both your safety and theirs throughout this process.

When to call 911

Call for emergency medical assistance immediately if:

• The seizure lasts longer than five minutes. This is a medical emergency.
• Someone experiences consecutive seizures (one right after the other).
• It is the person's first seizure.
• The person has difficulty breathing or shows unusual color changes.
• The person does not regain consciousness after the seizure ends.

Act quickly if:

• The person was hurt during the seizure.
• The seizure happened while the person was in water.
• The person has underlying conditions such as pregnancy or diabetes.

Special considerations: Emergency medications

If you've been trained to administer intranasal or intrarectal diazepam (Valium) or midazolam, you may administer these medications in a safe environment. However, only do so if you've received proper training and it's safe for both you and the person experiencing the seizure.

Common myths about seizure first aid

Myth #1: You can swallow your tongue during a seizure.

Truth: This is physically impossible. Placing objects in someone's mouth during a seizure can cause serious injury, broken teeth, or choking.

‍

Myth #2: You should hold someone down during a seizure. 

Truth: Never restrain someone during a seizure. Their muscles are extremely strong and stiff, and restraining them can cause injuries to both of you.

‍

Myth #3: All seizures involve dramatic shaking. 

Truth: Some seizures appear as blank staring, confusion, or subtle movements. Not all seizures are convulsive.

Living with seizures

For patients with epilepsy or seizure disorders:

1. Medical identification: Wear a medical alert bracelet or necklace. 
2. Seizure tracking: Maintain a detailed log of your seizures, including their duration, triggers, and patterns. 
3. Emergency information: Make sure that caregivers, family members, and coworkers are aware of your condition and know the emergency protocols. 
4. Regular medical care: Collaborate closely with a neurologist to manage your condition effectively.

Quick Recap

You're prepared to help

Seizures can be frightening to witness, but as Amanda Dendis, NP reminds us, they're typically self-limiting. With the knowledge you now have, you can respond effectively, keep someone safe, and potentially make a life-saving difference.

Remember: Stay calm, prioritize safety, and know when to call for emergency help. Your confidence and quick action can provide critical support when someone needs it most.

Need ongoing seizure management support? Neura Health's board-certified neurologists specialize in epilepsy and seizure disorders. Book a visit here.

‍