How common are seizures. What are the signs that require immediate medical attention. What are the general steps to help someone during a seizure. How to assist during a tonic-clonic seizure. What actions should be avoided during a seizure. Where to find additional resources and training for seizure management.

Understanding Seizure Prevalence and Emergency Situations

Seizures are more common than many people realize. Approximately 1 in 10 individuals may experience a seizure during their lifetime. This prevalence underscores the importance of being prepared to assist someone during or after a seizure event.

While most seizures don’t require emergency medical attention, certain situations call for immediate professional help. When should you call 911 during a seizure emergency? Consider the following circumstances:

• The person is experiencing their first-ever seizure
• Breathing difficulties or inability to regain consciousness after the seizure
• Seizure duration exceeds 5 minutes
• Multiple seizures occur in quick succession
• Injury occurs during the seizure
• The seizure happens while the person is in water
• The individual has pre-existing health conditions like diabetes, heart disease, or is pregnant

Recognizing these critical situations can help ensure timely medical intervention when necessary.

General Seizure First Aid: Key Steps to Remember

Knowing how to respond during a seizure can make a significant difference in the person’s safety and recovery. What are the essential steps for providing seizure first aid?

1. Stay with the person until the seizure ends and they regain full consciousness
2. Help them sit in a safe place once the seizure subsides
3. Explain what happened using simple terms when they’re alert and able to communicate
4. Offer comfort and speak calmly to reassure the person
5. Check for any medical identification, such as a bracelet or emergency information card
6. Maintain a calm environment for yourself and others present
7. Assist in arranging safe transportation home, such as offering to call a taxi

These general guidelines apply to various types of seizures and can help ensure the person’s safety and comfort during and after the event.

Tonic-Clonic Seizures: Specific Assistance Techniques

Tonic-clonic seizures, formerly known as grand mal seizures, are often what people envision when thinking about epileptic episodes. How can you effectively help someone experiencing this type of seizure?

• Gently ease the person to the floor to prevent falling injuries
• Turn them onto their side to facilitate breathing
• Remove any hard or sharp objects from the immediate area
• Place a soft, flat object (like a folded jacket) under their head
• Remove eyeglasses to prevent potential injury
• Loosen any tight clothing around the neck to ease breathing
• Time the seizure duration, calling 911 if it lasts longer than 5 minutes

By following these specific steps, you can significantly reduce the risk of injury and ensure the person’s safety during a tonic-clonic seizure.

Actions to Avoid During Seizure Episodes

Knowing what not to do during a seizure is equally important as knowing the correct actions to take. Which practices should be avoided when assisting someone having a seizure?

• Do not attempt to restrain the person or stop their movements
• Avoid placing any objects in the person’s mouth
• Refrain from administering mouth-to-mouth resuscitation
• Do not offer food or water until the person is fully alert and conscious

These precautions help prevent additional complications and ensure the safety of both the person experiencing the seizure and those providing assistance.

Resources and Training for Seizure Management

Enhancing your knowledge and skills in seizure first aid can be crucial. Where can you find reliable resources and training programs for seizure management?

• The American Red Cross First Aid App provides instant access to step-by-step advice on various emergency situations, including seizures and epilepsy
• The Epilepsy Foundation offers comprehensive information on seizure first aid and safety measures
• Mental Health First Aid Training programs can help individuals recognize mental health crises and connect people to appropriate care
• Professional training programs are available for specific groups, including school staff, first responders, law enforcement, older adult caregivers, mental health professionals, and childcare providers

Utilizing these resources can significantly improve your ability to respond effectively in seizure emergencies.

Understanding Different Types of Seizures

Seizures can manifest in various ways, and recognizing different types is crucial for appropriate response. What are the main categories of seizures, and how do they differ?

Focal Seizures

Focal seizures, also known as partial seizures, originate in one specific area of the brain. They can be further classified into two types:

• Simple focal seizures: These affect a small part of the body, such as twitching of a limb or sensory changes, without loss of consciousness
• Complex focal seizures: These can cause altered awareness or consciousness, often accompanied by repetitive movements or confusion

Generalized Seizures

Generalized seizures involve both hemispheres of the brain from the onset. They include several subtypes:

• Absence seizures: Brief lapses in awareness, often mistaken for daydreaming
• Tonic seizures: Characterized by sudden muscle stiffening
• Atonic seizures: Involve a sudden loss of muscle tone, often causing falls
• Myoclonic seizures: Brief, shock-like jerks of muscles
• Tonic-clonic seizures: The most dramatic type, involving loss of consciousness, muscle rigidity, and convulsions

Understanding these different seizure types can help in providing more targeted and effective assistance during an episode.

Epilepsy Management Strategies

While knowing how to respond to seizures is crucial, managing epilepsy effectively can reduce their frequency and severity. What are some key strategies for managing epilepsy?

Medication Adherence

Consistently taking prescribed anti-epileptic drugs (AEDs) is fundamental to seizure control. How can individuals ensure medication adherence?

• Use pill organizers or smartphone apps to track doses
• Set alarms as reminders for medication times
• Maintain a consistent daily routine
• Communicate with healthcare providers about any side effects or concerns

Lifestyle Modifications

Certain lifestyle changes can significantly impact seizure frequency. What adjustments can be beneficial?

• Maintain a regular sleep schedule
• Manage stress through relaxation techniques or counseling
• Avoid known seizure triggers, such as alcohol or specific foods
• Engage in regular, safe physical activity as approved by a healthcare provider

Diet Considerations

Dietary approaches can play a role in epilepsy management for some individuals. What dietary strategies might be considered?

• The ketogenic diet, which is high in fat and low in carbohydrates
• The modified Atkins diet, a less restrictive version of the ketogenic diet
• The low glycemic index diet, focusing on foods that have a minimal impact on blood sugar levels

It’s crucial to consult with a healthcare provider before making significant dietary changes, as these approaches may not be suitable for everyone and require careful monitoring.

Rescue Treatments for Epilepsy

In addition to daily management strategies, some individuals with epilepsy may benefit from rescue treatments. What are rescue treatments, and how are they used in epilepsy care?

Defining Rescue Treatments

Rescue treatments, also known as “as needed” medicines, are specifically designed for use during acute seizure situations. What characterizes an ideal rescue medicine?

• Ease of use
• Rapid onset of action
• Safety with minimal side effects
• Efficacy in seizure control

Types of Rescue Treatments

Various forms of rescue treatments are available for epilepsy management. What are some common types?

• Benzodiazepines: Available in different formulations, including rectal gels, nasal sprays, and buccal tablets
• Vagus Nerve Stimulator (VNS) magnet: For those with implanted VNS devices, swiping a magnet over the generator can provide additional seizure control
• Oral medications: Some fast-acting oral medications may be prescribed for use during prolonged seizures or clusters

Implementing Rescue Treatments

Proper use of rescue treatments is crucial for their effectiveness. How should rescue treatments be incorporated into epilepsy care?

• Develop a seizure action plan with your healthcare provider
• Ensure that family members, caregivers, or school staff are trained in administering the rescue treatment
• Keep the rescue treatment easily accessible
• Use the treatment as directed by your healthcare provider, typically for prolonged seizures or seizure clusters
• Seek emergency medical care if the seizure doesn’t respond to the rescue treatment or if other concerning symptoms develop

It’s important to note that rescue treatments do not replace daily anti-epileptic medications or emergency medical care when needed. They serve as an additional tool in comprehensive epilepsy management.

Epilepsy in the United States: Fast Facts and Statistics

Understanding the prevalence and impact of epilepsy in the United States can provide valuable context for its management and public health implications. What are some key statistics about epilepsy in the U.S.?

Prevalence

• Approximately 3.4 million people in the United States have active epilepsy
• This includes about 3 million adults and 470,000 children
• Epilepsy affects people of all ages, but is more common in young children and older adults

Economic Impact

The economic burden of epilepsy in the United States is significant. What are the estimated costs associated with epilepsy?

• Direct medical costs: Estimated at $15.5 billion annually
• Indirect costs (including lost productivity): Approximately $9.6 billion per year
• Total economic burden: About $25.1 billion annually

Quality of Life

Epilepsy can have a substantial impact on an individual’s quality of life. What are some common challenges faced by people with epilepsy?

• Higher rates of unemployment or underemployment
• Increased risk of mood disorders, including depression and anxiety
• Limitations on driving and independent living for some individuals
• Social stigma and misconceptions about the condition

Treatment Outcomes

While epilepsy can be challenging to manage, many individuals achieve good seizure control. What are the typical treatment outcomes for epilepsy?

• About 70% of people with epilepsy can become seizure-free with appropriate treatment
• For the remaining 30%, ongoing research into new therapies and treatment approaches offers hope for improved seizure control

These statistics highlight the significant prevalence of epilepsy in the United States and underscore the importance of continued research, public education, and support for individuals living with this condition.

Innovations in Epilepsy Treatment and Research

The field of epilepsy treatment is continually evolving, with new therapies and technologies emerging to improve seizure control and quality of life for those affected. What are some recent innovations and areas of ongoing research in epilepsy treatment?

Neurostimulation Devices

Neurostimulation technologies have shown promise in treating drug-resistant epilepsy. What are some examples of these devices?

• Responsive Neurostimulation (RNS): A implanted device that monitors brain activity and delivers electrical stimulation to prevent seizures
• Deep Brain Stimulation (DBS): Involves placing electrodes in specific areas of the brain to modulate seizure activity
• Transcranial Magnetic Stimulation (TMS): A non-invasive technique using magnetic fields to influence brain activity

Gene Therapy

Genetic research is opening new avenues for epilepsy treatment. How might gene therapy contribute to epilepsy management?

• Targeting specific genetic mutations associated with epilepsy
• Developing personalized treatments based on an individual’s genetic profile
• Exploring gene editing techniques to correct epilepsy-causing mutations

Cannabidiol (CBD) Research

CBD, a non-psychoactive component of cannabis, has shown potential in treating certain types of epilepsy. What developments have occurred in this area?

• FDA approval of CBD-based medication for specific epilepsy syndromes
• Ongoing research into the efficacy of CBD for various seizure types
• Investigation of optimal dosing and long-term effects

Precision Medicine Approaches

The concept of precision medicine aims to tailor treatments to individual patients. How is this being applied to epilepsy care?

• Using advanced brain imaging techniques to identify seizure foci more accurately
• Developing biomarkers to predict treatment response and guide therapy selection
• Integrating genetic, molecular, and clinical data to create personalized treatment plans

Artificial Intelligence in Epilepsy Management

AI and machine learning technologies are being leveraged to improve various aspects of epilepsy care. What are some applications of AI in epilepsy?

• Seizure prediction algorithms using EEG data
• Automated seizure detection systems for continuous monitoring
• AI-assisted interpretation of brain imaging studies
• Machine learning models to optimize medication selection and dosing

These innovative approaches represent the cutting edge of epilepsy research and treatment, offering hope for improved outcomes and quality of life for individuals living with epilepsy. As research progresses, it’s likely that new and more effective treatment options will continue to emerge, further advancing the field of epilepsy care.

Seizure First Aid | Epilepsy

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About 1 out of 10 people may have a seizure during his or her lifetime. That means seizures are common, and one day you might need to help someone during or after a seizure.

Learn what you can do to keep that person safe until the seizure stops by itself.

About 1 out of 10 people may have a seizure during his or her lifetime.

Seizures do not usually require emergency medical attention. Only call 911 if one or more of these are true:

• The person has never had a seizure before.
• The person has difficulty breathing or waking after the seizure.
• The seizure lasts longer than 5 minutes.
• The person has another seizure soon after the first one.
• The person is hurt during the seizure.
• The seizure happens in water.
• The person has a health condition like diabetes, heart disease, or is pregnant.

Stay with the person until the seizure ends and he or she is fully awake.

There are many types of seizures. Most seizures end in a few minutes.

These are general steps to help someone who is having any type seizure:

• Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
• Comfort the person and speak calmly.
• Check to see if the person is wearing a medical bracelet or other emergency information.
• Keep yourself and other people calm.
• Offer to call a taxi or another person to make sure the person gets home safely.

When most people think of a seizure, they think of a generalized tonic-clonic seizure, also called a grand mal seizure. In this type of seizure, the person may cry out, fall, shake or jerk, and become unaware of what’s going on around them.

Here are things you can do to help someone who is having this type of seizure:

• Ease the person to the floor.
• Turn the person gently onto one side. This will help the person breathe.
• Clear the area around the person of anything hard or sharp. This can prevent injury.
• Put something soft and flat, like a folded jacket, under his or her head.
• Remove eyeglasses.
• Loosen ties or anything around the neck that may make it hard to breathe.
• Time the seizure. Call 911 if the seizure lasts longer than 5 minutes.

Knowing what NOT to do is important for keeping a person safe during or after a seizure.

Never do any of the following things

• Do not hold the person down or try to stop his or her movements.
• Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
• Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
• Do not offer the person water or food until he or she is fully alert.

• American Red Cross First Aid Appexternal icon Download the free Red Cross app for instant access to step-by-step first aid advice, including advice about seizures and epilepsy.
• Epilepsy Foundation Seizure First Aid and Safetyexternal icon Learn more about how to respond to seizures safely.
• Mental Health First Aid Trainingexternal icon  This evidence-based program can help people recognize mental health crises and learn how to connect a person to mental health care.

• Types of Seizures Learn about the different types of seizures.
• Managing Epilepsy Learn what you can do to manage your epilepsy.
• Fast Facts Find out about epilepsy in the United States, such as how many people have epilepsy.

Epilepsy and seizure training programs for professionals including

• School staff.
• First responders and law enforcement.
• Older adult caregivers.
• Mental health professionals.
• Childcare providers.

Learn more about Training for Professionals.

Using Epilepsy Rescue Treatments | Epilepsy Foundation

On this page:

Talk with your healthcare provider about your seizure action plan and whether you need a rescue medicine.

What are “as needed” or rescue medicines?

“As needed” medicines are only given in specific situations. Some people also call them “rescue treatments.”

• The ideal rescue medicine (1) is easy to use, (2) works quickly, (3) is safe with little to no side effects, and (4) works well.
• The goal is to stop seizures quickly to prevent emergency situations. Hopefully this will prevent you from needing an emergency room. However, rescue medicines do NOT take the place of emergency medical care. If a true medical emergency happens, get emergency medical help right away.
• If medications are prescribed as rescue treatments, they do NOT take the place of daily seizure medications. Most people who have epilepsy are prescribed other medications that they take on a regular basis.
• People who have certain implanted devices for the treatment of epilepsy (such as a vagus nerve stimulator) can use a magnet to swipe over the device generator at the time of the seizure. This is also a form of rescue treatment.

What types of medicines can be used as a rescue treatment?

The most common type of rescue medicines are from a group of medicines called benzodiazepines. These medications get into the bloodstream quickly, to start working in the brain quickly.

• Benzodiazepines are available in several different forms. Depending on the specific benzodiazepine they can be
  • Swallowed in pill form (oral)
  • Placed under the tongue to dissolve (sublingual)
  • Placed between the cheek and the gum to dissolve (buccal)
  • Given via a gel through the anus (rectal)
  • Sprayed up the nose (nasal)
• In a hospital setting, other forms of benzodiazepines can be given by an injection directly into the bloodstream vein or injected into a muscle.
• The names of benzodiazepines that are most commonly used as rescue medications include diazepam, lorazepam, clonazepam, and midazolam.
  • The availability of these medicines in different forms and how they are used may vary from country to country.
  • Also, the brand names of these medications can change depending on the form it is given.
• In the United States, the U.S. Food and Drug Administration (FDA) has approved several medications for out-of-hospital use for the treatment of acute repetitive seizures or clusters.
  • Diastat^® – a diazepam rectal gel
  • Nayzilam^® – a midazolam nasal spray
  • Valtoco^® – a diazepam nasal spray
  • Other medications are commonly used for out-of-hospital rescue treatment but have not yet been approved by the FDA.

How do I choose the right rescue treatment for me?

• Choosing whether you need a rescue medication, and which medication to choose, should be done during a discussion with your healthcare provider about a seizure action plan. The action plan should involves more than just a taking medication and include seizure first aid and when emergency help is needed.
• Things to consider when talking to your healthcare provider:
  • How fast will it work?
  • How will I take it? (mouth, nose, etc…)
  • How easy is it to use?
  • What are the side effects?
  • How much does it cost?
• Some people who remain awake and alert may be able to swallow a pill such as lorazepam or diazepam.
• Other people who are not alert may need to be given a form that can be given under the tongue (sublingual), between the cheek and gum (buccally), or sprayed into a nostril (nasal spray).
  • People who are not able to take these forms can use rectal diazepam; however this is most often prescribed for children.

When should I use my rescue medicine?

Since seizure emergencies are not common, some people with epilepsy will not need to use any treatment other than their daily amount of seizure medicine. However, sometimes seizures occur in a different pattern that is more often or more severe. Several names have used to describe these patterns, such as seizure clusters and acute repetitive seizures. Stopping seizures early in these situations is the key to preventing a seizure emergency.

• There is no one-size-fits-all when it comes to rescue medicines. Since each person’s seizures are different, their seizure action plan and rescue medicine plan should be made specifically for them.
• When discussing with your health care provider, you should have a good understanding of your typical pattern of seizures and be able to recognize when seizures are not typical for you.
• As part of being prepared, ask your healthcare provider if “as needed” medicines are right for you and develop a clear plan with your provider about when they should be used.

General situations when rescue medicines may be recommended:

• Seizures occur that are different than your usual type or pattern.
• Seizures last longer than typical events.
• Seizure occur more frequently than usual
• Seizure clusters are different than usual – for example when more occur than normal or in a shorter period of time.
• Seizures occur at high-risk times – for example, during medicine changes or when sick.

Webinar Recording

Rescue Therapies for Children and Adults

Having a seizure action plan is essential for people living with epilepsy, their families, caregivers, classmates, and colleagues. A good seizure action plan includes information about what to do in the event of a seizure emergency. Watch the video for a discussion with Dr. Lawrence Hirsch and Registered Nurse Nancy Santilli about the latest options in rescue therapies for children and adults.

Webinar recorded on September 1, 2022

Learn More

• Understanding Seizures and Emergencies
• Responding to Seizures
• FDA News: Nayzilam (midazolam) Nasal Spray Approved for Seizure Clusters
• FDA News: Valtoco (diazepam) Nasal Spray Approved as Rescue Therapy for Seizures
• Innovations for Rescue Medications
• Six Questions to Help Decide Whether Your Child Should Have Acute Rescue Medications for Breakthrough Seizures

Authored By:

Matthew Hoerth MD

Patty Obsorne Shafer RN, MN

on Sunday, April 14, 2019

Reviewed By:

Elaine Wirrell MD

on Tuesday, April 14, 2020

First aid for epilepsy in humans.

What to do in case of an epileptic attack

First aid in case of an epileptic attack, as a rule, is provided to a person by those people who happened to be next to him at that moment. First of all, if you become a witness to an attack, you must call an ambulance so that the sick patient can receive the help of a qualified specialist. In addition, there are a number of simple rules that help to protect the patient during an attack before the ambulance arrives. You can turn to videos on the websites of professional medical communities, which in a popular way introduce how you can help a person with an epileptic seizure, whether an adult or a child.

An attack in an adult patient may begin with an “aura”, he anticipates loss of consciousness and convulsions and can inform others about this, the patient should lie on a bed or on the ground, away from traumatic objects, loosen his tie (if any).2

Immediately, without waiting for the arrival of a doctor, a child who has symptoms of “aura” should be placed on a flat surface (bed or floor), unbuttoned and loosened tight clothing, especially at the throat, to clear the airways. First aid for epilepsy in children, if an attack occurs outside the home, is to move the child to a safe place (away from water, traffic, sharp objects and corners), put something soft under his head, for example, a folded jacket . Remember that in the event of an attack, it is imperative to call an ambulance. It is necessary to protect the patient from injury, especially from head injury.6

If a convulsive attack in an adult or child occurs suddenly, and the patient does not anticipate it and cannot protect himself from injury, then first aid measures are taken after the onset of the attack. During an attack, the patient is not recommended to be transferred, except in cases where he may be in danger, for example, on the roadway, near the fire, on the stairs or in the water.

One of the standards in emergency care is to immediately put the victim in a comfortable position. With increased salivation and vomiting, the patient should be placed on his side so that he does not choke. This should be done gently, without using force. Before the arrival of doctors, you need to observe the patient. Do not try to keep the patient, limiting his movements. A dangerous complication of an attack – retraction of the tongue – occurs, as a rule, in the case of the position of the head face up with the head thrown back. Therefore, in no case should the position of throwing the head back be allowed! There is no need to try to open the patient’s mouth, even if the tongue is bitten, as this can lead to injury to the teeth, oral mucosa, upper and lower jaws, and the tongue itself. Among the urgent measures often mentioned is the need to lay an object between the teeth of the patient in order to prevent biting, which should never be done. Biting the tongue occurs at the very beginning of the attack. If the patient bit his tongue or cheek, then the injury has already occurred. Further attempts to open the mouth to avoid injury to the oral mucosa are useless and even dangerous.4

It is necessary to wait for the attack to end, being next to the patient and carefully observing his condition, in order to correctly and fully describe the manifestations of the attack to the doctor after the arrival of the ambulance. It is very important to note the time when the attack began, since the duration of the attack or series of attacks is very important for the attending physician. After an attack, as a rule, the patient feels weak, exhausted, or falls asleep. In this case, it is not necessary to disturb him in order to allow the nerve cells exhausted from the attack to recover. The standard of behavior of a person who happened to be close to the patient during an attack is to remain nearby and wait until the period of post-attack confusion (if any develops) ends and consciousness is fully restored. along with inappropriate behavior, aggressive actions towards others can also be noted. In such cases, it is important to remain calm and composed and try to provoke him to react as little as possible.3

When providing first aid for epilepsy in adults, do not pour water on the patient to “bring him to his senses”, do artificial respiration. It is also not recommended to try to wake the patient after an attack by shaking, tapping, inhaling pungent odors, or using any other methods. .

Seizures are often short-lived (several seconds or minutes) and end on their own. However, with prolonged seizures or seizures following one after another without recovery of consciousness, there is a threat of developing status epilepticus, and, in addition to providing emergency care, doctors should be immediately called for further hospitalization if necessary.7

It is important to remember the need to provide timely assistance for epilepsy and obtaining expert advice on how to act in an emergency, depending on the individual situation of the patient.

INTERNATIONAL LEAGUE OF ANTIEPILEPTIC RECOMMENDATIONS7

• 1. Voronkova K.V., Petrukhin A.S., Pylaeva O.A., Kholin A.A. Epilepsy is curable! Recommendations for patients and their relatives. Moscow, publishing house “Litterra” 2010. 176 p.
• 2. Karpova V. I., Krushinskaya N.S., Mukhin K.Yu. Epilepsy. Story. Diagnostics. Practice. Treatment. Tips for patients. Moscow, System Solutions, 2011. 224 p.
• 3. Mukhin K.Yu., Mironov M.B., Petrukhin A.S. epileptic syndromes. Diagnostics and therapy. Guide for doctors. Moscow, System Solutions, 2014. 376 p.
• 4. Devinsky O., Epilepsy. Patient and family guide. Demos Medical Publishing. 2008. 394 p.
• 5. Michalovska-Karlova E.P. journal Epilepsy.Medi.ru – No. 7, 2012. www.epilepsy.medi.ru Date of access – 11/28/2014.
• 6. Tikholaz T.V. journal Epilepsy.Medi.ru – No. 8, 2012 www.epilepsy.medi.ru Accessed 28.