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

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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.