Epileptic seizure: what to do?

Epileptic seizure: how can I provide first aid?

“I usually feel a seizure coming on just before it starts. Just a moment later, I’m lying on the floor and can’t remember what happened,” is how one epileptic describes his seizures. Even if it’s only for a short time, people with epilepsy lose control of their body and often feel disorientated, unwell and tired afterwards. This lack of control often leads to anxiety about having another seizure. If you’re on the scene, you can make the person feel better by keeping calm and being there for them.

Key rules on how to act when someone has an epileptic seizure

A seizure doesn’t follow a typical pattern and presents in different ways in different people. Here's how to react correctly to each type of seizure:

1. Stay calm: sounds easy, but isn’t always as simple as it sounds. Take a deep breath and stay with the person. Even if you forget all the other rules, just being there is the best thing you can do in the situation.
   
2. Protect the person from injury: put dangerous objects out of harm’s way and place something padded under their head. Loosen the clothing around their neck and remove glasses (if applicable).
3. Provide comfort and support: observe the seizure and stay with the person the whole time.
4. Keep an eye on the time: try to time the length of the seizure and call emergency services if it lasts longer than three minutes.
5. Administer the patient’s prescribed emergency medication (if available): if you’re aware of an emergency medication and it's on hand, administer it. However, avoid touching the person's mouth as there’s a risk of being bitten.
6. Offer help: stay with the person even after the seizure and offer your help. Make sure they can recover in peace and put them in the recovery position if they fall asleep.

What not to do when present at an epileptic seizure

In addition to these rules, there are also things you shouldn’t do.

• Don’t change the person’s position unless they are in danger.
• Don’t try to suppress the seizure by holding on to the person.
• Don’t put anything between the person's teeth.
• Don’t give them anything to drink.
• Don’t give the person artificial respiration.

When to call emergency services?

If the seizure lasts longer than 3 minutes, the person is injured or has problems breathing, don’t hesitate to call emergency services on 144. You should also call emergency services if the person doesn’t regain consciousness or has another seizure.

What is an epileptic seizure?

In medicine, a distinction is made between an epileptic seizure and epilepsy as a disease. An epileptic seizure is a once-off, sudden event triggered by a temporary disturbance in the brain and which usually subsides after a few seconds or minutes. Circumstances that can trigger a seizure include:

Epilepsy as a disease

After regeneration or recovery, the seizures usually no longer occur. But this isn't the case with epilepsy. If at least two such seizures occur without any recognisable cause more than 24 hours apart, or if a specialist considers the risk of a new seizure to be very high, the condition is described by doctors as epilepsy. It’s interesting to note that a third of all epileptics have their first seizure as a child and a further third only after the age of 60.

Types of epilepsy

Epilepsy can present in very different ways depending on its type. A distinction is made between focal and generalised seizures.

Convulsive seizures

Generalised seizures are also known as convulsive seizures and come closest to the common conception of epilepsy.

Grand mal

With generalised tonic-clonic seizures (also known as grand mal seizures), the whole body stiffens, the person breathes shallowly and loses consciousness. After 10 to 30 seconds, uncontrolled convulsions set in.

Focal seizures

In most cases, however, an epileptic seizure is much less dramatic. In adults, focal seizures (or also temporal lobe or frontal lobe epilepsy) are the most common form. People with this form of seizure may start moving in a jerky, robotic way and will appear to be in a trance.

Petit mal

In children, on the other hand, the most common type of seizure are absence seizures. The children experience sudden lapses of consciousness for 5 to 10 seconds. Their eyes are open, but their gaze is blank. The last two types are difficult for others to recognise.

Signs of an epileptic seizure

As different as the types of epilepsy are, so too are the warning signs. Some people with epilepsy notice the first signs several days or hours before the seizure. For others, it comes out of the blue.

An aura can warn of a seizure

The first sign of a seizure can be what’s known as an aura. This can often be equated to a change in the person’s perception, such as a strange taste in the mouth.

Indications: dizziness and feeling unwell

Dizziness or generally feeling unwell can also form part of an aura. At best, epileptics can use this as a warning and take safety measures, such as lying down on the floor or informing a third party.

Possible triggers and irritants

People with epilepsy may also find it helpful to look at the triggers likely to promote a new seizure. Possible triggers include:

• Stress
• Lack of sleep
• Flickering light
• Alcohol or drug abuse
• Reading
• Loud noises
• Moments of fright
• Feverish infections
• Certain medication

Note: As triggers can vary greatly from person to person, it can be worth keeping a kind of diary to find out any similarities linking the seizures and ultimately achieve better control over them.

Living with epilepsy

In principle, it’s possible to lead an independent and fulfilling life with epilepsy. With the right medication, many patients can also live seizure-free. However, depending on the type of epilepsy, it can be a good idea to consider which precautionary measures apply in your case. This may be: only entering water with experienced swimmers or only cycling in bicycle-friendly areas of the town. The best thing is to sit together with your healthcare professional and draw up your own personal risk assessment.

Aids for people with epilepsy and frequent seizures

Depending on the type and frequency of seizures, living an independent life can be a challenge. Epileptics can find peace of mind with emergency wristbands or seizure wristbands that alert emergency and other support services.

Educate the people around you

To help relieve the fears and uncertainty felt by family, friends or colleagues, you can provide them with factual information about your clinical picture and the type and frequency of your seizures. A short check list can also be useful, placed in an easily accessible place together with your emergency medication (if available). Posters are another option – hung in the common room at work, for example. Posters can be downloaded from the Swiss League Against Epilepsy and are available for adults and children.