Seizure Recognition and First Aid Chart
Seizure Recognition and
First Aid Chart

Seizure Recognition And First Aid

More than two million Americans have epilepsy (seizure disorders). You may see several of them in a day, and not even know it. People with epilepsy look just like everyone else . . . except when they have a seizure. Even then you might not recognize what you were seeing.

You might not know that the actions or movements taking place were being caused by a temporary medical condition. That lack of knowledge might lead you to take actions that you, and the person with epilepsy, might later regret.

If you are someone who deals frequently with the public, and if you have not been taught first aid for seizures, this short summary should help you recognize a seizure when it happens, and know how to give basic first aid . . . if it's needed.

What is Epilepsy?

Epilepsy is a common neurological condition. It is the general term for more than 20 different types of seizure disorders produced by brief, temporary changes in the normal functioning of the brain's electrical system.

These brief malfunctions mean that more than the usual amount of electrical energy passes between cells. The sudden overload may stay in just one small area of the brain, or it may swamp the whole system.

Of course, you can't see what's happening inside a person's brain. But you can see the unusual bodily movements, the effects on consciousness, and the changed behavior that the malfunctioning areas are producing. These changes are what we call seizures.

A single seizure may be caused by a number of health conditions. In addition to these, about one person in 100 has recurring seizures, known as epilepsy. Two out of four new cases begin in childhood. Epilepsy in adults may be the result of head injury -- often from auto accidents -- or may date from their childhood years. Epilepsy is not contagious at any age.

Recognition of seizure disorders and knowledge of first aid is important because it is very easy to mistake some seizures for some other condition.

A generalized tonic clonic seizure is a convulsion. But it may look like a heart attack, and CPR techniques may be used when they are not necessary.

A period of automatic behavior may be interpreted as being drunk or high on illegal drugs. The fact that a person undergoing this kind of seizure may have phenobarbital (an antiepileptic drug) with them adds to the confusion.

Type of Seizures

Seizure disorders take several forms, depending on where in the brain the malfunction takes place and how much of the total brain area is involved.

Generalized tonic clonic seizures are the ones which most people generally think of when they hear the word "epilepsy." In this type of seizure the person undergoes convulsions which usually last from two to five minutes, with complete loss of consciousness and muscle spasms.

Absence seizures take the form of a blank star lasting only a few seconds. Partial seizures produce involuntary movements of arm or leg, distorted sensations, or a period of automatic movements in which awareness is blurred or completely absent.

Since these seizure disorders are so different in their effects, they require different kinds of action from the public. Some require no action at all. Follow this link to a chart which describes seizures in detail, and how to handle each type. Consider printing out the web page to post on staff bulletin boards or other places where it can easily be seen by people who meet the public.

First Aid for Seizures in Special Circumstances

Although the chart gives information on basic first aid for a generalized tonic clonic (convulsive) seizure, there are some special circumstances in which additional steps should be taken.

A seizure in water

If a seizure occurs in water, the person should be supported in the water with the head tilted so his face and head stay above the surface. He should be removed from the water as quickly as possible with the head in this position. Once on dry land, he should be examined and, if he is not breathing, artificial respiration should be begun at once. Anyone who has a seizure in water should be taken to an emergency room for a careful medical checkup, even if he appears to be fully recovered afterwards. Heart or lung damage from ingestion of water is a possible hazard in such cases.

A seizure in an airplane

If the plane is not filled, and if the seat arms can be folded up, passengers to the left and/or right of the affected person may be reassigned to other seats, so that the person having the seizure can be helped to lie across two of more seats with head and body turned on one side.

Once consciousness has fully returned, the person can be helped into a resting position in a single reclining seat.

If there are no empty seats, the seat in which the person is sitting can be reclined, and once the rigidity phase has passed, he can be turned gently while in the seat so that he is leaning towards one side.

Pillows or blankets can be arranged so that the head doesn't hit unpadded areas of the plane. However, care should be taken that the angle at which the person is sitting is such that his airway stays clear and breathing is unobstructed.

A seizure on a bus

Ease the person across a double or triple seat. Turn him on his side, and follow the same steps as indicated above. If he wishes to do so, there is no reason why a person who has fully recovered from a seizure cannot stay on the bus until he arrives at his destination.

Is an Emergency Room Visit Needed?

An uncomplicated convulsive seizure in someone who has epilepsy is not a medical emergency, even though it looks like one. It stops naturally after a few minutes without ill effects. The average person is able to continue about his business after a rest period, and may need only limited assistance, or no assistance at all, in getting home.

However, occasionally a seizure will fail to stop naturally and as noted earlier, there are several medical conditions other than epilepsy that can cause seizures. These include:

diabetes
brain infections
heat exhaustion
pregnancy
poisoning
hypoglycemia
high fever
head injury

When seizures are continuous or any of these conditions exist, immediate medical attention is necessary.

The following are some suggestions to help people with epilepsy avoid unnecessary and expensive trips to the emergency room and to help you decide whether or not to call an ambulance:

No Need to Call an Ambulance

If medical I.D. jewelry or card says "epilepsy," and
If the seizure ends in under five minutes, and
If consciousness returns without further incident, and
If there are no signs of injury, physical distress, or pregnancy.

An Ambulance Should Be Called

If the seizure has happened in water.
If there's no medical I.D. and no way of knowing whether the seizure is caused by epilepsy.
If the person is pregnant, injured, or diabetic.
If the seizure continues for more than five minutes.
If a second seizure starts shortly after the first has ended.
If consciousness does not start to return after the shaking has stopped.

If the ambulance arrives after consciousness has returned, the person should be asked whether the seizure was associated with epilepsy and whether emergency room care is wanted.

For Law Enforcement Officers:
Epilepsy And Drugs

Despite medical progress, epilepsy cannot be cured in the same sense that an infection can be cured. However, seizures can be controlled completely or significantly reduced in most people who have the disorder. This control is achieved through regular, daily use of antiseizure drugs called anticonvulsants. Doses may have to be taken up to four times a day, and people with epilepsy therefore usually carry medication with them. To miss a scheduled dose is to risk a seizure.

More than 20 medications have been approved for treatment of epilepsy by the U.S. Food and Drug Administration. More than one drug may be prescribed. Among them are phenobarbital, Ativan (lorazepam), Klononpin (clonazepam), Tranzene (clorazepate) and Valium (diazepam).

If a law enforcement officer has any doubts about the legality of a person's possession of medication, the physician who prescribed the drug (or the pharmacy which dispensed it) should be contacted without delay. Depriving a person with epilepsy of access to his medication is putting his health -- even his life -- at risk.

When medication is taken away, for even as little as several hours, the following may happen:

A convulsive seizure with subsequent injury due to falling on cement floors, or in a confined area.
A series of convulsive seizures called status epilepticus, in which the convulsions continue non-stop or are followed by coma or a subsequent series of seizures. These are life threatening, and the mortality risk is high unless prompt treatment at a properly equipped medical facility is available.
Episodes of automatic behavior, known as complex partial seizures, in which the person, unaware of where he is or what his circumstances are, injures himself in unconscious efforts to escape, or is injured in struggles with law enforcement personnel. A person having this type of seizure is on automatic pilot so far as his actions are concerned. Efforts to restrain can produce a fighting reaction which he cannot control.

Could It Be Epilepsy?

Only a physician can say for certain whether or not a person has epilepsy. But many people miss the more subtle signs of the condition and therefore also miss the opportunity for early diagnosis and treatment. The symptoms listed below are not necessarily indicators of epilepsy, and may be caused by some other, unrelated condition. However, if one or more is present, a medical check-up is recommended.