Epileptic Seizure: First Aid in Epilepsy. How to Help the Patient?

Epilepsy is one of the most common neurological diseases, affecting 1% of the population (in Poland, this is about 400,000 people). Despite ongoing therapy, bioelectrical discharges in the brain often occur, leading to an attack. It is important to be aware of how to help the affected person and provide support when witnessing such an episode.

How to recognize an epileptic seizure?

Epilepsy is a disease that causes some nerve cells in the brain to malfunction. There are various types and causes of epileptic seizures (e.g., generalized tonic-clonic seizures, often characterized by the most severe course, or partial seizures). They may appear as we commonly see in films as classic epilepsy symptoms: a person collapses and has convulsions that stop after 2-3 minutes. Sometimes, however, these may progress into status epilepticus, lasting longer. A violent seizure may result in loss of consciousness or biting the tongue.

Fever-related convulsions can also appear dangerous but are not associated with nervous system diseases.

However, there are also cases when a person does not fall, lose consciousness, but loses contact with the environment (during such a seizure, the patient has impaired awareness). During such an epileptic episode, the person may walk, perform various seemingly ordinary activities, but is completely unaware of doing them.

It happens that these actions may be dangerous – for example, they might try to exit through a window or cross a busy street. Such an epileptic seizure usually lasts up to several minutes.

First aid in the event of an epileptic seizure

Immediately after recognizing epilepsy, it is crucial to know how to provide proper first aid to the injured person, even before the medical rescue team arrives.

During an epileptic attack:

Stay with the person having the seizure – if possible, measure the duration of the seizure and collect information about the patient.
Ensure safety – if the seizure occurred on the road, move the patient to the roadside or stop traffic.
Remove objects around the person that could injure or bruise them.
Place something soft (but not high) under the head of the person having the seizure to prevent them from hitting it during convulsions.
There may be involuntary urination – you can ensure a little privacy so that the injured person does not feel embarrassed.

After the epilepsy attack stops:

In case of unconsciousness, lay the patient on their side and gently tilt their head back to clear the airway.
Stay with the patient until they fully regain consciousness – that is, until they can speak completely logically with you.
Patients with epilepsy often experience postictal confusion. It usually lasts from a few to several minutes, during which the patient may be agitated, behave strangely, and pose a threat to themselves and their surroundings. It is very important to ensure their care at this time. Do not try to forcibly keep them in one place but ensure they do not hurt themselves.
When the patient fully regains consciousness, make sure they are not in pain and ask if they have had seizures before. If it was the first seizure in their life, you must call an ambulance.

What not to do when witnessing an epileptic seizure:

Do not put anything in the mouth.
Do not give water or medication.
Do not forcibly stop the convulsions.
Do not restrain the body.
Do not open clenched jaws.
Do not shake the patient.

Seizure with impaired consciousness

A specific situation occurs when the patient has impaired awareness – in this case:

Stay with the person who has impaired awareness seizures (measure the duration of the attack and collect information about the patient).
Ensure your and the patient’s safety (try to keep them in a safe place – do not cross a busy street).
A person with impaired awareness may misunderstand the rescuer's behavior and perceive help attempts as an attack. Therefore, limit your intervention to the most necessary actions when the patient clearly poses a danger to themselves.
Stay with the patient until they fully regain consciousness – that is, until they can speak completely logically with you.
When they regain full awareness, make sure they are not in pain and ask if they have had seizures before.

When to call emergency medical services?

Most epileptic seizures are not life-threatening. Seizures with convulsions usually subside after a few minutes, after which the patient sleeps or is confused for several minutes (rarely tens of minutes) and then recovers.

Seizures with impaired awareness are longer and also not life-threatening, but in every case, it is always worth consulting a doctor. However, sometimes a seizure may indicate a life-threatening condition and requires immediate medical assistance.

When should you call an ambulance?

The convulsive seizure lasts over 5 minutes.
The patient has convulsions, followed by a break during which they do not regain consciousness, and then they have more convulsions.
A seizure with impaired awareness lasts very long (over 30 minutes).
During the seizure, there was a serious injury, fracture, head trauma, etc.
After the seizure, the patient does not regain consciousness for a long time (over 30 minutes) and does not respond to attempts to wake them.
It was the first seizure in their life.

Author: Dr. Marta Banaszek