Would you recognise an epileptic seizure?

Understanding epilepsy

Most of us will have some awareness of what epilepsy is, but what you may not know is that anyone could have a single epileptic seizure at some point in their lives.

What is an epileptic seizure?

Epileptic seizures are caused by a disturbance in the brain’s electrical activity. There are different kinds of epileptic seizure, and you don’t have to have epilepsy to have one; epilepsy is a tendency to have these seizures. Not all seizures are epileptic, and the thing that differentiates epileptic seizures from others is that they all start in the brain.

Epileptic seizures can be triggered by a variety of things for epileptic sufferers, including lack of sleep, stress, alcohol, and not taking medication.

Types of epileptic seizure

There are six types of epileptic seizure, which fall into two main groups: focal and generalised seizure. While seizures are not usually a medical emergency (unless the person injures themselves during their seizure) one should be aware of ‘status epilepticus’.

A person’s seizures usually stop by themselves, and for someone who suffers from epilepsy, their seizures will normally last the same duration each time. However, sometimes seizures do not stop or one follows another without the person recovering in between. If this goes on for 30 minutes or more it is called ‘status’. This is uncommon, but can happen in any type of seizure.

Focal aware seizures

During this seizure, the casualty is conscious, usually knows something is happening, and will remember it afterwards. Some people find these seizures hard to describe, and the feelings associated vary depending on where in the brain it takes place. For some people, these seizures may develop into another type of seizure, with the focal aware seizure serving as a ‘warning’.

Tonic clonic seizure

These are the seizures most commonly associated with epilepsy, and have clearly visible effects. At the start of the seizure, the person’s body goes stiff, and if they are standing up they usually fall backwards. They will become unconscious, but may cry out first, and/or bite their own tongue or cheek.

During the seizure, the person will convulse as their muscles relax and tighten rhythmically. Their breathing may become difficult or noisy, and their skin may become very pale or bluish. Once the seizure stops, their breathing and colour should return to normal, but they may feel tired, confused, sleepy or have a headache.

These seizures tend to be brief and people usually recover quickly. However, for tonic clonic seizures, status is a medical emergency and you should call an ambulance. Don’t wait 30 minutes first. A general first aid guide for seizures will follow later.

Atonic seizure

This is also known as a ‘drop attack’, as the person’s muscles suddenly relax and they become floppy. This means that if they’re standing, they often fall, usually forwards. This may mean they injure their head or face. People usually recover quickly from this seizure, asides from any injuries they sustain from the fall.

Focal impaired awareness seizures

These affect a larger part of one side of the brain than focal aware seizures. While the person remains conscious, their behaviour is affected. They may become confused, may not be able to hear people, or fully understand what is being said to them. They may react unusually to other people and could become aggressive if you speak loudly to them.

When starting in the temporal lobe, these seizures usually last two to three minutes and may include:

  • Picking things up for no reason or fiddling with clothing
  • Chewing or lip-smacking movements
  • Muttering or repeating words nonsensically
  • Wandering around in a confused state

When starting in the frontal lobe, these seizures usually last 15-30 seconds and may include:

  • Making strange movements or postures
  • Loud crying out or screaming

Absence seizure

These are more common in children than adults and can be very frequent. During an absence seizure, the person becomes unconscious for a short time. They will not respond to what is happening around them, and they may stare or have a blank look. Sometimes the eyelids flutter. If they are walking, they may carry on doing so, but not be aware of what they are doing. This usually lasts only a few seconds and may not be noticed. Sometimes, it can last longer, and may cause the limbs to go limp and cause a fall.

Myoclonic seizure

This means ‘muscle jerk’. In a myoclonic seizure, the person is conscious, and their seizure is brief, but may happen in clusters. This often happens shortly after waking. Muscle jerks aren’t always caused by epilepsy.

First aid for seizures

Most seizures won’t require an ambulance or medical treatment in themselves, and bystanders should respond by comforting the individual and ensuring that they are safe. However, tonic clonic and atonic seizures involve sudden loss of consciousness and therefore may result in injury which require first aid or urgent medical attention, and you must always be aware that a tonic clonic seizure which lasts for more than 5 minutes warrants a 999 call.

If someone collapses and appears to be having an epileptic seizure, take the following steps:

  • Try to control the fall if you are able to in time
  • Ensure their safety by removing any objects that may cause injury if struck during a convulsion. If the person is in a dangerous place, attempt to move them. Otherwise, don’t move them
  • Place padding under their head. Never put anything in their mouth
  • Loosen any clothing that may restrict their airway
  • Time their seizure. They usually last up to three minutes, but may last longer. If the convulsions last over five minutes, call 999. If the casualty appears to have sustained a major injury, call 999

Once the seizure has subsided you should:Checking ABC after epileptic seizure

  • Check the casualty’s airway, breathing and circulation (ABC)
  • If unresponsive or semi-responsive and breathing normally, place them in the recovery position. If they are not breathing, begin CPR
  • Cover them with a blanket if possible. They may have wet themselves
  • Monitor any injuries and their airway, breathing and circulation

Call an ambulance if:

  • You have concerns with ABC’s
  • You feel unable to cope with the situation
  • The casualty is not known as an epilepsy sufferer and you suspect the seizure may be caused by something else, such as a head injury
  • The convulsions last over 5 minutes
  • They suffer more than one seizure with no recovery in between
  • They injure themselves badly (broken/fractured bone, dislocated joint, major bleeding, head injury, etc.)
  • There are no signs of recovery after 10 minutes
  • You are unsure if they are an epileptic

Responding to seizures is part of our Ofqual Accredited 3 day First Aid at Work course. Find out more here.