Seizure First Aid: What to Do and What NOT to Do

A seizure witnessed is a frightening experience — for the family, more than the person having it. The specific wrong responses are so common in Indian households (putting a metal spoon in the mouth, tying the person, calling faith healers) that many patients suffer more from the response than the seizure. The correct actions are simple and largely non-interventional.

What a seizure looks like

• Generalised tonic-clonic ("grand mal"): loss of consciousness, whole-body stiffening then rhythmic jerking, may bite tongue, may lose bladder/bowel control, usually lasts 1-3 minutes.
• Focal aware: consciousness preserved, involuntary movements in one part of body, unusual sensations.
• Focal impaired awareness: staring, unresponsive, may perform repetitive movements, doesn't remember afterward.
• Absence: brief staring, unresponsive, quick recovery, often in children.
• Myoclonic: brief muscle jerks.
• Atonic: sudden loss of muscle tone, may cause fall.

What to do during a seizure

• Stay calm.
• Note the time it started.
• Clear the area of hard or sharp objects.
• Place something soft under the head.
• Loosen tight clothing around neck.
• Turn the person on their side (recovery position) once movements slow or stop.
• Time the seizure.
• Stay with the person until they're fully alert.
• Reassure them when consciousness returns.

What NOT to do

• Do NOT put anything in their mouth — no spoon, no cloth, no finger.
• Do NOT try to hold them still.
• Do NOT try to give food, water, or medicine during the seizure.
• Do NOT slap or shake them.
• Do NOT throw water on them.
• Do NOT force limbs into normal position.
• Do NOT leave them alone.
• Do NOT take them to a faith healer.

The specific 'nothing in the mouth' rule

The persistent belief that seizures cause tongue-swallowing is wrong. The tongue cannot be swallowed. Putting something in the mouth causes: broken teeth, injured jaw, blocked airway, injury to the helper's finger. Every year Indian ERs see seizure patients with mouth injuries from well-meaning family members. Nothing goes in the mouth.

When to call ambulance

• First-ever seizure.
• Seizure lasting more than 5 minutes.
• Seizures repeated back-to-back without recovery.
• Injury during seizure.
• Breathing difficulty after seizure.
• Fever with the seizure.
• Pregnancy.
• Diabetes.
• Not returning to normal consciousness within 10-15 minutes.
• Occurred in water.

After the seizure — the postictal phase

• Confusion is normal, lasting 15-30 minutes.
• Sleepiness, fatigue.
• Sometimes headache, muscle soreness.
• Sometimes tearfulness or agitation.
• Speech may be slow.
• Memory of seizure absent.
• Reassure and stay calm — they'll recover fully.

For a person with known epilepsy

• They usually know their pattern.
• They usually don't need ambulance for a typical seizure of usual duration.
• Follow their action plan if they have one.
• Rescue medication (usually buccal midazolam or rectal diazepam) may be prescribed.
• Call ambulance if seizure lasts longer than usual or is different in character.

The specific paediatric consideration — febrile seizure

• Common in children 6 months - 5 years, associated with fever.
• Usually brief (1-3 minutes).
• Frightening but usually not dangerous.
• Treat the fever, ensure safety during seizure.
• Bring to hospital after — evaluation for cause of fever, first-time seizures always.
• Long-term epilepsy risk only slightly increased.

What to record

• Time seizure started.
• Duration.
• Description of what happened (limb movements, consciousness level, incontinence, tongue biting).
• Position at start (standing, sitting, sleeping).
• Any warning signs (aura) beforehand.
• How long recovery took.
• Any injuries.
• Time last ate and took medications.
• Recent illness, fever, sleep deprivation.
• Ideally video (family member can record on phone) — extremely useful for neurologist.

The specific video documentation

A short phone video of a seizure — even 30 seconds — is often more useful to the neurologist than any description. The specific type of seizure guides medication choice; visual patterns are often diagnostic. If safe to do so, video the event.

Living with epilepsy

• Medication adherence is critical — most seizures on treatment result from missed doses.
• Sleep deprivation is a common trigger.
• Alcohol interacts with anti-epileptics.
• Some medications interact — pharmacy or specialist check for new prescriptions.
• Driving restrictions apply — usually seizure-free 6-12 months required.
• Swimming with buddy, showering rather than bathing, avoid heights.
• Medical ID or bracelet.
• Family trained in first response.
• Regular neurology follow-up.

Seizure first aid is one of the specific things every household should know — because seizures can happen to anyone at any age, and the specific correct response prevents unnecessary injury.

References

• Epilepsy Foundation — first aid
• IEA — Indian Epilepsy Association
• WHO — epilepsy