Seizure Recognition & First Aid

Generalized Tonic Clonic (Grand Mal)

Sudden cry, fall, rigidity, followed by muscle jerks, shallow breathing or temporarily suspended breathing, bluish skin, and possible loss of bladder or bowel control. Usually lasts a couple of minutes. Normal breathing then starts again. Confusion and/or fatigue, followed by return to full consciousness.

What it is not

Heart attack.
Stroke.

Do’s & Don’ts

DO protect from nearby hazards. Loosen ties and collars.
DO turn on side to keep airway clear unless injury exists. If single seizure lasts less than 5 minutes, ask if medical evaluation is wanted.
DO call an ambulance if seizure lasts longer than 5 minutes, it is the first seizure, the person is pregnant or has diabetes.
DON’T put any object in the mouth or try to hold the tongue.
DON’T restrain.
DON’T give liquids.
DON’T use artificial respiration.

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Absence (Petit Mal)

A blank stare, beginning and ending abruptly, lasting only a few seconds, most common in children. May be accompanied by rapid blinking, some chewing movements of the mouth. Child or adult is unaware of what’s going on during the seizure, but quickly returns to full awareness once it has stopped.

What it is not

Daydreaming.
Lack of attention.

Do’s & Don’ts

No first aid necessary but if this is the first seizure,
DO recommend medical evaluation.
DO try to document duration of seizure.
DO be calm and reassure the patient.

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Simple Partial

Jerking may begin in one area of the body, arm, leg, or face. Patient stays awake. Jerking may proceed from one area of the body to another, and sometimes spreads to become a convulsive seizure. Partial sensory seizures may not be obvious to another. Patient experiences a distorted environment. May feel unexplained fear, sadness, anger, or joy. May have nausea, sense odd smells, and have a “funny” feeling in the stomach.

What it is not

Acting out, bizarre behavior.
Hysteria.
Mental illness.
Mystical experience.
Psychosomatic illness.

Do’s & Don’ts

No first aid necessary unless seizure becomes convulsive, then first aid as above.
No immediate action needed.
DO provide emotional support and reassurance.
DO recommend medical evaluation.

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Complex Partial (Psychomotor or Temporal Lobe)

Usually starts with blank stare, followed by chewing and random activity. Person appears unaware of surroundings and seems dazed. Unresponsive. Actions clumsy, not directed. May pick at clothing, pick up objects, try to take clothes off. May run, appear afraid. May struggle or flail at restraint. Once pattern established, same set of actions usually occur with each seizure. Lasts a few minutes, but post-seizure confusion can last substantially longer. No memory of seizure.

What it is not

Drunkenness.
Intoxication on drugs.
Mental illness.
Disorderly conduct.

Do’s & Don’ts

DO speak calmly and reassuringly to patient.
DO guide away from obvious hazards.
DON’T grab hold unless sudden danger such as a cliff or an approaching car.
DON’T try to restrain.
DON’T shout.

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Atonic Seizures (Drop Attacks)

An adult or child suddenly collapses and falls. After 10-60 seconds he/she recovers, regains consciousness and can stand and walk again.

What it is not

Clumsiness. Normal childhood “stage.”
Child: lack of good walking skills.
Adult: drunkenness, acute illness.

Do’s & Don’ts

No first aid needed unless hurt during a fall.
DO recommend a thorough medical evaluation.
DO provide emotional support and reassurance.

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Myoclonic Seizures

Sudden, brief, massive muscle jerks that may involve the whole body or parts of the body. May cause person to spill what they were holding or fall off a chair.

What it is not

Clumsiness.
Poor coordination.

Do’s & Don’ts

No first aid needed unless injury occurs.
DO recommend a thorough medical evaluation.
DO provide emotional support and reassurance.

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Infantile Spasms

Clusters of quick sudden movement between 3-24 months. If a child is sitting up, the head falls forward, and the arms flex forward. If lying down, the knees draw up while arms and head flex forward. The baby appears to reach for support.

What it is not

Normal movements of the baby.
Colic.

Do’s & Don’ts

No first aid needed.
DO consult a doctor.
DO document duration of seizure.

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Status Epilepticus and Seizure Clusters

When seizures do not stop on their own, or when seizures occur in clusters without any recovery period in between, the person having the seizures is said to be in “status epilepticus.” This state of continuous seizure can be a serious medical emergency for the individual who is in status. Emergency treatments for status epilepticus may differ from patient to patient, based on directions given by their physicians. However, if you do not know the person who is having the seizures well and if you are not familiar with the specifics of that emergency treatment recommended by the person’s physician, or if this is the first time a person has gone into status, call an ambulance and seek emergency care for the person.

Diastat

One of the emergency treatments for status epilepticus is Diastat, a prescription medication. Diastat is used in the treatment of both seizures that don’t stop and seizures that occur in clusters. Please speak with your physician if you have further questions about whether or not Diastat might be an appropriate prescription for you or for your family member who is affected by epilepsy.

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