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Epilepsy Seizure: What to Do in an Emergency

Tongue-biting, thrashing limbs, eyes rolled in the back of the head -- witnessing someone with epilepsy having a convulsive seizure can be truly frightening. But most seizures aren't an emergency; they stop on their own, with no permanent ill effects.

There is little you can do to stop a seizure once it has started. But by learning a few tips, you can protect a person with epilepsy from harm during seizures. It's worth knowing some basic first aid for seizures -- and when it's time to call 911.

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Understanding Epilepsy -- the Basics

Epilepsy is a brain disorder characterized by recurrent seizures -- episodes of abnormal electrical activity in almost any part of the brain. The symptoms of a seizure can mimic any form of human behavior, depending on which part of the brain is affected. Generally, the term epilepsy (or seizure disorder) refers to relatively stereotyped attacks of involuntary behavior. The exact symptoms and severity may vary, and the seizures may occur infrequently or in rapid succession. While every case of epilepsy...

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Types of Seizures, Degrees of Danger

Some seizures are more dangerous than others. The two main types are partial seizures and generalized seizures.

Partial seizures start in a single part of the brain. During simple partial seizures, a person with epilepsy is aware of what's happening. For example, a person's arm might start moving, or her face start twitching -- the person is awake and aware, but can't control it. This can be followed by decreased consciousness or staring as the seizure becomes complex. After the seizure, the person has no recollection of the event.

Generalized seizures involve both sides of the brain at once. People are rarely aware of what's happening during generalized seizures.

Convulsive seizures are known as generalized tonic-clonic seizures (grand mal seizures). These are the most frightening seizures to watch, and can be an emergency. In a generalized tonic-clonic seizure, this is the sequence of events:

  • The person may become unresponsive. Calling out to them brings no answer; waving your hand in their eyes or shaking them elicits no response. He may suddenly collapse. 
  • The person's muscles clench and he or she becomes rigid as a board (the ''tonic'' phase). This lasts a few seconds. 
  • Next, a series of jerking movements convulse the person's body (the ''clonic'' phase). The convulsions of a seizure can last for only seconds, or can go on for minutes. 
  • Eventually, the jerking stops and the person regains consciousness. Usually after a generalized seizure, a person is confused or disoriented for a short period of time.

Any generalized seizure can be dangerous, because the person becomes unaware of his surroundings and can't protect himself from harm, such as while driving. The uncontrollable thrashing movements during a generalized tonic-clonic seizure increase the risk of injury. Most seizures that result in trips to the emergency room are of this type.

If you witness someone with epilepsy having a generalized tonic-clonic seizure, remember that it's probably not an emergency, although it may look like one. Keep these first-aid tips in mind:

  • Keep other people out of the way. 
  • Clear hard or sharp objects away from around the person. 
  • Don't try to hold the person down, or stop the movements. 
  • Place the person on his or her side, to help keep the airway clear. 
  • Look at your watch at the start of the seizure, to time its length. 
  • Don't put anything in the person's mouth. Contrary to a popular misconception, it is not possible for a person to swallow his tongue during a seizure. However, placing an object in the mouth of a person who is having a seizure may cause the patient harm or injury. The patient may experience a dental injury or you may harm yourself by having your finger bit.

Milder seizures -- like brief periods of staring or shaking of the arms or legs -- also are not an emergency. You should, however, gently guide a person  away from any surrounding danger. They may be in a state similar to sleepwalking, and need protection from threats around them, like traffic or stairs.

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