Seizure (fit)
Someone suddenly loses consciousness and falls, the body stiffens, then the arms and legs start jerking rhythmically, the breathing sounds harsh, saliva comes…
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Medicines commonly prescribed for Seizure (fit)
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 1 mgActive substance: clonazepamManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 0.5 mgActive substance: clonazepamManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION DROPS, 2.5mg clonazepam/10mlActive substance: clonazepamManufacturer: Cheplapharm Arzneimittel GmbhPrescription required
Someone suddenly loses consciousness and falls, the body stiffens, then the arms and legs start jerking rhythmically, the breathing sounds harsh, saliva comes out of the mouth, the lips turn blue. From the outside it looks like a catastrophe, and the first urge is to do something at once: force the teeth apart, pour in some water, lift the person up and sit them down. Those are exactly the actions that do harm. Helping during a seizure comes down to very simple things, and the main one is not getting in the way. This page is written first of all for whoever is standing there, because more depends on them than on any medicine.
What to do while the seizure is happening
The sequence is short and worth knowing by heart.
- Note the time it started. Look at a clock or your phone straight away. It is the one number everyone will ask for afterwards: whether an ambulance is needed and what the doctor does both depend on it.
- Clear the danger away. Not the person, the objects: move the chair, the table with something hot on it, the heater, anything hard or sharp. You move the person only where there is no other way to keep them safe — beside a road, on stairs, next to a hot cooker, near water.
- Put something soft under the head — a jacket, a bag, a folded jumper. Banging the head on the floor is the main injury a seizure causes. Take off their glasses and loosen a collar, a tie or a tight scarf.
- Once the convulsions stop, turn the person on to their side. Head slightly downwards, so that saliva and anything in the mouth drains out rather than into the airway. Check that they are breathing.
- Stay with them and talk calmly until they are fully aware again. This is the longest part: for several minutes, sometimes half an hour, the person does not understand where they are, may get up and walk off, may take fright and push you away. Do not argue and do not restrain them — stay beside them, steer them away from anything dangerous, and keep repeating who you are and what has happened.
- If they are in a wheelchair, put the brakes on, leave any belts or harness fastened, support the head, and do not try to lift them out.
If someone else is nearby, ask them to keep track of the time.
What not to do
This list matters more than the previous one, because nearly everything on it is done with the best of intentions.
- Put nothing in their mouth. Not your fingers, not a spoon, not a handkerchief. The tongue is not swallowed during a seizure — that is an old belief. Broken teeth, a dislocated jaw, a bitten finger and an inhaled object, on the other hand, are all real.
- Do not force the teeth apart. The jaws are clenched by muscle and there is no way to open them without causing damage. If the tongue has been bitten, it happened in the first seconds and cannot be undone.
- Do not hold the person down. Pinning the arms and legs, sitting on them, trying to straighten them out: useless and dangerous, because the seizure is no shorter for it and dislocations, sprains and fractures happen exactly this way.
- Give nothing to drink, nothing to eat and no medicine until they are fully aware: water or a tablet going into the airway without a swallowing reflex is a disaster worse than the seizure itself.
- Do not lift them straight away. Do not sit them up, do not stand them up, do not walk them home or put them in a car. Let them lie on their side as long as they need.
- Do not splash water, do not slap the face, do not hold anything strong-smelling under the nose: waking someone earlier simply does not work.
- Do not start rescue breaths while the convulsions are going on: noisy, irregular breathing and blue lips during those seconds are usual and pass by themselves. Resuscitation begins only if the convulsions have stopped and there is no breathing.
When to call an ambulance
An ambulance is called on the single European number 112. Call without hesitating if:
- it is the person's first seizure ever, or you do not know whether they have had seizures before;
- the convulsions last longer than five minutes;
- seizures follow one after another without them becoming aware in between;
- they were injured during the seizure — hit their head, cut their face, damaged an arm;
- the seizure happened in water, in a pool, a bath or the sea: even if the person seems fine, water may have got into the lungs;
- it is a pregnant woman, or a woman who has recently given birth;
- they do not come round, stay unconscious, or have difficulty breathing once the convulsions have stopped;
- the person has diabetes or has a high temperature;
- the seizure looks different from the ones they usually have, or lasts longer than usual for them.
Someone with long-standing epilepsy does not need an ambulance every time: many have a plan agreed with their doctor setting out what to expect and what to do, including emergency medicine given by family or carers. If such a plan exists and you have been shown how to follow it, follow it. If there is no plan, if you are unsure, or if something does not match what the plan describes, call.
The faint that gets mistaken for a seizure
This happens more often than a true seizure. In a faint brought on by a stuffy room, by pain, by the sight of blood or by standing for a long time, the brain goes a few seconds without blood, and the body has time to stiffen and jerk — from the outside it is very convincing.
Three things help tell them apart: the person went pale beforehand and felt unwell, the whole thing lasted seconds, and awareness came back quickly without a long spell of confusion. The difference is not cosmetic: a faint is investigated in the heart, a seizure in the brain, and the tests are quite different. That is why the minutes before the fall matter to the doctor.
What else causes seizures
A seizure is an event, not a diagnosis, and it has many causes. They are worth sorting out, because some of them can be corrected and then it does not happen again.
- Low blood sugar. The most important reversible cause in anyone being treated for diabetes: sweating, trembling, hunger and odd behaviour often come first. That is why diabetes is a reason to call an ambulance.
- Alcohol withdrawal. The seizure comes not while someone is drunk but a day or two after a heavy, long-term drinker stops drinking. It is a dangerous state and it is treated in hospital.
- Medicines and poisoning: abruptly stopping sedatives or sleeping tablets, overdose, certain drugs, recreational drugs.
- Infection of the brain and its coverings — a seizure with a high temperature, a severe headache, drowsiness or confusion in an adult. This is an emergency.
- Head injury: a seizure straight after a blow, or some time after a serious injury.
- Eclampsia. A seizure in the second half of pregnancy or in the first weeks after birth, usually with raised blood pressure and swelling. It threatens the lives of both mother and baby, and here it is counted in minutes.
- A febrile convulsion in a child — a seizure as the temperature climbs quickly, nearly always under the age of five. To parents it looks like the end of the world, but these convulsions usually stop by themselves within minutes and are almost never dangerous. A child still needs to be seen after the first one: a brain infection has to be ruled out.
What to write down and tell the doctor
Seizures are diagnosed mainly from the description. The person does not remember their own seizure, and tests, the brain wave recording included, are often normal in between. A witness's account is worth more than any machine here, and it is best written down at once.
- Whether there was a warning: an odd smell or taste, a sensation rising from the stomach, sudden fear, a feeling of having seen this before. The person may have mentioned it seconds earlier.
- What the eyes and head did: whether the eyes rolled up or looked to one side, whether the head turned and which way. That tells the doctor where the seizure started.
- Where it began: the whole body at once, or one hand first, or one side of the face.
- Whether the tongue was bitten, usually at the side, and whether there was loss of urine.
- What happened to the breathing and the colour of the face, and how long it all lasted by the clock. If it happens again and someone else is present, a video will tell the doctor more than any account.
- How long it took to come round and what they were like afterwards: confused, drowsy, wrung out, whether they slept for a long time, whether weakness was left in an arm or a leg.
- What the day before was like: a night without sleep, alcohol, a missed tablet, a high temperature, a new medicine, a stifling room and a long time on your feet.
After a first seizure: no driving
After a seizure with loss of consciousness, nobody drives until a doctor decides. Not for a day, and not "until my head clears": the length of time is set by the doctor and depends on what the investigations show. The rules differ from country to country and have to be checked where you live, but one thing is the same everywhere: permission comes from a doctor, not from feeling well.
For the first weeks, while the cause is still unclear, a few more things make sense:
- do not swim or bathe alone; a shower is safer than a bath, and it is better not to lock the door;
- do not work at height, near fire or with machinery, and do not be alone anywhere a fall would be dangerous;
- do not go without sleep and do not drink alcohol: those are the two commonest triggers for another seizure;
- take what has been prescribed exactly on time — a missed dose of an anti-seizure medicine is the commonest reason seizures return, and these drugs are never started or stopped on your own;
- tell family and colleagues what to do if it happens again: a short explanation is enough to keep anyone from putting a hand in your mouth.
And the most important point: one seizure does not mean epilepsy. The diagnosis rests on everything together — the description, the tests and sometimes watching over time — and for some people the seizure remains the only one of their life.
Online consultation
A seizure leaves a great many questions and very little clarity, and in this subject the diagnosis is built out of conversation. An Oladoctor doctor will go through everything above with the patient or the witness, help separate a seizure from a faint, work through what may have acted as a trigger, and explain which investigations are needed and in what order. They will say how to manage the first weeks at home and what to note down if it happens again. And they will say plainly when talking is not enough: if a seizure is going on right now, lasts more than five minutes, repeats without the person becoming aware, or has happened to a pregnant woman, to someone with diabetes, with a fever or in water, what is needed is an ambulance on 112 and not a message.
This material is for information only and does not replace medical advice.
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