What to do when someone has a seizure

The steps, in order. Stay with them. Keep them safe. Turn them on their side. When to call an ambulance.

Do this now

1. Stay with them. Look at a clock and start timing it. Say their name and talk calmly. Most seizures stop on their own in a few minutes.
2. Move things out of the way. Push back chairs, tables and anything hard or sharp. If they are walking around and confused, steer them away from stairs, the road, or anything they could fall from.
3. Help them to the floor if they look like they are falling. Put something soft and flat under the head, like a folded coat. Take off their glasses. Loosen anything tight around the neck.
4. Turn them on their side, with the mouth pointing at the ground. This keeps spit from blocking the airway and helps them breathe.
5. Look for a medical ID on the wrist or neck, or on their phone. If they have a rescue medicinerescue medicine: A medicine kept at home to stop a seizure that is going on too long. Depending on which one your doctor picks, it goes up the nose, under the tongue, or into the bottom. See the glossary their doctor gave them for this, give it the way the doctor said.
6. Stay until they are fully awake. Then tell them, simply, what happened.

Call an ambulance if

Most seizures do not need one. Call 911 (or your local emergency number) if:

• the seizure lasts longer than 5 minutes
• another seizure starts before they have come round from the first
• they are having trouble breathing, or they seem to be choking
• they do not wake up after it stops
• they got hurt
• it happened in water
• this is their first ever seizure
• they are pregnant
• they have diabetes and do not come round
• they ask you to

If you are frightened and you are not sure, call. That is what the number is for.

Do not

• Do not put anything in their mouth. Not your fingers, not a spoon, not a wallet. They cannot swallow their tongue. The jaw clamps hard, so you can be bitten and they can break a tooth.
• Do not hold them down or try to stop the shaking. It does not end the seizure. It can hurt them, and someone who is confused may fight back.
• Do not give food, drink or pills until they are properly awake. It can go into the lungs.
• Do not start rescue breathing during the seizure. Breathing often looks like it has stopped while the chest muscles are tight, and it starts again on its own. If they are still not breathing once the seizure is over, start CPR and call an ambulance.

If it happens in water

A seizure in water is different. It can kill, and it needs an ambulance every time.

1. Hold their head so the face stays above the water.
2. Get them out of the water as fast as you can.
3. Check whether they are breathing. If they are not, start CPR.
4. Call an ambulance, even if they seem completely fine afterwards. Water that got into the lungs can cause trouble later, and it is treatable when someone is looking for it.

This is the one situation where you call every single time.

After it stops

Coming round takes a while. They may be muddled, exhausted, upset, or sore. They may not remember any of it. All of that is normal, and it is not a sign that something has gone wrong.

Ask them their name, where they are, and what day it is. If they cannot say, tell them, kindly, and say they are safe. Do not leave them alone until they can answer you, they are breathing normally, and you can wake them if they doze off.

Then offer to sit with them, or to call someone who can get them home.

What to write down

They probably cannot tell anyone what happened, because they were not there for it. You were. What you write down is the thing most likely to change their treatment.

• What time it started, and how long it lasted.
• What they were doing just before.
• What you saw first: staring, a jerk in one arm, a noise, a fall.
• Which parts of the body moved, and whether it was one side or both.
• Whether they were awake or aware at any point.
• How long it took them to come back to themselves.
• Anything different that day: a missed dose, a bad night's sleep, being ill, alcohol, heat.

Take it to the next appointment. If they keep a seizure diary, add it to that.

Why this happens with a brain tumor

A seizure is a burst of unusual electrical activity in the brain. A tumor, and the irritated brain around it, can set one off. Seizures are one of the most common symptoms of a gliomaglioma: A tumor that starts in the glial cells, the support cells of the brain and spinal cord. Gliomas are given a grade from 1 to 4 describing how the tumor is expected to behave. See the glossary, and for many people a seizure is the thing that led to the tumor being found in the first place.

That means a seizure is not automatically bad news about the tumor. It is information for the care team, and it is often something medicine can control.

If this is likely to happen again

• Write a short seizure action planseizure action plan: A short written page that says what your seizures look like, what people should do, whether you have a rescue medicine, and who to call. You keep copies where they will be needed. See the glossary: what a seizure looks like for this person, what to do, whether they have rescue medicine, and who to call. Give a copy to family, work and school.
• Get a medical ID bracelet, or put the details in the phone's medical ID so a stranger can find them.
• Never stop seizure medicine suddenly. Stopping can cause a seizure. If it needs to change, the care team changes it slowly.
• The rest of daily life has its own page: living with seizures.

What to ask your team

• What do this person's seizures usually look like?
• Should we have a rescue medicine at home, and when would I use it?
• When do you want me to call you, and when should I call an ambulance instead?
• What should I write down when one happens?
• Who do we call out of hours?