Seizures

You may think that every seizure causes dramatic shaking, or that one seizure automatically means epilepsy. Seizures can affect movement, awareness, sensation, emotion or behaviour. They may have several causes, and epilepsy is diagnosed only after appropriate specialist assessment.

A seizure is a temporary episode of abnormal brain activity A seizure occurs when abnormal electrical activity temporarily disrupts normal brain function. Depending on the area involved, a seizure may cause changes in awareness, memory, movement, muscle tone, sensation, vision, smell or taste, emotion, behaviour, or speech. Some seizures are obvious. Others may appear as a brief pause, an unusual sensation or a period of confused behaviour. A convulsion is one possible seizure pattern A convulsive seizure may involve sudden loss of consciousness, body stiffening, rhythmic jerking, altered breathing, saliva around the mouth, a temporary change in skin colour, loss of bladder control, or sleepiness or confusion afterwards. These features can look frightening. Most brief seizures stop without physical restraint or anything being placed in the mouth. Not all seizures cause shaking A seizure may instead involve: Staring and reduced responsiveness. Repetitive lip smacking or swallowing. Picking at clothes. Sudden stiffening. Brief muscle jerks. A sensation rising through the stomach. Déjà vu. An unusual smell or taste. Sudden fear. Tingling. Visual changes. Temporary difficulty speaking. Wandering or confused behaviour. The person may remain fully aware, have reduced awareness or lose consciousness. One seizure does not automatically mean epilepsy Epilepsy is a neurological condition involving an ongoing tendency to have epileptic seizures. A single seizure may be provoked by a temporary problem, such as low blood glucose, alcohol withdrawal, a serious infection. A head injury, a stroke, a medicine or drug, a disturbance in blood salts, or high fever in a young child. Some people have a first unprovoked seizure and never have another. Clinical guidance recommends individualised assessment of the risk of recurrence rather than assuming that a first event establishes epilepsy. A faint can resemble a seizure Syncope may sometimes involve brief stiffening or jerking. Other events that can resemble seizures include migraine, sleep disorders, panic episodes, movement disorders, cardiac rhythm disturbances, psychological non epileptic seizures, or low blood glucose. This does not mean the event is imagined. It means that different conditions require different treatment, so accurate diagnosis matters. Witness information is highly valuable A witness should note, where safely possible, what happened immediately before the event, whether the person gave a warning, the first visible change, whether the head or eyes turned, whether one side moved before the other. Whether the body stiffened, how long jerking lasted, whether the person changed colour, whether breathing was difficult, how long recovery took, and what the person was like afterwards. Video footage may support assessment where available. Safety and first aid take priority over recording. Time the seizure Look at a clock or start a timer as soon as you can. People often overestimate or underestimate seizure duration under stress. The duration determines whether emergency medicine or an ambulance may be required. A convulsive seizure lasting five minutes or more is a medical emergency when there is no individual plan stating a different threshold. First aid during a convulsive seizure You should stay calm, move dangerous objects away, cushion the person's head, loosen tight clothing around the neck, note the time, allow the movements to occur. Stay with the person, after the jerking stops check breathing, place them in the recovery position when safe, and reassure them as they regain awareness. You should not hold the person down, try to stop the movements, put fingers, a spoon or any object in their mouth, give food. Drink or tablets during the seizure or before they are fully alert and able to swallow safely afterwards, move them unless they are in immediate danger, or attempt mouth to mouth breathing during active jerking. A person cannot swallow their tongue. Objects placed in the mouth can damage teeth, obstruct breathing or injure the person providing help. First aid for a non convulsive seizure If someone is confused, staring or moving automatically: stay with them, speak calmly, guide them away from roads, stairs, water or heat, do not restrain them unless needed to prevent immediate injury. Do not shout or demand that they respond, time the episode, allow recovery in a quiet place, and explain what happened when they are ready. They may not remember the event. Recovery can take time After a seizure, you may experience confusion, sleepiness, headache, muscle pain, weakness, embarrassment, temporary memory difficulty, or a need to sleep. This post seizure period is called the postictal phase. Recovery varies between people and seizure types. Persistent breathing difficulty, severe weakness, another seizure or failure to regain usual consciousness requires emergency help. Call 999 for a first seizure Call 999 when it is the first time someone has had a suspected seizure. This allows assessment for urgent causes, injury and continuing seizure activity. Call 999 for a prolonged or repeated seizure Call 999 if the seizure lasts longer than usual for the person, it lasts five minutes or more and you do not know their usual duration, another seizure begins before full recovery. They do not regain full consciousness, they have difficulty breathing, they are seriously injured, the seizure occurred in water, you are concerned about pregnancy, or they have had three or more seizures within 24 hours. Someone with established epilepsy may have an individual emergency plan. Follow it, including any prescribed rescue medicine, if you have been trained and authorised. Febrile seizures occur in young children A febrile seizure can occur when a young child has a fever. It does not automatically mean that the child has epilepsy. Call 999 when it is the child's first seizure, the seizure lasts more than five minutes, breathing is difficult, movement is limited to one side, the child remains unusually sleepy, or another seizure occurs during the same illness. Do not take a child to A&E by car while they are actively seizing or unconscious. Call an ambulance. Possible triggers do not remove the need for assessment A seizure may occur after missed antiseizure medicine, sleep deprivation, heavy alcohol use, alcohol withdrawal, recreational drug use, acute illness, fever, flashing lights in a minority of people, menstrual or hormonal changes, or metabolic disturbance. Identifying a trigger may help prevent recurrence, but it does not prove the diagnosis or remove the need to assess a first event. Medicines should not be changed independently If you take antiseizure medicine: take it at the prescribed times, do not stop it suddenly, ask what to do after a missed dose. Check before starting interacting medicines, discuss pregnancy planning before conception where possible, report significant side effects, and keep emergency medicine available according to your plan. Abrupt withdrawal can increase seizure risk. A first suspected seizure needs urgent specialist review Children, young people and adults with a first suspected seizure should be referred urgently for specialist assessment, with an appointment within two weeks. Adults should see a clinician with expertise in first seizures and epilepsy. Children and young people should see a paediatrician with relevant expertise. This referral does not mean epilepsy has already been diagnosed. Initial assessment considers several possible causes The clinician may review the event and witness account, past health problems, health problems in the family, medicines, alcohol and drugs, sleep, recent illness, previous unexplained episodes, neurological examination, cardiovascular findings, injuries, and mental wellbeing. An ECG may be performed because some heart rhythm conditions can cause blackouts that resemble seizures. Tests support rather than replace clinical assessment Possible tests include blood glucose, blood chemistry, ECG, EEG, brain MRI, CT in urgent situations, and other tests directed by the suspected cause. An electroencephalogram, or EEG, records electrical activity from the scalp. A normal EEG does not exclude epilepsy. It should not be used as the sole test to decide that a seizure did not occur. Diagnosis rests on the complete clinical assessment. Safety while awaiting assessment Until you have received advice: do not drive, prefer showers to baths, do not swim alone, avoid heights and unguarded machinery. Take care near open fires and hot surfaces, tell a trusted person what happened, follow workplace risk procedures, avoid excessive alcohol and recreational drugs, and prioritise regular sleep. Safety advice should be proportionate to the event and your circumstances. Driving must stop In Great Britain, you must stop driving after an epileptic seizure. You must tell the DVLA about fits, seizures or convulsions. The rules for returning to driving depend on the diagnosis, cause, seizure pattern and licence type. Do not wait for another seizure before obtaining licensing advice. Emotional effects deserve attention A suspected seizure can affect confidence, work, driving, parenting, sleep, independence, fear of recurrence, and relationships. Uncertainty can be difficult. Ask the specialist team which activities are safe, what investigations are planned and whom to contact if another event occurs.

A seizure is a temporary disruption of brain function. A safe response has three stages: protect the person during the event, recognise when the seizure requires emergency treatment, and reconstruct what happened and investigate why it occurred. The visible movements are only one part of the event timing, awareness, recovery and possible triggers all matter.