Seizure Symptoms: How to Assist the Victim

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Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Seizures occur because the brain becomes irritated and an "electrical storm" occurs. This "electrical storm" occurs because the normal connections between the cells in the brain do not function properly. This causes the brain to try to shut down because of the electrical surge. The muscle shaking occurs because the brain is ending out signals to every muscle group, asking them to contract. Most seizures are self-limiting and are followed by a so-called postictal period, in which the brain can be considered to "reboot and restart" all its programs, similar to a computer when it is rebooted.

Seizures are a common event, and 4% of people will experience one in their lifetime. The potential to have a seizure depends upon the threshold of the brain to withstand excess electrical activity. In infants and children, high fevers can cause this threshold to lower, resulting in febrile seizures. A blow to the head can cause an electrical spike causing a seizure, and sometimes seizures just happen.

The patient needs evaluation to look for the reason for the seizure. Is there an infection? Are there electrolyte abnormalities in the blood? Is there a structural problem in the brain? Often there is no obvious reason why the first seizure occurred, and CT or MRI scans of the brain as well as an EEG (electroencephalogram) may be ordered to look for a cause.

Most people get a "freebie" seizure before requiring medication (medication should not necessarily be prescribed for every person who has had one seizure), but that doesn't mean that the event should be ignored. The chance of having another seizure sometime in the future is approximately 20%, and that is the reason why it is required that people need to be seizure free for 3-6 months before being allowed to drive a vehicle (the required time varies between states), scuba dive, sky dive, or participate in other potentially risky situations in which a seizure could put the individual or others in danger.

Generalized seizures are frightening to witness. There is loss of consciousness; the body stiffens, arches, and may shake; and grunting sounds may be heard. But most seizures stop themselves and the role of the Good Samaritan, bystander, friend, or family is to protect the individual from themselves.

Steps to take if you witness an individual having a seizure include:

• The first step is to take a deep breath and try to stay calm.
  
  
• Make certain that there is nothing nearby that can be struck by the person having the seizure.
  
  
• Don't hold the person down. A seizure is a violent and forceful event, and bystander injury is a possibility.
  
  
• Do not put anything in the victim's mouth. A person who is seizing can't swallow their tongue and usually are breathing adequately. Forcing open the jaw can break teeth or get fingers bitten.
  
  
• If the individual's seizure lasts more than 3-5 minutes, call 911 immediately.
  
  
• After the seizure stops, lay the person on their side and stay with them until they are awake or until medical assistance arrives.

REFERENCE: Herman ST. Single Unprovoked Seizures. Curr Treat Options Neurol. 2004 may:6 (3) 243-255