Your First Seizure: What to Do, When to Call 911 and What Comes Next

What it involves

MedlinePlus explains that a seizure is a set of physical changes in behavior during an episode of abnormal electrical activity in the brain. Seizures are symptoms of a brain problem and they have many causes. People who have recurring seizures due to a brain disorder have epilepsy.

Who this is for

• Adults who have had a first seizure and been seen in an emergency room
• Family members who want to know how to help someone during a seizure
• People with diabetes, a head injury or a new medicine who have had a blackout or staring spell
• Patients who had a seizure and need help coordinating follow-up with a neurologist

What to expect

• A review of what happened, from a witness if possible, and of the medicines, alcohol and other substances involved
• Blood work to check conditions that can cause seizures, such as abnormal blood sugar or sodium
• A referral for a head CT or MRI and an EEG, which MedlinePlus lists among the tests for a new seizure
• Follow-up on medicines once you are home

What a seizure can look like

MedlinePlus says it can be hard to tell if someone is having a seizure, because some seizures only cause staring spells that may go unnoticed. Others involve a brief blackout followed by confusion, sudden falling, shaking of the whole body, drooling, loss of bladder or bowel control, teeth clenching, or a bitter or metallic taste. Symptoms may stop after a few seconds or minutes, or continue for up to 15 minutes. The health topic page divides seizures into focal seizures in one part of the brain and generalized seizures on both sides.

How to help during a seizure

The main goal, the encyclopedia says, is to protect the person from injury. Try to prevent a fall, lay the person on the ground in a safe area, clear away furniture and sharp objects, cushion the head, loosen tight clothing around the neck and turn the person onto their side. Look for a medical ID bracelet and stay until the person recovers or help arrives. Do not hold the person down, put anything between the teeth, hold the tongue, or give anything by mouth until they are fully awake, and do not start CPR unless the seizure has clearly stopped and the person is not breathing.

When to call 911

MedlinePlus says to call 911 or the local emergency number if it is the first time the person has had a seizure, if a seizure lasts more than two to five minutes, if the person does not awaken or behave normally afterward, or if another seizure starts soon after one ends. The same applies if the seizure happened in water, if the person is pregnant, injured or has diabetes, if there is no medical ID bracelet, or if anything is different from the person's usual seizures. The health topic page adds that seizures lasting longer than five minutes are a medical emergency.

What can cause a seizure

The encyclopedia lists abnormal blood sodium or glucose, brain infection, head injury, heart disease, heat illness, stroke, very high blood pressure, poisoning, street drugs, withdrawal from alcohol or certain medicines, and liver or kidney failure, among others. Sometimes no cause is found. The low blood sugar guide, the heat illness guide and the alcohol use screening guide each cover one of those triggers.

Tests after a seizure

A person who has had a new or severe seizure is usually seen in a hospital emergency room. MedlinePlus says the provider will try to diagnose the type of seizure from the symptoms and test for other conditions that cause seizures or look like them, such as fainting, a mini-stroke, panic attacks, migraine and sleep disturbances. Tests may include blood and urine tests, a head CT or MRI, an EEG, which is usually not done in the emergency room, and sometimes a lumbar puncture. The fainting guide and the panic attacks guide describe two look-alikes.

Follow-up with your own provider

Report all seizures to the person's provider, MedlinePlus says, because the provider may need to adjust or change medicines. For a person with epilepsy, further testing makes sure the right amount of medicine is being taken. At a follow-up visit at Serenity By A Dr. Sareen, a provider reviews the hospital's findings, your medicine list, blood sugar and blood pressure, and helps arrange a neurologist visit. Bring the discharge papers from the emergency room to that appointment. Sudden loss of muscle control during strong emotion while you stay aware can be mistaken for a seizure, but it is a feature of narcolepsy, which the narcolepsy guide explains.

Sources

• MedlinePlus: Seizures (health topic)
• MedlinePlus: Seizures (medical encyclopedia)