If a generalized seizure occurs, give appropriate emergency first aid.

EMERGENCY FIRST-AID TREATMENT

• Protect the person from injury. Clear the area of furniture or other objects that may cause injury from falls during the seizure.
• Do not attempt to force a hard object (such as a spoon, or a tongue depressor, etc.) between the teeth. You can cause more damage than you can prevent by doing this!
• Do not attempt to restrain or hold the person down during the seizure.
• Protect the person from inhaling vomit or mucus. Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
• If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from obstructing the airway. Breathing usually starts on its own once the seizure is over.
• CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.
• Repeated or prolonged seizures without regaining consciousness or returning to normal behavior between them (status epilepticus) may cause severe lack of oxygen in the body. This an emergency situation requiring immediate professional assistance!

EMERGENCY TREATMENT BY MEDICAL PERSONNEL (status epilepticus)

• Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
• Thiamine and/or intravenous glucose may be given.
• Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications such as phenytoin or phenobarbital, may control prolonged, repeated generalized seizures. They are usually injected into a vein. Other medical treatment may be needed, including general anesthesia with muscle-paralyzing medications.
• After status epilepticus is controlled, anticonvulsants may be begun and tests are performed to determine the cause of the condition, if not known already.

AFTER THE SEIZURE

• Treat any injuries from bumps or falls.
• Record details of the seizure to report to the health care provider. Important details include the date and time of the seizure, how long it lasted, which body parts were affected, the type of movements or other symptoms, possible causes, behavior after the seizure, and other factors noted.

Treating the cause, if one has been identified, may stop seizures. This may include medication, surgical repair of tumors or brain lesions, or other treatments. An isolated seizure with an obvious trigger (such as fever and toxic reaction) is treated by eliminating or avoiding the precipitating factor.

An isolated seizure without an obvious trigger (the examination and EEG are normal and there are no abnormalities on other testing) may not require treatment.

Oral anticonvulsants (anti-seizure medications) may prevent or reduce the number of future seizures. The response is individual, and the medication and dosage may have to be adjusted repeatedly. There are numerous medications which may be effective alone or when used in combination. Side effects of these medications and plasma drug-levels will need to be monitored to various degrees, depending on which medications are used.

Women who might get pregnant may need to take additional medications or vitamins to reduce the risk of birth defects associated with some of these medications. Such women may need to be followed in a high-risk pregnancy clinic.

Patients who continue to have seizures despite several medications may benefit from a vagal nerve stimulator (implantable device that stimulates a nerve in the neck) or from brain surgery to remove tissue responsible for causing the seizures.

The use of informational jewelry or cards (such as Medic-Alert or similar products) that indicate a seizure disorder may be advised to help the patient receive prompt medical treatment if a seizure occurs.

Seizures can occur as a single isolated occurrence, as closely repeated seizures, or at various intervals. Seizures that recur create a condition known as epilepsy.

Seizures that occur singly or in closely associated groups are commonly caused by a condition such as brain injury. They may occur as an isolated incident or may develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.

A seizure-free period may indicate that reduction or elimination of medications may be possible. Medications should be changed only under the supervision of the health care provider.

Death or permanent brain damage from seizures is rare. A serious injury can occur if a seizure occurs while driving or operating dangerous equipment; these activities are often restricted for people with poorly controlled seizure disorders.

Infrequent seizures may not severely restrict the patient's lifestyle. Work, school, and recreation do not necessarily need to be restricted.

• recurrent seizures (seizure disorder)
• prolonged or closely occurring seizures without returning to normal behavior(status epilepticus)
• injury from falls, bumps, and biting oneself
• injury to oneself or others if seizure occurs during driving or operating machinery
• inhaling fluid into the lungs, pneumonia
• permanent brain damage (stroke or other damage)
• side effects of medications (with or without observable symptoms)
• women planning to get pregnant need to alert their physician in advance in order to adjust their medications (many anti-epileptic medications cause birth defects)
• learning disorders (either from seizures or medications)

Call your local emergency number (911) if this the first time a person has had a seizure or a seizure is occuring in someone without a medical ID bracelet (instructions explaining what to do). In the case of someone who has had seizures before, call the ambulance for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.