People with epilepsy should always wear a medical alert tag.

Most seizures are self-limiting and stop by themselves after various periods of time. However, a person having a seizure may be injured; breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a seizure, it is important to protect the person from injury. Turn the person on his or her side, so that any vomit is expelled. See seizure first aid.

After a convulsion, most people go into a deep sleep. Don't prevent the person from sleeping. He or she will probably be disoriented, or possibly agitated for awhile after awakening.

Stay with the person until recovery or until you have professional medical help. Meanwhile, monitor their pulse, rate of breathing, and blood pressure.

• DO NOT restrain the person.
• DO NOT place anything between the person's teeth during a seizure (including your fingers).
• DO NOT move the person unless he or she is in danger or near something hazardous.
• DO NOT try to make the person stop convulsing. He or she can't control the seizure and is not aware of what is happening at the time.
• DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Some patients with epilepsy may have a vagal nerve stimulator implanted in their chest. In these persons, a seizure can be halted by activating the device. Other patients may have been prescribed medication to administer rectally during a seizure. Never try to administer anything (even medications) by mouth.

Report all seizures (even a mild one) to the health care provider. If the patient is known to have epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or other instructions given.

If this is the first time a patient has ever had a seizure, or if this an unusually prolonged seizure for someone known to have a seizure disorder, call for emergency transportation to the hospital. These symptoms may represent a life-threatening condition, such as a stroke or meningitis.

The doctor will perform a physical examination and ask questions to help understand the cause of the seizures, such as:

• Did it occur or start on one side of the body?
• Was there movement of the muscles and if so, what was the pattern?
• Are there any risk factors (such as recent head injury)?
• Was consciousness maintained during the seizure?
• How long did the seizure last?
• What are the frequency of the seizures?
• Was there any warning (aura) of the seizures?
• Were there any other symptoms present (visual changes, abnormal smells)?

• CT scan of the head or MRI of the head
• EEG
• Lumbar puncture
• Blood tests

Medications are often prescribed. Instructions for taking them should be strictly followed. Family members should observe and record any seizures to ensure the patient gets proper treatment.

People with uncontrolled seizures should not drive. Each state has a different law that determines which patients are allowed to drive. People with seizures also should not swim or bike alone.

There is no specific way to prevent seizures. Use helmets when appropriate to prevent head injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid recreational drugs. People with epilepsy should take medication as directed and avoid excessive amounts of alcohol.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, MO: WB Saunders; 2003: 1158-1160.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:145-149, 1445.