Recognizing Seizures and Performing First Aid

Written by Vania Ahmadi

Medical Marvels Los Angeles Chapter

Introduction

Oftentimes, people are unaware of the difference between seizure and epilepsy, and the two terms are used incorrectly. Seizures are often described as an abrupt shift in behavior brought on by an involuntary change in the electrical activity of the brain. Meanwhile, epilepsy is a brain disorder where someone suffers from repeated seizures. When at least two unprovoked seizures occur at least 24 hours apart, it is determined that one has epilepsy and that their seizure was not just non-epileptic.

Types of Seizures

There are three major groups of seizures, including generalized onset seizures, focal onset seizures, and unknown onset seizures.

• Generalized onset: seizures that affect both sides of the brain/groups of cells that are on both sides of the brain, which happens at the same time. Types of generalized onset seizures include atonic, tonic-clonic, and absence.

• Focal onset: seizures that start in one area/group of cells in one side of the brain.

• Focal Onset Aware Seizures - when one is aware, as well as awake during a seizure.

• Focal Onset Impaired Awareness - when one is confused about their situation or their awareness is affected in a way.

• Unknown onset seizures: seizures where the beginning of the seizure is unknown. They can also occur when the seizure is not witnessed or seen by anyone. With more information, the unknown onset seizure could then be identified as either generalized onset or focal onset.

Identifying Seizures

In terms of generalized onset seizures:

• Motor symptoms can include epileptic spasms (body flexing and extending repeatedly), weak or limp muscles (atonic), tense or rigid muscles (tonic), rhythmic jerking movements (clonic), and even brief muscle twitching (myoclonus).

• The non-motor symptoms are called absence seizures. There are typical and atypical seizures, which mean staring spells. Additionally, absence seizures can also have brief twitches which are myoclonus that affect a specific part of one’s body or just the eyelid.

In terms of focal onset seizures:

• The motor symptoms could include muscles becoming limp/weak (atonic), tense/rigid muscles (tonic), epileptic spasms, jerking (clonic), and muscles twitching (myoclonus). Repeated automatic movements such as lip smacking, chewing, or clapping/rubbing of hands may occur as well.

• The non-motor symptoms include changes in emotion, thinking, sensation, cognition, and autonomic functions such as gastrointestinal sensations, heart racing, goosebumps, waves of cold/heat, and etc, and even lack of movement.

In terms of unknown onset seizures:

• Motor symptoms for this are epileptic spasms or tonic-clonic.

• The non-motor symptoms are when one stops their movement and stares, which is called a behavior arrest.

Performing First Aid

It is extremely important to be able to identify different types of seizures to know if there’s any specific procedures that need to be done for the type that one is witnessing.

Stay, Safe, and Side are three words to always keep in mind. When witnessing a seizure, always stay with the person until they are awake. Make sure to keep the person safe as well by moving or guiding them away from any harm. Finally, if they are not awake and aware, turn them onto their side. If these procedures are completed  but the seizure lasts  more than 5 minutes, call 911 immediately. 

Never hold someone down when they are having a seizure as it can injure them or make them more aggressive, agitated, or confused. A seizure does not cause people to fight on purpose. However, if they are constrained when they are perplexed, they could respond violently. If they try to walk around, let them as long as the surroundings are safe.

The myth that one can swallow their tongue during a seizure is also false. Make sure to never put anything in the person’s mouth since their jaw and cheek muscles tense up during a seizure and they may bite down. If they have something in their mouth, they run the risk of breaking it or chipping their teeth.

Checking for breathing is significant and turning them on their side so their mouths are pointed at the ground is extremely helpful. This makes it easier for them to breathe and prevents saliva from obstructing their airway. Convulsive (or tonic-clonic) seizures can make it appear as though the person is not breathing. This occurs when the chest muscles constrict during a seizure's tonic phase. The muscles will relax after this phase of a seizure is through, and breathing will resume regularly. For this sort of change in breathing, no CPR nor rescue breathing are required.

Knowing different types of seizures, being able to recognize them, and knowing how to perform first aid will save someone’s life, so it’s important to be educated and prepared at all times. If you are interested in being certified for seizure recognition and first aid, feel free to check out this link to complete a course: https://www.epilepsy.com/recognition/first-aid-resources

Works Cited

“Epilepsy – Seizure Types, Symptoms and Treatment Options.” American Association of Neurological Surgeons, https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy. Accessed 15 August 2023.

“Epilepsy - Symptoms and causes.” Mayo Clinic, 28 April 2023, https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093. Accessed 15 August 2023.

“Evaluation of a First-Time Seizure.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/evaluation-of-a-firsttime-seizure. Accessed 15 August 2023.

“Non-epileptic seizures and dissociative seizures.” Epilepsy Society, 16 February 2020, https://epilepsysociety.org.uk/about-epilepsy/what-epilepsy/non-epileptic-seizures. Accessed 15 August 2023.

Shafer, Patty Obsorne. “General First Aid for Seizures.” Epilepsy Foundation, https://www.epilepsy.com/recognition/seizure-first-aid. Accessed 15 August 2023.

Shafer, Patty Osborne. “First Aid.” Epilepsy Foundation, https://www.epilepsy.com/parents-and-caregivers/talking-kids-about-epilepsy/first-aid. Accessed 15 August 2023.

“Types of Seizures.” Epilepsy Foundation, https://www.epilepsy.com/what-is-epilepsy/seizure-types. Accessed 15 August 2023.

“Understanding different kinds of seizures | NIH MedlinePlus Magazine.” NIH MedlinePlus Magazine, 17 August 2021, https://magazine.medlineplus.gov/article/understanding-different-kinds-of-seizures. Accessed 15 August 2023.