At least 1 in 30 people in the UK develop epilepsy at some stage. It most commonly starts in childhood and in people over the age of 60. However, epilepsy can begin at any age. Seizures are well controlled by treatment in about 4 in 5 cases. There are different types of epilepsy. This leaflet is about epilepsy with tonic-clonic seizures.
What is a seizure and what is epilepsy?
A seizure is a short episode of symptoms caused by a burst of abnormal electrical activity in the brain. Typically, a seizure lasts from a few seconds to a few minutes. (Older words for seizures include convulsions and fits.)
If you have epilepsy, it means that you have had repeated seizures. If you have a single seizure, it does not necessarily mean that you have epilepsy. About 1 person in 20 has a seizure at some time in their life. It may be the only one that occurs. The definition of epilepsy is more than one seizure. The frequency of seizures in people with epilepsy varies.
What is a tonic-clonic seizure?
A tonic-clonic seizure is the most common type of generalised seizure. The following gives a typical description:
Your body becomes rigid due to strong muscular contractions (the tonic part). You lose consciousness and fall. Your chest muscles contract and force air out of your mouth, often with a grunt. Your jaw muscles contract and you may bite your tongue. Saliva may escape from your mouth. Your bladder may contract and you may pass urine. This stiff or tonic phase soon passes into the clonic (shaking or convulsive) phase. This occurs when the muscles repeatedly contract and relax. Your whole body appears to shake. This may last from a few seconds to a few minutes.
When the seizure has stopped, you gradually regain consciousness but you may be confused and dazed for a while. The time taken to recover varies. You may have some soreness due to the muscular contractions. You may have a headache and want to sleep after a seizure.
You may have some warning symptoms for a short while before a seizure. This is called an aura. The aura can take various forms - for example, odd movements, odd sensations, or intense emotions. However, many people do not have auras, and a seizure commonly occurs without any warning.
How can I help someone having a tonic-clonic seizure?
A seizure cannot be shortened or altered. However, a bystander can help in the following ways:
During a seizure
- Note the time.
- Do - prevent crowds gathering round.
- Do - place a cushion or some clothing under the person's head to prevent injury.
- Do not - try to restrain the person. If there is a warning (aura) before a seizure, it may be possible to guide the person to a safe place or cushion the expected fall to the ground. When the seizure starts, do not try to hold the person upright but let them lie down.
- Do not - move the person unless they are in a dangerous place (for example, in a road or next to a fire). If possible, move dangerous objects away from the person.
- Do not - place anything in the person's mouth or try to move their tongue.
Once the seizure has stopped
- Do - roll the person on to their side into the recovery position.
- Do - check that breathing has resumed normally. It is normal for breathing to stop for a short while during the stiff (tonic) part of the seizure. The face will go pale or bluish. During the convulsive (clonic) part, breathing is irregular. After the seizure is over, breathing returns to normal. If not, check there is nothing stopping breathing, such as food or false teeth. The recovery position helps saliva and anything in the mouth - such as food or sick (vomit) - to drain out of the mouth and not back into the throat.
- Do - stay and talk to the person. Give reassurance until they are fully recovered. It may take a while for the person to wake up fully. Do not leave a person alone whilst they remain dazed or confused.
- Do not - offer something to eat or drink until you are sure they are fully recovered.
Calling a doctor or an ambulance
There is usually no need to call a doctor or an ambulance, unless:
- It is their first seizure.
- Injury has occurred which cannot be dealt with.
- The seizure does not stop after a few minutes. Status epilepticus is rare but means a seizure does not stop, or they keep recurring one after the other. This is an emergency and needs urgent treatment to stop the seizure.
- There is difficulty with breathing.
What are the treatments and can seizures be prevented?
There are many different treatments for epilepsy and also medicines to help prevent people with epilepsy having seizures. For information about treatments and prevention, see the separate leaflet called Treatments for Epilepsy.
Further reading and references
; NICE Clinical Guideline (January 2012)
; Scottish Intercollegiate Guidelines Network - SIGN (2015)
; NICE CKS, March 2018 (UK access only)
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