Epilepsy - first aid and safety

Epilepsy is a common condition of the brain in which a person has a tendency to have recurrent unprovoked seizures. About 70 per cent of people with epilepsy gain control of their seizures with medication. People who continue to have seizures are more vulnerable to the safety risks linked with seizures, especially when seizures happen without warning and affect awareness.

Understanding seizure-related risks#

Good seizure control is the first step in reducing seizure-related risks. Seizures can sometimes lead to injuries or falls, and in rare cases they can be more serious, even contributing to or causing death. These risks are higher when seizures are poorly controlled.

Different types of seizures carry different risks. Your own risk level depends on the type of seizures you have and on your lifestyle. For example, poorly controlled tonic-clonic seizures pose the highest safety risk, and activities such as mountain climbing increase that risk further.

Life is never risk-free, but you can take positive steps: work towards fewer seizures, think about the risks that are specific to you, and discuss seizure management with your doctor.

First aid for a tonic-clonic seizure#

In a tonic-clonic seizure the body stiffens and this is followed by general muscle jerking. If you are with someone having this kind of seizure:

• Stay calm and remain with the person.
• Keep them safe and protect them from injury.
• Place something soft under their head and loosen any tight clothing.
• Time the seizure if you can.
• Do not put anything in their mouth, and do not restrain or move the person unless they are in danger.

After the jerking stops, roll the person onto their side. If there is food or fluid in their mouth, roll them onto their side straight away. Reassure the person until they have fully recovered.

If the person is in a wheelchair, car seat or stroller#

• Leave the person seated with the seatbelt on, unless it is causing injury.
• Put the wheelchair brakes on. If it is a tilt wheelchair, tilt the seat and lock it in position.
• Support their head until the seizure has ended.
• Lean the person slightly to one side to help any fluid drain from the mouth.

After the seizure, if the person is having trouble breathing or needs to sleep, take them out of the chair and place them in the recovery position. If breathing difficulties continue, call an ambulance and monitor the person closely.

First aid for a seizure in water#

A seizure in water can quickly become life-threatening. If a seizure happens in water:

• Support the person’s head so their face stays out of the water.
• Tilt their head back to keep the airway clear.
• If they are in a pool, remove them from the water once the jerking stops. In the rare event that jerking does not stop, get help from others if possible and remove the person at the shallowest end.
• If they are in the surf, remove them from the water immediately. Flotation devices can help.

Once out of the water, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance immediately, even if the person is breathing, as they may have inhaled water. Place the person on their side and check whether they are breathing. If they are not breathing, or not breathing normally, reposition them onto their back and begin the appropriate form of CPR. The CPR technique for adults differs from that for young children and infants.

When to call an ambulance#

Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance if:

• the seizure lasts 5 minutes or more, or longer than is usual for the person
• a second seizure quickly follows the first
• the person does not respond for more than 5 minutes after the seizure ends
• the person has breathing difficulties after the jerking stops
• it is the person’s first known seizure
• the seizure happens in water
• the person is injured, or you are in any doubt

Epilepsy and driving#

Anything that affects a person’s conscious state, awareness or judgement can increase the risk of accidents. If you have a seizure or are diagnosed with epilepsy, your doctor will advise you about driving, the use of dangerous machinery, working above ground level and general safety.

You will usually be told that you cannot drive for a period of time. How long this lasts depends on several things, including the type of epilepsy. If you later meet the criteria set by your local driving authority, you may be able to drive again safely and legally. If you do not, your licence may not be renewed, or you may be issued a conditional licence.

It is your responsibility to inform the relevant driving authority about having epilepsy or a seizure. Driving against medical advice is illegal and dangerous to you, your passengers and the public. If you continue to drive during a recommended non-driving period and are involved in a crash in which a seizure was a contributing factor, you may face prosecution.

Some people choose to wear a medical alert bracelet or pendant with epilepsy information, or to carry medical information in their wallet, in case of an accident.

Water safety at home and outdoors#

Because seizures can happen without warning, it helps to plan ahead around water:

• Never swim alone.
• Wear an approved life jacket for water activities, including boating and fishing.
• Avoid water sports such as scuba diving and high-board diving.
• Have a shower rather than a bath, as showers pose less risk. If you only have a bath, use a hand-held shower attachment.
• Try not to shower or bathe while alone in the house. Shower at a time when seizures are less likely.
• Fit bathrooms with outward-opening, sliding, half or easily removable doors, and keep bathroom doors unlocked.

Making your home safer#

Injuries and accidents tend to happen more around the home than anywhere else. Arrange your home, and where possible your work or study space, to be safe if you have a seizure:

• Fit a door that opens both ways into the bathroom and toilet.
• If you wander or become confused during or after a seizure, shut your door when home alone so you are less likely to wander into danger, and consider wearing some form of medical ID.
• If you are likely to fall during seizures, fall-proof your home: lay carpets, pad sharp corners, use non-slip flooring, and avoid glass tables and shower screens.
• Place good barriers in front of fireplaces or heaters, and take care around heights, railings and stairs.
• Make sure someone else has a key so they can get in and check on you.
• Consider wearing a protective helmet if you have frequent falls; helmets designed as casual wear are available.

Keep your safety precautions sensible and relevant, with a balance between risk and restrictions. Enjoy life as much as you can and do not restrict your activities to the point where you lose interest and fun.

Seizure emergencies#

Most seizures last less than 2 minutes. However, some people with epilepsy tend to have severe or life-threatening seizures that are prolonged or happen in clusters, and in some people these happen regularly. These situations are considered seizure emergencies.

They can lead to brain injury and can be life-threatening, so it is important to recognise and treat them quickly. In some cases, medication can be given in the community to help stop a severe seizure. This medication can be prescribed by your neurologist for use in a seizure emergency.

Sudden Unexpected Death in Epilepsy (SUDEP)#

SUDEP is when a person with epilepsy dies suddenly and prematurely and no cause of death is found. These deaths are often unwitnessed, with many occurring overnight. There may be obvious signs that a seizure has happened, though this is not always the case.

The cause of SUDEP is not yet known. Researchers are investigating possibilities such as the effect of seizures on breathing and the heart. SUDEP occurs in approximately 1 in 1,000 people with epilepsy (around 1 in 4,500 children), and certain types of seizure increase the risk. Ask your doctor for more information about SUDEP.

Active or poorly controlled seizures can put you at risk of injury and death. Knowing about these risks means you can act to reduce them:

• Get the best seizure control possible, and take your medication as prescribed.
• Speak to your doctor if you are unhappy with your current medication or its side effects.
• Have regular reviews with your doctor and be involved in self-management.
• Avoid any known seizure triggers, and avoid drinking too much alcohol.
• Learn when your seizures are most likely to occur.
• Get enough sleep and manage stress.
• Make sure those close to you know what to do during a seizure.

Key points#

• Epilepsy is a common condition of the brain in which a person has a tendency to have recurrent unprovoked seizures.
• Seizure-related risks are higher when seizures are poorly controlled.
• Good seizure control is the first step in reducing seizure-related risks.
• Different types of seizures carry different risks.
• Safety precautions should be sensible and relevant, with a balance between risk and restrictions.

Where to get help#