What to do when someone has an epileptic seizure

What is epilepsy?

Epilepsy is a common neurological condition affecting more than 600,000 people in the UK. It can develop at any point in your life, and isn't always lifelong - many people whose condition starts before the age of 20 should recover and no longer have seizures.

The causes can vary significantly. Some of the time it can develop in response to a head trauma, or after meningitis, a brain tumour or a stroke. In other cases, the causes are often genetic. More often than not, however, it is impossible to say why someone is prone to epileptic seizures.

"Six out of ten people have no clear cause," says Chantal Spittles, a spokesperson for Epilepsy Action. "People take medicine usually as a first line of treatment, but it can be difficult to get the medicine balance right regardless of the cause."

In principle, anti-epileptic drugs will work for around 7 out 10 people with epilepsy - meaning they won't have seizures at all. In practice, however, only around 5 in 10 of those with epilepsy in the UK are seizure-free, largely due to problems finding the right combination of drugs.

If you are living with epilepsy it is helpful to learn to recognise your individual triggers, as well as the warning signs that a seizure is coming on. There is always, however, the chance of being caught unawares.

Epilepsy and pregnancy

Some women stop their medicine without medical advice if they're trying to get pregnant - which is not recommended, as there are health hazards to both baby and mother from uncontrolled epilepsy. However, there are also hazards to taking some epilepsy medicine whilst trying to conceive, and during pregnancy to the baby. Always talk to a medical professional if there's a chance you may be pregnant, or you're wanting to get pregnant. This includes men who are planning a family or donating sperm.

Restrictions on prescribing some epilepsy medicine - such as sodium valproate or topiramate, in women and men who want a family have added to some people's concerns. Always have a full review of your epilepsy medicine before you start trying to conceive.

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Epilepsy with tonic-clonic seizures

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What is an epileptic seizure?

According to the International League Against Epilepsy (ILAE), an epileptic seizure is a brief disruption of brain function. It can cause changes in behaviour, movement or consciousness.

Spittles explains: "It's a sudden surge of electrical activity in the brain which causes a temporary disturbance in the way the brain cells talk to each other."

Types of epileptic seizure

The ILAE also recently introduced a new way to group seizures, with a view to helping doctors prescribe the best treatments.

They are further categorised depending on whether or not a person's awareness is affected, and whether there are other symptoms.

Toni-clonic seizures - once called 'grand mal', these are one of the most prevalent. The person will fall unconscious and will often fall backwards, as their body goes stiff and begins to shake for several minutes. They may also cry out, breathe abnormally, or lose control of their bladder.

Absence seizures - once called 'petit mal', these are much more subtle in their presentation, and can be mistaken for a brief interlude of daydreaming. A further common category is atonic seizures, in which the person suddenly loses muscle tone, and their head and body go limp.

Non-epileptic seizures - these can have a range of causes, both psychological and physiological. Although they do not involve the same brain patterns as epileptic seizures, the symptoms, and recommended response, are the same.

What to do if someone has an epileptic seizure

The most important thing you can do is to make sure the person is safe.

"Assess the situation around them and check they're not in immediate danger," says Spittles. "For example, you might have to cushion their head if they're on the floor. Just stay with them till the seizure is over. If it's a tonic-clonic seizure, once that seizure's over you need to put them in the recovery position, but it's very important not to restrain them."

Although the symptoms of a tonic-clonic seizure may look scary, most of the time there's no need to call an ambulance. However, it is advisable to do so if the seizure persists for more than five minutes or the person is not known to experience seizures. Epilepsy Action recommends timing the episode to make sure.

"This is advisable especially if you don't know the person," says Spittles. "If you know the person you can have a feel for how their seizures affect them and be a bit more flexible."

Overall, though, it is simply a matter of staying calm, and offering reassurance once the seizure is over. You may be able to find further information on the person.

As Spittles explains, many people with epilepsy carry some form of ID.

"That's something you should look for if possible, because it's such an individual condition and it will affect people in very different ways," she says. "It's never one size fits all because of the sheer breadth of seizure types."

What not to do if someone has an epileptic seizure

Spittles warns: "Many people think you should restrain someone or put something in their mouth, but that's actually really dangerous. It's a concerning misconception that we want to put right."

The situation is complicated by the fact that all seizures are not made alike. In actuality, there are dozens of different types of epileptic seizure, as well as other variants of seizure with a non-epileptic cause.

"People often think of tonic-clonic seizures - the common one where people fall to the floor - but you can also have absence seizures where people just look like they're not paying attention or are zoning out," says Spittles. "There's a very wide range of seizures and each one has a different approach that you need to take."

With that in mind, generalisations can be unhelpful. However, the more informed you are as a bystander, the better equipped you'll be to help.