Epilepsy: the right actions to manage a seizure

Epilepsy is a chronic neurological disorder characterised by the tendency to have recurrent, unprovoked epileptic seizures. These seizures are the manifestation of abnormal, excessive or synchronised electrical activity of a group of nerve cells in the brain.

Epilepsy affects around 70 million people worldwide. It is not a single disease, but a spectrum of conditions that require long-term management. Knowing how to manage a seizure in the pre-hospital setting is crucial for the safety of the patient.

Pre-hospital management during the seizure

Pre-hospital care focuses on protecting the patient from secondary injuries, given that most seizures are self-limiting.

1. Timing and composure: immediately note the start time of the seizure. Composure is essential, as most seizures last less than three minutes.
2. Environment safety: immediately remove all hard or sharp objects from the area around the patient.
3. Head protection: place a soft support under their head, to protect from injury.
4. No intervention: do not attempt to hold down or immobilise the patient. It is strictly forbidden to insert any object into the mouth (fingers, spoon), as it can cause serious injury. Do not give any medication by mouth.

Care after the seizure and the emergency call

As soon as the convulsions stop:

1. Placing on the side: after checking that the patient is breathing, carefully turn them into the recovery position (on their side). This keeps the airway open and prevents the aspiration of fluids (e.g. vomit).
2. Monitoring: stay next to them, frequently checking their breathing and level of consciousness, until they fully regain their orientation. Do not give fluids or food.

When to call the emergency number (112) immediately:

• If the seizure lasts more than five minutes (status epilepticus).
• If it is the person's first ever seizure.
• If the patient has consecutive seizures without regaining consciousness in between.
• If they have suffered a serious injury during the seizure.

Febrile seizures are not epilepsy

Febrile seizures are a separate condition, mainly in children aged 6 months to 5 years.

• Cause: the sudden rise in temperature (fever), usually above 38°C.
• Prognosis: they are not epilepsy. They are usually benign and do not cause permanent neurological damage.

Pre-hospital care is similar (safety, placing on the side). After the convulsion stops, however, treatment focuses on reducing the fever (antipyretics, on medical advice) and on immediate medical assessment to identify the cause of the fever (e.g. an infection). Calling the ambulance service is necessary only if the seizure exceeds five minutes.

Correct recognition and the application of these basic steps is the best pre-hospital care to protect those affected.