What should I do if I have a seizure?

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What to Do If You Have a Seizure

Experiencing a seizure can be a frightening and confusing event. Knowing the appropriate steps to take can help manage the situation effectively and reduce potential risks. This article synthesizes current research on the management of seizures, particularly focusing on first-time unprovoked seizures.

Immediate Steps During a Seizure

Ensure Safety and Prevent Injury

The primary concern during a seizure is to ensure the safety of the person experiencing it. Clear the area of any sharp or hard objects that could cause injury. If possible, gently guide the person to the floor and place something soft under their head to prevent head injury .

Do Not Restrain or Insert Objects

Do not attempt to restrain the person or insert any objects into their mouth. These actions can cause more harm than good. Instead, turn the person onto their side to help keep their airway clear and allow any fluids to drain from their mouth .

Time the Seizure

It is important to time the seizure. If it lasts longer than five minutes, seek emergency medical assistance immediately, as this could indicate status epilepticus, a medical emergency requiring urgent treatment .

Post-Seizure Care

Recovery Position

After the seizure subsides, place the person in the recovery position (on their side) to maintain an open airway and prevent choking. Stay with them until they are fully alert and oriented .

Reassurance and Monitoring

Provide reassurance as the person regains consciousness. They may be confused or disoriented. Monitor their breathing and responsiveness, and be prepared to provide information to medical personnel if needed .

Medical Evaluation and Treatment

Seek Medical Attention

After a first seizure, it is crucial to seek medical evaluation to determine the cause and assess the risk of recurrence. This typically involves a thorough history, clinical examination, electroencephalography (EEG), and brain imaging .

Risk of Recurrence

Research indicates that the risk of seizure recurrence is highest within the first two years following an unprovoked first seizure, with recurrence rates ranging from 21% to 45%. Factors that increase the risk of recurrence include a prior brain insult, EEG abnormalities, significant brain imaging findings, and nocturnal seizures.

Antiepileptic Drug (AED) Therapy

Immediate AED therapy can reduce the risk of seizure recurrence within the first two years but does not necessarily improve long-term prognosis for seizure remission . The decision to start AED therapy should be individualized, weighing the risks of recurrence against potential adverse effects of the medication .

Counseling and Lifestyle Adjustments

Patients should receive counseling about lifestyle modifications, such as avoiding activities that could be dangerous if a seizure occurs (e.g., swimming alone, driving) and understanding the legal implications related to driving. Educating patients and their families about seizure management and safety is a critical component of care .

Conclusion

Managing a seizure involves ensuring immediate safety, seeking medical evaluation, and considering long-term treatment options based on individual risk factors. By understanding these steps, individuals and their caregivers can better handle seizure events and reduce associated risks.