A tonic-clonic seizure is the kind most people picture when they hear the word seizure. The person loses consciousness, their body stiffens, and their arms and legs jerk rhythmically. It is frightening to watch, especially the first time. But most tonic-clonic seizures stop on their own within one to three minutes, and the help the person needs while it happens is simple. You do not need medical training to do it well.
The whole job comes down to three things: stay with the person, keep them from getting hurt, and turn them onto their side. Everything below is a longer version of that sentence.
What to do while the seizure is happening
- Check the time or start a timer on your phone. How long the seizure lasts is the most important piece of information you can gather, because it is one of the main things that determines whether you need to call 911.
- Ease the person to the floor if they are standing or sitting so they do not fall.
- Clear the area. Push furniture away and move anything hard or sharp out of reach.
- Put something soft and flat under their head, like a folded jacket.
- Loosen anything tight around the neck, such as a collar or tie, and take off their eyeglasses.
- Stay with them the entire time. Speak calmly as they come around, even before they can answer you.
- Look for a medical ID bracelet or necklace, which may identify epilepsy and list emergency contacts.
What not to do
Two pieces of folk wisdom cause real injuries, and both should be retired.
- Never put anything in the person's mouth — not a spoon, not a wallet, not your fingers. It is impossible to swallow your own tongue during a seizure. Objects in the mouth break teeth, injure the jaw, and can block the airway, and fingers get bitten hard.
- Do not hold the person down or try to stop the jerking. Restraint does not shorten a seizure, and it can dislocate a shoulder or break a bone.
- Do not give water, food, or medication by mouth until the person is fully awake and able to swallow normally.
One more thing worth knowing in advance: breathing often looks wrong during a tonic-clonic seizure. The person may grunt, breathe irregularly, or briefly turn bluish around the lips. This usually corrects itself as soon as the convulsion ends. If normal breathing does not return once the jerking stops, that is an emergency.
Turn them onto their side
As soon as the jerking stops, roll the person gently onto their side, into what is called the recovery position. Bend the top knee forward so the body stays in place and tilt the head slightly downward. This lets saliva, and any blood from a bitten tongue or cheek, drain out of the mouth instead of pooling near the airway, and it keeps vomit from being inhaled. If you can turn the person during the seizure without forcing their body, that is fine, but never fight the convulsions to do it.
Why five minutes is the line
Most tonic-clonic seizures end within one to three minutes. A seizure that reaches five minutes may not stop without emergency medication, and the longer it continues, the harder it is to stop and the greater the risk of harm to the brain. This is why the clock matters more than anything else you do. A seizure you are watching feels far longer than it is, so trust the timer, not your sense of time.
When to call 911
For someone with known epilepsy, a typical seizure that ends within a couple of minutes usually does not require an ambulance. Call 911 right away if any of the following is true:
- The seizure lasts five minutes or longer.
- A second seizure starts before the person has fully woken up from the first.
- This is the person's first seizure, or you have no way of knowing whether they have epilepsy.
- The person is injured, hit their head hard, or is bleeding heavily.
- The seizure happens in water. Anyone who seizes in water should be checked in an emergency department afterward, even if they seem fine.
- The person is pregnant.
- Breathing does not return to normal after the jerking stops, or the person does not begin waking up.
What recovery looks like
The period after a seizure is called the postictal phase, and it can be unsettling if you are not expecting it. The person may be confused, agitated, exhausted, or unable to speak clearly for many minutes. Headache and sore muscles are common, and many people sleep deeply afterward. Stay until they know where they are and can answer simple questions. When they are alert, tell them plainly what happened — most people do not remember the seizure itself.
If seizures are part of your family's life
If you or someone in your household has epilepsy, do two things before the next seizure. Ask the treating neurologist for a written seizure action plan, including whether a rescue medication is prescribed and exactly when bystanders should call 911. Then walk the people you spend time with through the steps on this page, since the person having the seizure is the one person who cannot act on them. Epilepsy support groups exist in most communities and can make this easier to carry. If seizures are new for you or are not yet well controlled, the neurology team at United Neuroscience Institute in Bakersfield evaluates seizure disorders and can help you put that plan in place.
This article is general health information, not medical advice, and does not replace evaluation by a clinician who knows your history. If you think you may be having a stroke or another neurological emergency, call 911.
