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• Epilepsy, a general introduction

Epilepsy - dealing with a tonic-clonic seizure

Tonic-clonic seizures are a common form of epileptic seizure. A seizure cannot be shortened or altered. However, this leaflet gives some tips on how a bystander can help.

During a seizure:

• Note the time.
• Do - prevent crowds gathering round.
• Do - place a cushion or some clothing under the head to prevent injury.
• Do not - try to restrain the person. If there is a warning or 'aura' before a seizure, it may be possible to guide the person to a safe place or cushion the expected fall to the ground. When the seizure starts, do not try and hold the person upright, but let them lie down.
• Do not - move the person unless they are in a dangerous place (for example in a road or next to a fire). If possible, move dangerous objects away from the person.
• Do not - place anything in the person's mouth, or try to move the tongue.

Once the seizure has stopped:

• Do - roll the person on to their side into the 'recovery position'.
• Do - check that breathing has resumed normally. It is normal for breathing to stop for a short while during the stiff (tonic) part of the seizure. The face will go pale or bluish. During the convulsive (clonic) part, breathing is irregular. After the seizure is over, breathing returns to normal. If not, check there is nothing stopping breathing such as food or false teeth. The recovery position helps saliva and anything in the mouth (such as food or vomit) to drain out of the mouth and not back into the throat.
• Do - stay and talk to the person. Give reassurance until they are fully recovered. It may take a while for the person to fully wake up. Do not leave a person alone whilst they remain dazed or confused.
• Do not - offer something to eat or drink until you are sure they are fully recovered.

There is usually no need to call a doctor or an ambulance unless:

• It is their first seizure.
• Injury has occurred which cannot be dealt with.
• The seizure does not stop after a few minutes. Status epilepticus is rare but means a seizure does not stop, or they keep recurring one after the other. This is an emergency and needs urgent treatment to stop the seizure.
• There is difficulty with breathing.

You can get further advice from the helplines of:

• Epilepsy Action - 0808 800 50 50, or
• The National Society for Epilepsy - 01494 601400.

© EMIS and PIP 2005 Updated: September 2005 PRODIGY Validated

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