Seizures
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CDC seizure first aid emergency when call 911
If someone is having a seizure right now:
- Stay calm and time it.
- Move dangerous objects away and cushion their head.
- Turn them gently onto their side once safe to do so.
- Loosen tight clothing around the neck.
- Do not restrain them and do not put anything in their mouth.
- Stay with them until they are fully awake and oriented.
Call emergency services now if the seizure lasts 5 minutes or more, repeats without recovery, is the person’s first known seizure, occurs in water, involves injury or breathing difficulty, or the person is pregnant or has diabetes. These are consistent with CDC seizure first-aid guidance.
A seizure is a temporary episode of abnormal electrical activity in the brain. It can cause convulsions, staring spells, unusual sensations, confusion, or loss of awareness. A single seizure does not necessarily mean epilepsy, but a first seizure needs medical assessment.
Are you asking about seizure first aid, causes, types, or a specific person’s symptoms?
Explain
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CDC types seizures causes diagnosis epilepsy
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Seizures explained
A seizure is a sudden, temporary change in brain function caused by abnormal, excessive electrical activity in brain cells. It may last seconds to a few minutes and can affect movement, awareness, sensation, behavior, speech, or memory.
A seizure is not always the dramatic shaking episode shown in media.
What can a seizure look like?
1. Focal seizures
These begin in one area of the brain.
These begin in one area of the brain.
- Focal aware seizure: the person remains conscious. They may experience a strange smell or taste, tingling, visual changes, fear, nausea, or involuntary twitching.
- Focal impaired-awareness seizure: the person is confused or unaware, may stare, smack their lips, pick at clothing, wander, or fail to respond. They often do not remember it afterward.
- A focal seizure can spread to both sides of the brain and become a bilateral tonic-clonic seizure.
2. Generalized seizures
These involve both sides of the brain from the start.
These involve both sides of the brain from the start.
- Tonic-clonic seizure: loss of consciousness, body stiffening followed by rhythmic jerking, sometimes with tongue biting, loss of bladder control, and confusion or sleepiness afterward.
- Absence seizure: brief blank stare and interruption of activity, usually lasting only seconds. It can be mistaken for daydreaming.
- Myoclonic seizure: sudden, brief muscle jerks.
- Atonic seizure: sudden loss of muscle tone, causing head drops or falls.
The current broad classification into focal and generalized seizures is summarized by the CDC seizure-type guidance.
Why do seizures happen?
Some occur because of a temporary trigger, called a provoked or acute symptomatic seizure. Examples include:
- Low blood sugar
- Low sodium or other metabolic disturbance
- High fever in young children
- Alcohol or drug intoxication or withdrawal
- Certain medicines or toxins
- Serious infection affecting the brain
- Recent head injury or stroke
An unprovoked seizure happens without a temporary, reversible trigger. It can be associated with genetic predisposition, old brain injury, stroke, brain tumor, previous brain infection, or sometimes no identifiable cause. Frameworks for Internal Medicine explains that head injury, stroke, tumors, and intracranial infection can leave a lasting predisposition to future seizures.
Seizure versus epilepsy
- Seizure: one event of abnormal brain electrical activity.
- Epilepsy: a condition in which a person has an ongoing tendency to have recurrent unprovoked seizures.
So, a single seizure does not automatically mean epilepsy. Epilepsy is usually diagnosed after two unprovoked seizures more than 24 hours apart, or after one unprovoked seizure when the estimated risk of recurrence is high. Frameworks for Internal Medicine notes a roughly 40% to 50% chance of recurrence over 2 to 8 years after a first unprovoked seizure.
What happens after a seizure?
The recovery phase is called the postictal period. The person may be confused, sleepy, have a headache, muscle soreness, difficulty speaking, or temporary weakness of one side of the body. This can last minutes to hours.
How is a first seizure assessed?
A clinician will ask a witness what happened before, during, and after the episode, review medical history, and look for triggers. Tests may include:
- Blood glucose and electrolytes
- Toxicology or infection testing when indicated
- EEG, which records brain electrical activity
- Brain MRI or CT in selected situations
The immediate priorities are airway, breathing, circulation, stopping recurrent seizures, and identifying dangerous causes such as infection, metabolic disturbance, or drug toxicity. Harrison’s Principles of Internal Medicine, 22nd ed., p. 3459.
Treatment
Treatment depends on the cause and seizure type:
- Correct a reversible trigger, such as low glucose or low sodium.
- A prolonged seizure may require urgent emergency medicines.
- Recurrent unprovoked seizures may be treated with an antiseizure medicine chosen for the individual seizure type and patient factors.
- Some people with medication-resistant epilepsy may be candidates for surgery, implanted neurostimulation, or dietary therapy under specialist care.
When it is an emergency
Call emergency services if a seizure:
- Lasts 5 minutes or more
- Occurs repeatedly without the person waking fully between episodes
- Is the person’s first known seizure
- Happens in water
- Causes injury or breathing problems
- Occurs during pregnancy or in someone with diabetes
For someone actively convulsing, protect them from injury, cushion the head, time the episode, turn them onto their side when safe, and do not put anything in their mouth or hold them down. See the CDC first-aid instructions.
If it is caused due to hypotension
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syncope versus seizure convulsive syncope hypotension authoritative guideline
Low blood pressure usually causes fainting (syncope), not epilepsy. When blood pressure drops sharply, the brain briefly receives too little blood and oxygen. The person may feel dizzy, sweaty, nauseated, have tunnel vision, then collapse.
During a faint, brief stiffening or jerking can occur. This is called convulsive syncope and can look like a tonic-clonic seizure, but it is caused by transient reduced blood flow to the brain, not abnormal electrical brain activity. Tintinalli’s Emergency Medicine notes that brief tonic-clonic movements can accompany syncope.
Features suggesting hypotensive fainting
- Trigger such as standing up suddenly, dehydration, heat, pain, blood loss, vomiting/diarrhea, or some medicines
- Warning symptoms: light-headedness, blurred vision, nausea, sweating, ringing in ears
- Often pale and limp initially
- Loss of consciousness is usually short
- Rapid return of awareness after lying flat, with little prolonged confusion
Features more suggestive of an epileptic seizure
- No clear fainting trigger
- Aura, such as an unusual smell, sensation, or déjà vu
- Tongue biting, particularly the side of the tongue
- Sustained rhythmic movements
- Marked confusion, sleepiness, headache, or muscle aches lasting more than several minutes afterward
However, these are not definitive. A clinician may need to assess blood pressure lying and standing, ECG/heart rhythm, glucose, electrolytes, medicines, bleeding, and possibly EEG or brain imaging. This matters because serious causes of hypotension include internal bleeding, severe infection, dehydration, heart rhythm problems, heart attack, and medication effects.
Seek urgent emergency care now if there is collapse with persistent low blood pressure, chest pain, shortness of breath, bleeding or black stools, severe headache, injury, pregnancy, repeated episodes, a seizure lasting 5 minutes or more, or failure to regain normal awareness.
Treatment
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orthostatic hypotension treatment patient guidance CDC NIH
If the seizure-like episode is due to hypotension with fainting (convulsive syncope), treatment is aimed at restoring blood flow to the brain and treating the cause of low blood pressure, not usually antiseizure medication.
During an episode
- Lay the person flat on their back and raise their legs if possible.
- Loosen tight clothing and ensure an open airway.
- Turn them on their side if vomiting or still drowsy.
- Do not give food, drink, or tablets until they are completely awake.
- Check for injury and seek emergency help if they do not promptly regain normal awareness.
Call emergency services if there is persistent faintness or low blood pressure, chest pain, shortness of breath, severe bleeding, black stools, fever/severe illness, pregnancy, significant injury, repeated collapse, or a convulsive episode lasting 5 minutes or more.
Treatment depends on the cause
| Likely cause | Usual medical approach |
|---|---|
| Dehydration, vomiting, diarrhea, heat exposure | Oral fluids if fully awake and safe to swallow; IV fluids if severe or unable to drink |
| Standing up quickly / orthostatic hypotension | Rise slowly, sit at the bedside before standing, maintain fluids, consider compression garments and clinician review |
| Medication-related low BP | A clinician reviews blood-pressure medicines, diuretics, nitrates, antidepressants, and other contributing medicines. Do not stop prescribed medicines abruptly without advice. |
| Low blood sugar | Measure glucose and correct it urgently according to local medical advice |
| Bleeding | Emergency evaluation and treatment, including fluids/blood products and control of the bleeding source |
| Heart rhythm or structural heart problem | ECG and urgent cardiac evaluation; treatment may involve medication, ablation, pacemaker, or other targeted therapy |
| Severe infection or allergic reaction | Emergency hospital treatment |
Preventing recurrent orthostatic hypotension
After a clinician has ruled out dangerous causes:
- Drink adequate fluids, unless you have been told to restrict fluids for heart or kidney disease.
- Stand up slowly, especially after waking or after meals.
- Avoid prolonged standing, hot showers, overheating, alcohol, and large heavy meals if these trigger symptoms.
- Sit or lie down immediately when warning symptoms begin.
- A clinician may recommend increased salt intake in selected people, but this is not appropriate for everyone, particularly people with heart failure, kidney disease, or uncontrolled high blood pressure.
- Persistent symptomatic cases may need prescription treatment, such as a drug to expand circulating volume or raise standing blood pressure. These require supervision because they can cause high blood pressure while lying down.
The aim is symptom and fall prevention while the underlying cause is identified. NIH-reviewed guidance recommends correcting aggravating factors and using non-drug measures before considering medication.
A first fainting episode with seizure-like jerks should still be medically assessed, particularly if it is new, recurrent, occurs during exercise, or happens without an obvious trigger.
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