How to help someone having an epileptic seizure without causing further harm

A KAWE expert explains how to respond to epileptic seizures, avoid dangerous first-aid mistakes, identify triggers and ensure patients receive proper.

How to help someone having an epileptic seizure without causing further harm

A KAWE expert explains how to respond to epileptic seizures, avoid dangerous first-aid mistakes, identify triggers and ensure patients receive proper treatment.

When someone suddenly collapses, loses consciousness and begins jerking uncontrollably, fear can quickly take over. Some bystanders may flee, while others rush to hold the person down or force a spoon into their mouth, believing they are preventing them from swallowing their tongue.

However, such reactions can cause further injuries and prevent the person from receiving the help they need.

Nicholas Otieno, a clinical epileptologist at the Kenya Association for the Welfare of People with Epilepsy (KAWE), says knowing how to respond during a seizure is essential to protecting people living with epilepsy.

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“The injuries that they will have are not as a result of the seizure. The injuries that they will have are as a result of your reaction,” he says, warning that panic, crowding around the person and attempts to restrain them can cause additional harm.

Bystanders should move hard or sharp objects away from the person and place something soft under their head. A folded coat or other available clothing can serve as a cushion if a pillow is unavailable. Tight clothing around the neck, such as a tie, should also be loosened to avoid restricting breathing.

The person should never be restrained or held down, as this can cause further injuries. Bystanders should also avoid forcing the person's mouth open or inserting anything into it. Spoons, sticks, fingers and pieces of cloth can injure the mouth, break teeth or obstruct the airway. Contrary to a common misconception, a person having a seizure cannot swallow their tongue.

Allow the seizure to run its course while keeping track of how long it lasts. A seizure lasting five minutes or longer is a medical emergency. Urgent medical attention is also necessary if seizures occur repeatedly without the person regaining consciousness, if they experience breathing difficulties or serious injuries, or if a seizure occurs during pregnancy.

Prolonged seizures can develop into a potentially life-threatening condition known as status epilepticus, which requires emergency treatment.

What happens after a seizure?

When a seizure ends, the person may not regain consciousness immediately. They may remain confused, feel exhausted or struggle to recognise their surroundings.

If the person remains unconscious but is breathing normally, gently place them on their side in the recovery position when it is safe to do so. This helps keep the airway clear and allows saliva or vomit to drain from the mouth rather than block the airway.

Stay with the person as they recover. Once they begin responding, ask simple questions, such as their name and where they are, to establish whether they are becoming alert.

Do not leave them alone immediately after the episode, as another seizure may occur before they have fully recovered. Once they are alert, help them contact a relative, caregiver or another responsible person.

Avoid giving them water, food or oral medication until they are fully alert and can swallow safely. If they are not breathing normally after the seizure, seek emergency medical assistance immediately and follow the emergency operator's instructions.

What causes epilepsy, and what can trigger a seizure?

Epilepsy is associated with abnormal electrical activity in the brain. However, seizures can occur for different reasons, and not everyone who experiences a seizure necessarily has epilepsy.

Otieno explains that diagnosing the condition requires a detailed medical history and physical examination. Information from someone who witnessed the episode can be particularly valuable because the person who experienced the seizure may not remember what happened.

Health professionals may ask what happened immediately before, during and after the episode. They may also seek information about the patient's birth history, previous illnesses and family medical history.

Depending on the findings, additional investigations may be necessary to identify underlying problems, including head injuries, infections affecting the brain or abnormal growths.

Brain imaging, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may help identify these underlying causes. An electroencephalogram (EEG), which records electrical activity in the brain, may also be used when further assessment is required.

Otieno cautions that normal brain imaging does not automatically rule out epilepsy. Some seizures result from abnormal electrical activity that may not be visible on a brain scan. Similarly, an EEG may fail to capture seizure activity if no seizure occurs during the recording.

Accurate diagnosis is important because different seizure types may require different medicines. Treatment should therefore be guided by a qualified health professional rather than guesswork.

Otieno also highlights several factors that may trigger seizures in susceptible people, including lack of sleep, hunger, stress, anger, depression, alcohol and drug use, and certain infections.

Flickering lights and sudden, unexpected sounds may trigger seizures in some people, while prolonged exposure to screens may be a concern for certain individuals.

Identifying personal triggers can help people reduce the likelihood of further episodes. However, triggers vary from one individual to another, and people living with epilepsy do not necessarily respond to the same factors.

Why consistent treatment matters

Epilepsy is treatable, and many people can achieve good seizure control with appropriate medication and regular follow-up care.

Otieno warns that patients should not stop taking their medication simply because their seizures have disappeared. Stopping treatment suddenly can cause seizures to return.

Medication should be taken according to the prescribed schedule. Missing doses or taking medicines inconsistently can undermine seizure control and lead patients to mistakenly believe that their treatment is ineffective.

For some patients who remain seizure-free for a period, a clinician may consider gradually reducing their medication. However, the decision must be made by a qualified health professional rather than the patient independently.

The cost of treatment can also discourage people from seeking care, particularly when they are referred to specialists located far from their homes.

Otieno says epilepsy is not always inherited and that people living with the condition can study, work, marry and participate fully in community life.

When a seizure occurs, a calm and informed response can prevent avoidable injuries. Bystanders should protect the person's head, move dangerous objects away, loosen tight clothing and time the episode. They should never restrain the person or put anything in their mouth.

Once the seizure stops, the person should be placed on their side if they remain unconscious but are breathing normally. Bystanders should stay with them as they recover and seek emergency medical assistance when warning signs appear.

With timely medical care, appropriate treatment and greater public understanding, people living with epilepsy can manage their condition and lead productive lives.