If someone near you is having a tonic-clonic seizure, your main jobs are to keep them safe, protect their head, time the seizure, and turn them on their side. Most tonic-clonic seizures end on their own within one to three minutes. What you do in that short window, and what you avoid doing, can make a real difference.
What You’re Seeing
A tonic-clonic seizure has two distinct phases. In the tonic phase, the person’s muscles suddenly stiffen. Their body goes rigid, their arms and legs tense up, and they may fall to the ground. This stiffening typically lasts about 20 seconds. Then the clonic phase begins: repeated, rhythmic jerking of the arms and legs on one or both sides of the body. The person is unconscious through both phases and will not respond to you.
Knowing this helps you stay calm. The stiffening and jerking will stop. Your role is not to stop the seizure but to keep the person safe until it ends.
Step by Step: What to Do
Start timing the seizure immediately. Use your phone or a watch. The duration matters because a seizure lasting five minutes or longer is a medical emergency. While you’re timing, follow these steps:
- Clear the area. Move furniture, sharp objects, or anything hard away from the person. If they’ve fallen near a road or staircase, gently guide their body away from danger only if you can do so safely.
- Protect their head. Place something soft, like a folded jacket or towel, under their head to cushion it against the ground.
- Loosen tight clothing. Undo ties, scarves, or anything around the neck that could restrict breathing.
- Stay with them. Do not leave the person alone. Your presence is important both during and after the seizure.
- Turn them on their side. Once the jerking slows or stops, roll the person onto their side with their mouth pointing toward the ground. This allows saliva to drain and keeps their airway clear so they can breathe easily. This position also prevents them from choking if they vomit.
What Not to Do
Some of the most common instincts during a seizure are the most dangerous. Do not put anything in the person’s mouth. It’s a myth that someone can swallow their tongue during a seizure. Placing an object between their teeth can break teeth, injure the jaw, or cause choking. Do not hold the person down or try to stop their movements. Restraining someone during a seizure can cause muscle tears, joint injuries, or fractures.
Do not attempt CPR or mouth-to-mouth breathing while the seizure is happening. Breathing may sound labored or even pause briefly during a tonic-clonic seizure, but people normally start breathing on their own once it ends. Do not offer food, water, or medication until the person is fully awake and alert.
If They Have a Rescue Medication
Some people with epilepsy carry prescribed rescue medications for prolonged seizures. These are typically nasal sprays, and a seizure action plan (often on a card or medical alert bracelet) will tell you when and how to use them. One common type is an intranasal spray that delivers a single dose you spray into one nostril. Another is a nasal diazepam spray dosed by age and weight.
If the person has a rescue medication and you have access to their seizure action plan, follow those specific instructions. These medications were designed to be used by non-medical bystanders, including parents, teachers, and caregivers, in exactly this kind of situation. If the person also has a vagus nerve stimulator (a small device implanted under the skin on the chest), they may carry a magnet. You swipe the magnet over the chest area where the device sits for one to two seconds. Their action plan will tell you how many times to repeat. If you call 911, let the dispatcher know the person has this device.
When to Call 911
A seizure lasting five minutes or more is classified as a neurological emergency called status epilepticus. At that threshold, the brain is at risk for serious damage, and the person needs emergency medical treatment. Call 911 if the seizure reaches the five-minute mark.
You should also call 911 if:
- The person has a second seizure shortly after the first without fully recovering in between.
- They have trouble breathing or cannot be woken up after the seizure ends.
- They were injured during the seizure.
- The seizure happened in water.
- This is their first seizure ever.
- The person is pregnant.
- The person has diabetes and has lost consciousness.
If It Happens in Water
A seizure in a pool, bathtub, or any body of water is immediately life-threatening. Support the person’s head and keep their face above the water’s surface. Get them out of the water as quickly as possible, then place them on their side. Check whether they’re breathing. If their breathing sounds labored or noisy, or they’re not alert, call 911. Begin CPR if they are not breathing at all. This is the one scenario where CPR may be needed during or right after a seizure.
After the Seizure Ends
When the jerking stops, the person enters what’s called the postictal phase, a recovery period that can last anywhere from a few minutes to over an hour. During this time, the person may be confused, disoriented, exhausted, or emotional. They may not know where they are or what happened. Some people experience headaches, nausea, or temporary weakness or numbness on one side of the body.
Stay with them and speak calmly. Check whether they can respond to your voice, tell you their name, or remember what happened. Don’t rush them. Many people need to sleep after a tonic-clonic seizure, and that’s normal. Keep them on their side until they’re fully awake and aware of their surroundings. Once they’re alert, you can offer water or help them get comfortable.
If the person has epilepsy and this was a typical seizure for them, they may not need emergency care. But it’s helpful to tell them how long the seizure lasted, what it looked like, and anything that happened beforehand. These details are valuable information for their neurologist and can help with managing their treatment going forward.