If someone near you is having a tonic-clonic seizure, the most important things you can do are protect them from injury, turn them on their side, time the seizure, and call 911 if it lasts longer than 5 minutes. You cannot stop the seizure once it starts, but your actions during and after it can prevent serious harm.
What a Tonic-Clonic Seizure Looks Like
A tonic-clonic seizure (sometimes called a grand mal seizure) has two distinct phases. The tonic phase comes first and lasts about 10 to 30 seconds. The person loses consciousness, their muscles suddenly stiffen, and they may fall to the ground. They might let out a groan or cry as air is forced past their vocal cords.
The clonic phase follows and typically lasts 30 to 60 seconds. The person’s body shakes with rhythmic, full-body muscle jerks. They may lose bladder or bowel control. The whole event usually ends within one to three minutes.
Step-by-Step First Aid During the Seizure
Stay calm and stay with the person. Here’s what to do, in order:
- Clear the area. Move furniture, sharp objects, or anything hard away from the person. If they’re near stairs or a ledge, gently guide them away from the edge if you can do so safely.
- Ease them to the ground if they haven’t already fallen. Place something soft and flat under their head, like a folded jacket.
- Turn them on their side. This keeps their airway clear and prevents them from choking on saliva or vomit.
- Start timing. Note when the seizure begins. If it goes past 5 minutes, call 911 immediately.
- Loosen tight clothing around the neck, such as ties or buttoned collars, to help with breathing.
What You Should Never Do
Do not put anything in the person’s mouth. People do not swallow their tongues during seizures, and forcing an object between clenched teeth can break teeth, injure the jaw, or hurt your fingers. Do not try to hold the person down or restrain their movements. The convulsions need to run their course, and restraining someone mid-seizure can cause muscle tears, joint injuries, or fractures. Do not attempt CPR while the seizure is happening. Wait until it stops and then check if the person is breathing normally.
What Happens After the Seizure Ends
Once the shaking stops, the person enters a recovery phase called the postictal state. This typically lasts between 5 and 30 minutes but can sometimes stretch longer. During this time, the person will likely be confused, drowsy, and disoriented. They may have a headache, feel nauseous, or have trouble speaking. Some people cough, spit, or drool excessively. These symptoms are all normal parts of recovery.
Keep the person on their side in the recovery position until they’re fully awake. Speak calmly and reassure them about what happened. Don’t offer food or water until they’re alert enough to swallow safely. Some people recover within an hour or two, while others experience lingering confusion, mood changes, or fatigue that can last a day or more. In rare cases, temporary weakness on one side of the body (called Todd’s paralysis) can take one to two days to resolve completely.
When to Call 911
Not every tonic-clonic seizure requires an ambulance, especially if the person has a known seizure disorder and recovers normally. But call 911 if any of the following apply:
- The seizure lasts longer than 5 minutes.
- A second seizure follows shortly after the first.
- The person has trouble breathing or doesn’t wake up after the seizure.
- 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.
A seizure lasting longer than 5 minutes is a medical emergency called status epilepticus. Brain damage becomes increasingly likely the longer it continues, so don’t wait to see if it stops on its own.
Rescue Medications for People With Epilepsy
If you’re a caregiver for someone with a known seizure disorder, their neurologist may have prescribed a rescue medication to use during prolonged seizures or seizure clusters. These are fast-acting sedatives designed to stop seizure activity before it becomes an emergency.
The two most common forms available for home use are nasal sprays and rectal gels. Nasal spray versions were approved by the FDA in 2019 and 2020 for different age groups, making them a more practical option than rectal formulations for many families. The nasal spray is a single dose that can be repeated after 10 minutes if needed. Using rescue medication has been shown to significantly reduce the chance of a seizure lasting beyond 5 minutes.
About two-thirds of caregivers who have rescue medication on hand have received formal training on how to use it, but fewer than half have a written seizure action plan. If your loved one has been prescribed a rescue medication, ask their doctor to walk you through administration step by step, and keep a written plan somewhere accessible so anyone in the household can find it quickly.
Seizures in Water
A seizure in a pool, bathtub, or any body of water is always an emergency. Support the person’s head above the surface while they’re seizing, keeping their face tilted upward so they can breathe. Get them out of the water as quickly as possible once the convulsions stop. If they’re not breathing, start CPR right away and call for an ambulance. Even if the person seems fine afterward, they need a medical evaluation. Inhaling even a small amount of water during a seizure can cause lung or heart complications that aren’t immediately obvious.