If someone near you is having a tonic-clonic seizure, your main job is to keep them safe, time the seizure, and stay calm. Most tonic-clonic seizures end on their own within one to three minutes and don’t require emergency medical care. Knowing the right steps, and avoiding a few common mistakes, can prevent injury and help the person recover faster.
What Happens During the Seizure
A tonic-clonic seizure has two distinct phases. In the tonic phase, the person loses consciousness and their muscles stiffen. They may fall suddenly, and the muscle contraction can force air out of their lungs, producing a cry or moan even though they’re completely unaware of their surroundings. Their face may turn bluish or gray because the stiff chest muscles temporarily impair breathing. You might see saliva or foam at the mouth, and if they accidentally bite their tongue or cheek, there may be blood.
The clonic phase follows, bringing rhythmic jerking movements of the face, arms, and legs. These start intense and rapid, then gradually slow over one to three minutes. When the jerking stops, the body relaxes. The person may lose control of their bladder or bowel. This is all part of the seizure and resolves on its own.
Step-by-Step First Aid
As soon as you recognize what’s happening, ease the person to the ground if they appear to be falling. Move away anything hard or sharp they could strike during the jerking phase: chairs, table legs, glass objects. Put something soft and flat under their head, like a folded jacket or sweater.
Turn them gently onto one side with their mouth pointing toward the ground. This keeps their airway clear and lets saliva or any fluid drain out rather than pooling in the back of the throat. Once they’re positioned, start timing. Note the clock or start a timer on your phone, because knowing exactly how long the seizure lasts matters for deciding whether to call for help.
Stay with them the entire time. Loosen anything tight around their neck, like a tie or buttoned collar. Speak calmly if others are gathering. There’s nothing more you need to do while the seizure is active. Your presence and the safe environment you’ve created are the intervention.
What Not to Do
Never put anything in the person’s mouth. Not a spoon, not a wallet, not your fingers. This is one of the most persistent myths about seizures, and it causes real harm: broken teeth, cut gums, and injury to the person trying to help. It’s physically impossible to swallow your tongue during a seizure.
Don’t try to hold the person down or restrain their movements. You won’t stop the seizure, and you risk injuring their joints or muscles, or getting hurt yourself. Don’t attempt CPR while the seizure is happening. Breathing may look irregular or even pause briefly during the tonic phase, but it returns once the seizure ends. Don’t offer food or water until they’re fully alert.
Caring for Someone After the Seizure
When the jerking stops, the person enters a recovery period. They’ll be groggy, confused, and possibly frightened. They may not know where they are or what happened. This confusion can last anywhere from a few minutes to an hour or more.
If they’re not already on their side, roll them into the recovery position: place the arm nearest to you at a right angle with the palm up, then put the back of their other hand against their opposite cheek. Bend their top knee and gently roll them toward you, using the bent leg to stabilize their body. Tilt their chin up slightly to open the airway, and check that nothing is blocking their mouth. If you see food or another obstruction, remove it only if you can do so safely.
Stay with them, speak in a calm and reassuring tone, and let them know what happened. Don’t rush them to stand up. Many people feel exhausted, sore, or emotionally overwhelmed after a tonic-clonic seizure and need time to reorient.
When to Call 911
Call emergency services if the seizure lasts longer than five minutes. A seizure that doesn’t stop on its own is a medical emergency called status epilepticus, and it requires immediate treatment. Also call 911 if:
- It’s the person’s first seizure, or you don’t know whether they have a seizure disorder
- A second seizure starts before the person has recovered from the first
- They have trouble breathing after the seizure stops
- They’ve injured themselves badly during the fall or convulsions
- The person is pregnant
- The seizure happened in water
Seizures during the third trimester of pregnancy or shortly after delivery can signal a dangerous condition called eclampsia, which needs emergency treatment even if the seizure stops quickly.
Making a Home Safer for Recurring Seizures
If you or someone in your household has epilepsy with tonic-clonic seizures, small changes around the home reduce the risk of injury during a fall. Carpet floors with heavy pile and thick padding underneath. Pad the sharp corners of tables and furniture, and when replacing pieces, choose options with rounded edges. Use chairs with arms that help prevent someone from sliding off if they lose consciousness.
The kitchen carries particular risk. Cook on back burners when possible. Use plastic plates, cups, and containers instead of glass. Lidded travel mugs prevent scalding spills. If you need to move hot pots or liquids, slide them along the counter or use a cart rather than carrying them. Wearing rubber gloves while handling knives or washing glassware adds a layer of protection.
In the bathroom, rehang doors so they swing outward. If someone falls against an inward-opening door, rescuers can’t get in. Keep fireplace screens closed during use, avoid space heaters that can tip over, and make sure appliances like irons and curling irons have automatic shut-off switches to prevent burns if they’re dropped mid-use.