Most epileptic seizures end on their own within one to three minutes, and your main job is to keep the person safe until it stops. You don’t need medical training to help. Stay calm, stay nearby, and focus on preventing injury rather than trying to stop the seizure itself.
During a Convulsive Seizure
When someone collapses and their body stiffens or shakes (a tonic-clonic seizure, the type most people picture), take these steps:
- Ease them to the ground if they’re standing. Move chairs, tables, sharp objects, or anything hard away from them so they can’t strike it during convulsions.
- Place something soft under their head. A folded jacket or sweater works. This protects the back of the skull from repeated impact on a hard floor.
- Turn them gently onto their side. This keeps the airway clear and lets saliva or vomit drain out of the mouth instead of blocking breathing.
- Start timing the seizure. Check a clock or your phone. The duration matters for deciding whether to call emergency services.
- Loosen tight clothing around the neck, such as a tie or buttoned collar, to help with breathing.
- Stay with them until the seizure ends and they are fully awake and aware.
What Not to Do
Some of the most common instincts people have during a seizure are exactly the wrong ones. Do not hold the person down or try to stop their movements. Restraining someone mid-seizure can dislocate joints or cause muscle tears, in them or in you.
Do not put anything in their mouth. No wallet, no spoon, no belt. People cannot swallow their own tongue during a seizure. Forcing an object between clenched teeth can crack teeth, injure the jaw, or create a choking hazard. Do not attempt mouth-to-mouth breathing while the seizure is happening. Breathing typically resumes on its own once the convulsions stop. And do not offer food or water until the person is fully alert, because swallowing reflexes are unreliable during and immediately after a seizure.
When to Call Emergency Services
Not every seizure requires an ambulance, but several situations do. Call 911 (or your local emergency number) if:
- The seizure lasts five minutes or longer. At the five-minute mark, the medical definition shifts from a seizure to “status epilepticus,” a true emergency. Prolonged seizure activity can cause brain damage, breathing failure, and dangerous heart rhythms.
- A second seizure follows quickly without the person regaining awareness between them.
- The person is injured, has difficulty breathing after the seizure ends, or the seizure happened in water.
- You know, or suspect, it’s the person’s first seizure.
- The person is pregnant, has diabetes, or has another serious medical condition.
- The person does not return to normal awareness within several minutes of the seizure ending.
If someone with known epilepsy tells you in advance that ambulances aren’t needed for their typical seizures, you can generally follow their guidance, unless the seizure looks different from what they described or meets any of the criteria above.
Helping Someone After the Seizure Ends
The period right after a seizure, called the postictal phase, typically lasts between 5 and 30 minutes but can stretch longer. During this window, the person may be confused, drowsy, or disoriented. Some people experience headaches, nausea, or difficulty speaking. A few won’t remember what happened or even where they are.
Keep your voice calm and your words simple. Tell them who you are, where they are, and what happened. Don’t rush them to stand up or move. Let them sit or lie down comfortably until the fog clears. If they try to wander or seem agitated, gently guide them without restraining them.
In some cases, confusion can persist for one to two hours, especially after certain types of focal seizures. Temporary weakness on one side of the body (sometimes called Todd’s paresis) can take a day or two to fully resolve. And some people notice changes in mood, energy, or concentration that linger for days afterward. All of this is a normal part of the brain’s recovery process, not a sign of permanent damage.
What to Do During a Non-Convulsive Seizure
Not all seizures involve falling and shaking. Focal seizures with impaired awareness (previously called complex partial seizures) can look like the person has simply “checked out.” They may stare blankly, smack their lips, fidget with their clothing, or wander aimlessly. They typically can’t respond to you or control their actions during the episode.
Your role here is quieter but just as important. Stay beside them and speak calmly and reassuringly. Don’t shout or grab them. Gently steer them away from traffic, stairways, hot surfaces, or sharp objects. If their automatic movements are drawing unwanted attention, guide them to a more private spot. These seizures usually last one to two minutes, after which the person will gradually become aware again but may be confused for a while.
Seizures in Water
A seizure in a pool, bathtub, or any body of water is immediately life-threatening because of drowning risk. Support the person’s head above the surface and get them out of the water as quickly as possible. Once they’re on solid ground, check whether they’re breathing. If they’re not, begin CPR right away and call an ambulance. Even if the person seems to recover fully afterward, they need a medical evaluation. Water aspiration can cause complications that aren’t immediately obvious.
Rescue Medications
Some people with epilepsy carry prescription rescue medications designed to stop prolonged seizures or clusters of seizures (three or more in 24 hours). These are typically fast-acting sedatives delivered as a nasal spray or a solution placed inside the cheek. If you’re a caregiver, family member, or close friend of someone with epilepsy, ask their doctor to walk you through when and how to administer their specific rescue medication. The instructions vary by product, including how long to wait before giving a second dose.
Rescue medications are not something bystanders carry or use on strangers. They’re pre-prescribed for a specific person, with specific dosing. If you encounter a stranger having a seizure and you don’t have their medication or instructions, focus on basic first aid and call for help if the seizure passes the five-minute mark.