If you feel a seizure coming on, you have a narrow but valuable window to protect yourself. Most people get seconds to minutes of warning, and the priority is simple: get to the ground safely, move away from anything that could hurt you, and alert someone nearby if possible. What you do in that short window can prevent injuries that are often more dangerous than the seizure itself.
Recognizing Your Warning Signs
The warning phase before a seizure is called an aura, and it’s actually the very first stage of the seizure itself. Auras vary widely from person to person but tend to be consistent for the same individual. You might experience déjà vu, a sudden wave of fear or panic, strange tastes or smells, visual disturbances, or a rising sensation in your stomach. Some people describe it as a hard-to-define feeling that something is about to happen.
Beyond the aura, some people notice a broader prodrome phase, with subtle behavioral or mood changes in the hours or even days before a seizure. Learning your personal pattern is one of the most useful things you can do. If you consistently notice certain feelings before a seizure, you can start acting on them immediately rather than second-guessing what’s happening.
Your First Priority: Get Safe Physically
The moment you recognize an aura, focus on your body’s position and your surroundings. Lower yourself to the ground before you lose the ability to do so. Falling from standing height onto a hard surface is one of the most common ways people get injured during seizures, and it’s entirely preventable if you have warning.
Once you’re down, try to:
- Roll onto your side with your mouth angled toward the ground. This keeps your airway clear. When you’re unconscious, you lose your cough reflex, so blood, vomit, or saliva can block your breathing. The side-lying position lets fluids drain out of your mouth and prevents your tongue from falling back into your airway.
- Move away from hazards. Push away from sharp furniture edges, glass tables, or hard objects within arm’s reach. If you’re near stairs, sit down immediately and move away from the edge. If you’re in or near water, get out of the water or to the shallowest area possible.
- Remove your glasses and loosen anything tight around your neck, like a scarf or tie, that could restrict breathing.
- Put something soft under your head if you can grab a jacket, bag, or pillow quickly. Don’t waste precious seconds searching for one.
If you’re in a high-risk environment like a kitchen with hot surfaces, a busy road, or at the top of a ladder, getting away from the immediate danger matters more than anything else. Even a few steps toward safety can make a significant difference.
Tell Someone What’s Happening
If anyone is nearby, tell them clearly: “I’m about to have a seizure.” Most bystanders have never witnessed a seizure and won’t know what to do. If you have time, give them one or two instructions: “Don’t put anything in my mouth. Roll me on my side. Time it.”
Timing matters because a seizure lasting longer than five minutes is a medical emergency. Most seizures last 30 seconds to two minutes, but without someone watching the clock, it’s nearly impossible to know how long one has gone on. If you can hand someone your phone with a timer, that’s ideal.
A medical ID bracelet or card is worth wearing if you have epilepsy. If you seize in public and can’t speak afterward, a medical ID gives bystanders your diagnosis, emergency contacts, and any critical medication information. This is especially important if you’re often alone in public spaces.
Using a Rescue Medication
If your doctor has prescribed a rescue medication, your aura is the signal to use it. The most common rescue medications come as nasal sprays, which are designed to be easy to administer even when your coordination is failing. You spray it into one nostril without pressing the plunger until the device is properly placed in your nose. If you don’t respond to the first dose and your doctor has authorized a second, it goes into the other nostril after 10 minutes.
The key is keeping the medication accessible. It doesn’t help if it’s in a medicine cabinet at home while you’re at work. Many people carry it in a bag, purse, or pocket at all times, and make sure the people closest to them know where it is and how to use it. If you can’t administer it yourself once the seizure progresses, a caregiver, partner, or coworker who knows the plan can step in.
Using a Vagus Nerve Stimulator
If you have a vagus nerve stimulator (VNS) implanted, the aura is also the time to use your magnet. Place or swipe the magnet over the generator on your left chest for one to two seconds. This triggers a 60-second burst of extra nerve stimulation that may shorten or stop the seizure. If the seizure continues after a full minute, you can use the magnet again the same way. You can repeat this up to three times for a single seizure, waiting at least 60 seconds between each use. The VNS doesn’t stop every seizure, but it’s a tool worth reaching for the moment you feel warning signs.
What Happens After the Seizure
The period after a seizure, called the postictal state, lasts anywhere from a few minutes to a few days, with an average of five to 30 minutes. During this time you may feel confused, exhausted, have a headache, or have difficulty speaking. This is normal. Your brain needs time to recover.
Be gentle with yourself afterward. You may need to rest for hours or even spend the day in bed. Avoid anything that demands intense concentration or physical effort. An over-the-counter pain reliever can help with a post-seizure headache. If someone is with you, having them stay until you’re fully oriented provides both safety and reassurance.
Pay attention to whether this seizure felt different from your usual pattern. If the postictal symptoms are more severe than normal, last longer than 24 hours, or if the seizure itself was noticeably different in character or duration, that’s worth reporting to your neurologist. Changes in seizure patterns can signal that your treatment plan needs adjusting.
Building a Seizure Action Plan
The best time to figure out what to do during a seizure is before one happens. A seizure action plan is a simple document that outlines your specific steps: what your auras feel like, where your rescue medication is, who to call, and when bystanders should call emergency services. Share it with the people who spend the most time with you, whether that’s a partner, roommate, coworker, or teacher.
Practice the physical steps when you’re well. Know exactly how your rescue medication works so the motions are automatic. Keep your medical ID current. If your seizures tend to cluster at certain times of day or around specific triggers like sleep deprivation or stress, plan your highest-risk activities accordingly. The aura gives you a head start, but preparation before the aura is what makes that head start count.