When is a seizure a medical emergency?

Watching someone experiencing a seizure, or experiencing one yourself, can be frightening. But it’s important to know they aren’t always a medical emergency. Seizures are common for some people with conditions like epilepsy. The more you know and understand about seizures, the better prepared you’ll be if you ever have one yourself — or need to assist someone else.

What is a seizure?

A seizure happens when abnormal electrical activity in the brain causes sudden, involuntary changes in behavior, movement, or consciousness.

Seizures can be triggered by many factors, including:

• Alcoholism
• Alzheimer's disease
• Brain tumors
• Genetic tissues
• Head injuries
• High fever
• Infectious diseases
• Kidney failure
• Lupus
• Stroke

Interestingly, about half of all seizures are cryptogenic — meaning their cause is unknown.

Types of seizures

There are many different types of seizures, but two basic categories:

• Focal seizures start off in one part of the brain and one side of the body. These tend to be less severe and are the most common type of seizures associated with epilepsy. Focal seizures  can accompany conditions such as head injuries and strokes, which is why it is important to seek medical attention immediately if someone has a first-ever seizure of this type.
• Generalized seizures affect both sides of the brain at once and commonly happen without warning. They usually cause people to lose consciousness for a few seconds to minutes, and most people don’t remember what happened to them.
  • Tonic-clonic seizures (formerly known as grand mal seizures) are generalized but can start off as a focal seizure. They are the type most people think of as epilepsy. They involve two phases:
    • The tonic phase causes the body to stiffen.
    • The clonic phase causes muscles to twitch or jerk.

However, it’s important to know that, according to the Epilepsy Society, not all involve jerking or shaking movements. It’s possible to have an epileptic seizure and simply appear vacant or confused.

What to do is someone has a seizure?

If you witness a seizure, you can help by offering seizure first aid. Be sure to stay calm and look for the behaviors that signal a medical emergency. 

Here are ways you can help:

• Cushion their head with something soft
• Loosen any clothing around their neck
• Move harmful objects out of the way
• Pay attention to how long they're unconscious and how well they recover from it
• Prevent them from falling
• Roll them onto their side to prevent choking, especially if they are drooling or vomiting
• Try to keep their airway clear and monitor their breathing

Do not put anything in their mouth or try to restrain them physically. Stay near them until they’re fully conscious and aware of their surroundings.

It’s also helpful to know that temporary loss of bladder control is common during a seizure since the body temporarily can’t control its muscles. Incontinence during a seizure is not cause for alarm.

If you called 911, stay with the person and share details about what you observed — this can help the medical team provide better care.

When to call 911 for a seizure

Most seizures aren’t medical emergencies and often resolve on their own. However, certain situations do require immediate medical attention. Call 911 if a seizure:

• Is the first time a person had an episode or is different than their usual seizure type
• Is accompanied by difficulty breathing, a head injury, or a high fever
• Occurs in someone who is pregnant or has diabetes
• Lasts longer than five minutes
• Leaves the person unresponsive for several minutes afterwards
• Happens more than once in a short period
• Results in an injury, such as hitting their head or pain in a limb which may require urgent testing

Seizure care in the emergency room

In the emergency room (ER), you’ll likely receive a fast-acting benzodiazepine (medication names include diazepam, lorazepam and midazolam, among many others) to calm your brain’s overactive electrical activity. These medications are administered through an intravenous (IV) injection or via nasal spray to stop the seizure quickly.

Here for your when your need us most

Even if  a seizure is mild, it’s important to follow up with a neurologist as soon as possible. They can help determine the cause, rule out underlying conditions, and create a treatment plan tailored to your needs.

Seizures can be linked to long-term health issues or signal the onset of a new disorder. Partnering with a primary care doctor who understands your health history is key to managing your condition and protecting your well-being.