What should you do during an epilepsy fit? Dr. Abhishek Pathak, HOD of Psychiatry at HIMS, provides a detailed guide on seizure first aid, common myths & when to seek emergency help.

The Essential Guide to Seizure First Aid: Expert Advice from Dr. Abhishek Pathak

Witnessing a seizure can be a distressing and overwhelming experience, especially if it happens to a loved one or a stranger in public. In those intense moments, the urge to “do something” often leads to common mistakes that can inadvertently cause harm.

Dr. Abhishek Pathak, Consultant Neuro-Psychiatrist and Professor & HOD of the Department of Psychiatry at HIMS, explains that while seizures look like a medical crisis, most are self-limiting. The goal of first aid is not to stop the seizure, but to keep the person safe until it stops on its own.

1. The Immediate Response: Creating a Safe Zone

The primary risk during a seizure is physical trauma from the environment. As soon as a seizure begins:

• Clear the Perimeter: Quickly move furniture, sharp objects, or hard items away from the person. If they are near stairs or water, gently guide them away if possible.
• Protect the Head: This is critical. Place something soft—a pillow, a rolled-up jacket, or even a laptop bag—under their head to prevent repetitive impact against the floor.
• Time the Event: Start looking at your watch or a clock. Knowing exactly how long a seizure lasts is the most important piece of information you can give to a doctor later.
• Loosen Tight Clothing: To assist with breathing, loosen neckties, collars, and belts. If the person wears glasses, remove them carefully.

2. What NOT to Do: Debunking Common Myths

Misinformation about epilepsy can lead to dangerous interventions. Dr. Pathak highlights three critical things to avoid:

• Do Not Restrain: It is a common myth that you should hold a person down to stop the shaking. Forcing a person’s limbs to stay still during a convulsion can lead to dislocated joints or bone fractures.
• The “Spoon” Myth: Never put anything in the person’s mouth. You cannot “swallow your tongue,” but you can choke on an object or suffer broken teeth if someone tries to pry your jaw open.
• No Liquids or Food: Never attempt to give water, milk, or medicine by mouth during or immediately after a seizure. If the person is not fully conscious, these liquids can enter the lungs (aspiration), leading to life-threatening complications like aspiration pneumonia.

3. The Recovery Phase: Post-Ictal Care

Once the shaking stops, the person enters the “post-ictal” phase. They may be confused, drowsy, or agitated.

• The Recovery Position: Gently turn the person onto their side (the lateral rescue position). This allows any excess saliva or fluid to drain out of the mouth safely, keeping the airway clear.
• Maintain Dignity: Seizures can sometimes result in loss of bladder or bowel control. If this happens, try to shield the person from onlookers with a coat or blanket to help them maintain their dignity when they wake up.
• Stay Calm and Reassuring: As they regain consciousness, speak in a low, calm voice. Reassure them that they are safe and explain what happened.

4. Identifying a Medical Emergency

Most seizures end within 1 to 2 minutes. However, there is a specific threshold where a seizure becomes a life-threatening emergency.

“If a seizure lasts longer than 5 minutes, or if a second seizure starts before the person regains consciousness from the first, this is a condition called Status Epilepticus,” warns Dr. Pathak. “This is a grave clinical concern that requires immediate intervention in an Emergency Room.”

When to Call an Ambulance:

1. The seizure lasts longer than 5 minutes.
2. The person is pregnant or has diabetes.
3. The seizure happened in water.
4. It is the person’s first-ever seizure.
5. The person does not return to normal breathing after the shaking stops.

Final Thoughts

Understanding the science of a seizure removes the fear associated with it. By following the expert guidance of Dr. Abhishek Pathak, you can transform from a panicked bystander into a lifesaver.

About the Author: Dr. Abhishek Pathak is a renowned Consultant Neuro-Psychiatrist and the HOD of Psychiatry at HIMS. His work focuses on integrating neurological care with psychiatric wellness to improve the lives of patients with epilepsy and related disorders.