Seizures in School

Understanding and Assisting Students with Epilepsy

What is epilepsy?

Epilepsy is a neurological condition, which means it affects the brain, the main part of the nervous system. Epilepsy may also be called a “seizure disorder.” People are usually diagnosed with epilepsy if:

• They have had at least 1 seizure.
• They are likely to have more seizures.
• The seizure wasn’t provoked or caused by another treatable medical condition like an infection or diabetes.

What are seizures?

Seizures seen in epilepsy are temporary changes in behavior caused by problems with the electrical and chemical activity of the brain. Seizures may look and feel different from one person to the next. What happens during a seizure depends on the area of brain affected.

Epilepsy seizures may be caused by a number of things such as brain injury, infection, or a family (genetic) tendency. Most of the time, however, the cause is unknown.

What happens in the brain during a seizure?

The short answer is that complex chemical changes happen in nerve cells in your brain and lead to a sudden surge of unusual electrical activity.

To understand this, you need to know that brain cells can either excite (start) or inhibit (stop) other brain cells from sending messages. Usually there is a balance in your brain of cells that start and stop the messages. But when a seizure happens, there may be too much or too little activity, which causes an imbalance between the starting and stopping messages. These chemical changes can lead to the surges of electrical activity that cause seizures.

A single seizure is not a disease . Recurring seizures that are considered epilepsy can be thought of as a disease or disorder. The terms disease and disorder essentially mean the same thing. Merriam-Webster online medical dictionary defines these terms as:

• A disorder is “an abnormal physical or mental condition”
• A disease is “ an illness that affects a person” or "a condition that prevents the body or mind from working normally”

Seizures are symptoms of many different disorders or diseases that affect the brain. Some seizures are so mild that you hardly notice them, while others are very severe.

General First Aid for All Seizure Types

The most important thing is to keep the person safe and comfortable. For most seizures, giving basic seizure first aid is all you need to do.

Always stay with the person until the seizure is over. 

Seizures can be unpredictable. It’s hard to tell how long they will last or what will happen during them. Some may start with minor symptoms, and then lead to a fall or a loss of consciousness. Other seizures may end in just a few seconds.

If the person is injured during or after a seizure, they may need help.

Pay attention to how long the seizure lasts.

Look at your watch and time the seizure. Keep track of:

• How much time there is between the beginning and the end of the active seizure
• How long it takes for the person to recover and return to their usual activity level

If the active seizure lasts longer than usual for that person, call for help.

Know when to give “as needed” (or rescue treatments), if prescribed — and when to call for emergency help.

Stay calm. Most seizures only last a few minutes.

Your response can affect how other people act. If you stay calm, it will help others stay calm, too.

Talk calmly and be reassuring to the person during and after the seizure. This will help them feel better as they recover.

Prevent injury by moving nearby objects out of the way.

Remove sharp objects from around the person, if you can.

If the person is wandering or confused, help steer them away from dangerous situations. For example, keep them away from traffic, the edge of a train or subway platform, high places, and sharp objects.

Make the person as comfortable as possible.

Help them sit down in a safe place. If they are at risk of falling, get someone to help you and lay the person down on the floor.

Support the person’s head to keep it from hitting the floor.

Keep onlookers away.

Once the situation is under control, encourage people to step back and give the person some room. Waking up in a crowd can be embarrassing and confusing for a person after a seizure.

Ask someone to stay nearby in case you need more help.

Don’t hold the person down.

Stopping the person’s movements won’t stop the seizure. It can cause injuries and make the person more confused, agitated, or aggressive.

People don’t fight on purpose during a seizure. But if they are restrained when they are confused, they may react aggressively.

If a person tries to walk around, let them walk in a safe, enclosed area if possible.

Don’t put anything in the person's mouth.

A person may bite down during a seizure if their jaw and face muscles tighten. If something is in their mouth, they could break and swallow the object, or break their teeth!

Remember, a person can’t swallow their tongue during a seizure. So don’t worry about that.

Make sure their breathing is okay.

If the person is lying down, turn them on their side, with their mouth pointing to the ground. This helps them breathe more easily and keeps saliva from blocking their airway.

During a convulsive (or tonic-clonic) seizure, it may look like the person has stopped breathing. This happens when the chest muscles tighten during the tonic phase of a seizure. As this part of a seizure ends, the muscles will relax and the person will start breathing normally again. You don’t need to do rescue breathing or CPR for that kind of change in breathing.

Don’t give water, pills, or food by mouth unless the person is fully alert.

If a person is not fully awake or aware of what is going on, they might not swallow correctly. Food, liquid, or pills could go into their lungs instead of their stomach and make them choke.

If the person appears to be choking, turn them on their side and call for help.

Call 911 right away if:

• The person can’t cough and clear their airway on their own
• The person is having trouble breathing

Know when to call for emergency medical help.

Call 911 for help if:

• A seizure lasts 5 minutes or longer
• One seizure happens right after another without the person regaining consciousness (“coming to”) between seizures
• Seizures happen closer together than usual for that person
• The person has trouble breathing
• The person appears to be choking
• The seizure happens in water, like a swimming pool or bathtub
• The person is injured during the seizure
• You believe this is the first seizure the person has had
• The person asks for medical help

Be sensitive and supportive, and ask others to do the same.

Seizures can be frightening for the person having one, as well as for others. Someone who has a seizure may feel embarrassed or confused about what happened. Keep this in mind as the person wakes up.

• Reassure the person that they are safe.
• Once they are alert and able to communicate, tell them what happened in very simple terms.
• Offer to stay with them until they are ready to go back to normal activity. Or call someone else who can stay with them.