Prevent and prepare

• Encourage those who look after a person prone to seizures to recognise what regular seizure activity looks like for that individual, as well as their prescribed treatment and first aid action plan. If the seizure activity is abnormal or the recommended intervention from a healthcare professional is ineffective, the caregiver should access help immediately.
• Refer schoolteachers and other caregivers to first aid learning (where appropriate) to build their confidence and comfort in emergencies (Kaleyias et al., 2005; Berhe et al., 2017).
• Raise awareness among caregivers that a fever can cause seizures in babies and children. Prevention includes treating the Fever and dressing babies and children appropriately for their environment.
• In contexts where malaria is prevalent, one of the most common causes of seizures in children is a fever caused by malaria. Therefore, malaria prevention (e.g., insecticide-treated mosquito nets or mosquito repellents) may be effective at preventing episodes in settings where anti-epileptic treatment is unavailable (Ba-Diop et al., 2014).

Early recognition

People with epilepsy may experience a warning sign before an epileptic seizure, known as an “aura”, causing them to feel strange or experience a particular taste or smell. Other than epilepsy, a seizure may also be the result of a head injury, disease, infection, poisoning or fever (especially in babies and children). Conversely, there may be no apparent reason for the seizure.

Seizures may look different from one individual to the next.

Signs of a seizure include:

• sudden loss of responsiveness
• sudden collapse
• involuntary muscle movements such as twitching, jerky movements, stiffness, arching of the back, clenched jaw
• noisy, difficult breathing
• saliva foaming around the mouth.

Following the active stage of a seizure the person may:

• fall into a deep sleep
• start to breathe normally or deeply
• become responsive again, often after a few minutes
• be unaware of what has happened.

Someone who experiences an absence seizure may:

• have a blank stare
• have mild twitching
• be unaware of their surroundings.

First aid steps

1. Protect the person from harm by moving any nearby objects that may hurt them. Avoid moving the person unless they are in immediate danger (e.g., they are in oncoming traffic).
2. Place soft padding (e.g., a cushion or sweater) under the person’s head to protect it. Remove eyeglasses and loosen any restrictive clothing from around their neck. Do not restrain the person.
3. Access emergency medical services (EMS) in any of the following cases:
             a. the person has hurt themselves
             b. it is the person’s first seizure
             c. the seizure lasts more than five consecutive minutes
             d. the person does not regain responsiveness after the seizure
             e. the person is experiencing repeated or different types of seizures than usual or the seizures have increased in frequency
             f. the person is pregnant or diabetic
             g. the person has a high fever
             h. the person is under the influence of alcohol or drugs
             i. when in doubt.
4. Note the start and stop time of the seizure, as well as if it reoccurs. Communicate this information to EMS if available.
5. When the seizure is over, check the person’s breathing and keep checking this regularly. Remove the padding from under their head if it may interfere with their breathing.
             a. If they are breathing normally, move them onto their side and ensure their airway is open.
             b. If they have abnormal breathing, see Unresponsive with abnormal breathing adolescent and adult or baby and child.

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SPECIAL CASE

Babies and children

• In addition to the steps above, check the baby or child’s temperature. If they are too hot, cool them by removing any excess clothing and expose them to fresh, cool air. Treat any Fever if necessary.

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NOTE

• Do not force anything between the person’s teeth.
• If you do not know the person, look for any medical information they may have on them, such as a medical bracelet with details of their condition, before accessing help.
• If present, ask a family member or caregiver if the person has any anti-seizure medication. There are many ways this medication can be administered, including orally, a spray in the nose, an injection or rectally. Assist the caregiver if you feel comfortable doing so.
• Protect the person’s dignity. For example, move bystanders along or cover any signs of accidental urination.
• If the person has a mild seizure, stay calm and keep the person safe. Stay with them until the seizure has passed.
• Be aware that, once the seizure is over, a person may be confused or aggressive. Mind your own safety and avoid touching the person excessively.

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Access help

• A person with epilepsy may wish to manage their condition independently and request that you do not access help. If they are with a companion (e.g., partner, parent or caregiver), listen and support what this person says as they are more familiar with the condition than you are. If the person having a seizure is alone, check for a medical bracelet or necklace before accessing help.
• A seizure that lasts longer than five minutes is called “status epilepticus”. It is a severe condition and requires immediate medical assistance – access help right away.

Context considerations

• In schools or other environments involving children, educate peer groups and teachers on seizures and epilepsy to reduce the stigma surrounding these conditions. Ensure they know how to keep children with epilepsy safe and comfortable.

Learner considerations

• New parents or caregivers may benefit from learning about seizures in babies and children.

Facilitation tips and tools

• Address any misconceptions about epilepsy and seizures to reduce stigma and prejudice. Conduct activities that incorporate accurate information about the causes of epilepsy and seizures.
• Focus on building learners’ confidence to help someone having a seizure.
• Facilitate a discussion to understand what learners already know about seizures and build on this knowledge. Be aware that there is a difference between knowledge, understanding and confidence to act.
• Discuss learner’s experiences with seizures and address any barriers to providing care.
• Acknowledge common mistakes when caring for a person experiencing a seizure. Explain that these actions may injure the person and that it is best to let the seizure run its course. 
  >   opening the person’s mouth
  >   putting something in the person’s mouth
  >   restraining the person.
• Acknowledge that it can be frightening to see someone having a seizure for the first time but reassure that there are simple things learners can do to protect the person from harm.
• Create scenarios to allow learners to explore some of the social considerations relevant to seizures such as bystanders watching, the person passing urine while having a seizure, bystanders insisting on incorrect help like CPR, concerns about helping or touching another gender in public.
• Use group discussion to explore how people describe seizure. If appropriate, use video sensitively to support learners’ ability to identify the signs and symptoms of seizures.

Learning connections

• Seizures in babies and children are often caused by Fever.
• After the active stage of a seizure, the person will usually be Unresponsive and breathing normally.
• Make a connection to providing emotional support to the person having a seizure. The first aid provider should provide reassurance and comfort by letting the person know they are there and will not leave them alone.
• Make a connection to managing the scene. For example, bystanders may gather to see what is happening. This can be embarrassing for the person having a seizure. The first aid provider should protect the dignity of the person and have any bystanders clear the area.