🧠⚡Understanding Seizures: What You Need to Know and How to Stay Safe

Seizures can be surprising and sometimes frightening, both for the person experiencing them and for those around them. Knowing what a seizure is, how it might present, and how to respond can help keep everyone safe and empowered.

A seizure is a sudden, uncontrolled burst of electrical activity in the brain that temporarily changes how the brain works. This can affect movement, awareness, sensation, emotions, or behavior depending on where it starts and how far it spreads (Fisher, 2017). Seizures can happen in people with epilepsy as well as those with acute medical issues such as metabolic changes, infection, stroke, or brain injury (Beghi, 2020).

Types of Seizures and How They Present

Seizures are classified by where they begin in the brain and how they affect awareness and movement (Fisher, 2017). Understanding the type of seizure can help caregivers, clients, and therapists respond appropriately.

Focal Seizures

These start in one part of the brain.

• Focal aware seizures: The person stays conscious but may notice unusual sensations, sudden emotions, tingling, or visual changes (Jobst, 2020).

• Focal impaired awareness seizures: Awareness is altered. The person may appear confused, stare, wander, or perform repetitive movements called automatisms (Ryvlin, 2018).

Generalized Seizures

These involve both sides of the brain.

• Absence seizures: Brief staring spells or lapses in awareness, often seen in children (Tenney, 2013).

• Myoclonic seizures: Quick, shocklike muscle jerks (Wirrell, 2014).

• Tonic seizures: Sudden muscle stiffening.

• Clonic seizures: Rhythmic jerking movements.

• Tonic clonic seizures: Stiffening followed by rhythmic jerking with loss of consciousness (Beghi, 2020).

• Atonic seizures: Loss of muscle tone that may cause falls (Holmes, 2015).

Unknown Onset Seizures

Sometimes it is not clear where or how a seizure began, especially if it happens during sleep or is unwitnessed.

Warning Signs Before a Seizure

Not every seizure comes with warning signs, but some people notice early symptoms.

• Prodrome: Changes in mood or behavior hours or days before a seizure, such as irritability, anxiety, or trouble concentrating (Haut, 2018).

• Aura: A brief sensory or emotional experience just before a seizure, like a strange smell, taste, visual change, or sudden fear (Ryvlin, 2018).

Being aware of these signs can help someone prepare and seek a safe environment if possible.

What Someone Experiences During a Seizure

Seizure experiences are highly individual and depend on the type and brain region involved.

• Focal seizures with awareness: The person may feel strange sensations or emotions but remain fully conscious (Jobst, 2020).

• Focal seizures with impaired awareness: The person may seem confused, unresponsive, or perform repetitive actions (Ryvlin, 2018).

• Generalized seizures: Consciousness is lost, and muscles may stiffen and jerk. Post-seizure recovery can include fatigue, confusion, headache, or temporary weakness (Beghi, 2020).

Each person’s experience is unique, which is why careful observation and clear reporting of seizures are so important.

How to Respond if Someone Has a Seizure

If you are with someone during a seizure, your goal is safety and calm reassurance (Bleck, 2015):

1. Stay with them and remain calm.

2. Protect their head with something soft.

3. Clear the area of hard or sharp objects.

4. Turn the person on their side if possible to keep the airway clear.

5. Do not restrain them.

6. Do not put anything in their mouth.

7. Time the seizure.

8. Call emergency services if the seizure lasts more than five minutes, repeats without recovery, occurs in water, or if the person is injured or pregnant.

After the seizure, speak calmly and provide gentle reassurance while they recover. Your support can make a big difference.

Seizure Precautions and Occupational Therapy

Occupational therapy focuses on helping people live safely and fully, even when they experience seizures. This includes:

• Modifying the environment to reduce risk, like removing sharp edges or adding non-slip surfaces (Zeng, 2018).

• Adapting activities that could be dangerous if a seizure occurs, such as cooking, bathing, or using community transportation (Haut, 2018).

• Teaching clients and caregivers to recognize early symptoms and manage triggers, including stress, sleep disruption, or missed medications (Beghi, 2020).

• Supporting routines, energy management, and cognitive strategies to promote safety and independence (Zeng, 2018).

• Supervising higher-risk activities in therapy, including balance or motor coordination exercises.

OT helps people continue participating in meaningful activities while prioritizing safety, confidence, and independence.

References

1. Beghi, E. (2020). The epidemiology of epilepsy. Neuroepidemiology, 54(2).

2. Bleck, T. (2015). Convulsive seizures: emergency management. Neurologic Clinics, 33(3).

3. Fisher, R. et al. (2017). Operational classification of seizure types by the International League Against Epilepsy. Epilepsia, 58(4).

4. Haut, S. (2018). Seizure warning signs and patient self management. Epilepsy & Behavior, 80.

5. Holmes, G. (2015). Atonic seizures and drop attacks: clinical overview. Epilepsy Research, 119.

6. Jobst, B., & Cascino, G. (2020). Focal epilepsy. New England Journal of Medicine, 383(13).

7. Ryvlin, P. (2018). Focal impaired awareness seizures: clinical features and treatment. The Lancet Neurology, 17(12).

8. Tenney, J. (2013). Absence epilepsy. Pediatrics in Review, 34(8).

9. Wirrell, E. (2014). Myoclonic seizures: diagnosis and treatment. Epilepsia, 55(1).

10. Zeng, L. (2018). Occupational therapy approaches for people with epilepsy. American Journal of Occupational Therapy, 72(4).