Seizures, Convulsions and Epilepsy: What To Do, and When To Call for Help

Last reviewed: 9 October 2026 · Written by Biswa Prakash Swain, Nursing Officer (BSc Nursing, MPH)

A seizure can happen at home, at a bus stop, in an office or on a train. Most people who see one have never seen one before — and the instinct to hold the person down, force something into the mouth or splash water on the face makes things worse.

Most seizures stop on their own within a few minutes. Your job is not to stop it. It is to keep the person safe while it runs its course, and to recognise the small number of situations that need an ambulance.

What is a seizure? How is it different from convulsions and epilepsy?

The brain’s nerve cells communicate through electrical signals. A seizure is a temporary episode of abnormal electrical activity that can affect movement, awareness, feelings or behaviour.

Convulsions are uncontrolled muscle stiffening and jerking. They can happen during a seizure, but not every seizure causes convulsions. Some people briefly stare, become confused, make repeated movements such as lip-smacking or fumbling with clothes, or simply stop responding for a few seconds.

Epilepsy is a condition in which the brain has an ongoing tendency to produce seizures. One seizure does not mean epilepsy.

Epilepsy is diagnosed when any one of these is true
At least two unprovoked seizures more than 24 hours apart
One unprovoked seizure plus a recurrence risk of about 60% or more over the next 10 years
Diagnosis of an epilepsy syndrome

“Unprovoked” means there was no immediate, temporary cause — no acute trigger such as very low blood sugar or a head injury that explains the episode by itself.

Why do seizures happen?

Causes include epilepsy, very low blood sugar, disturbances in blood salts such as sodium, brain infections, stroke, head injury, brain tumours and alcohol withdrawal. In young children, fever can trigger a febrile seizure. Often no cause is found.

Fainting, low blood pressure, some heart-rhythm problems and certain psychological conditions can look very like a seizure. As a bystander, your job is to describe what you saw — not to decide what it was. That description is often the single most useful thing the doctor receives.

What to do during a seizure

• Stay calm and start timing. Note the clock. Ask bystanders to step back and give space.
• Protect them from injury. Move away hard or sharp objects, hot tea, furniture corners. Put something soft and flat under the head — a folded dupatta, jacket or bag. Loosen anything tight around the neck. Remove their spectacles.
• Move them only if there is real danger — traffic, fire, water, a railway platform edge.
• Do not hold them down. Restraining the arms or legs does not shorten the seizure and can dislocate a shoulder or injure you.
• Put nothing in their mouth. No spoon, no key, no finger, no cloth, no onion. Do not try to force the jaw open. A person cannot swallow their tongue. Objects in the mouth break teeth, cut gums and can cause choking.
• Do not give water, food or tablets while they are not fully alert. Do not slap them, throw water on their face, or try to make them stand or walk.
• Look for a medical ID — a bracelet, pendant or card naming epilepsy, diabetes or a medicine. It tells the ambulance team a great deal.
• Protect their dignity. People can lose bladder control during a seizure. Clear onlookers and cover them if needed. Helping comes before filming.

If instead of convulsing the person is confused, wandering or picking at their clothes, do not grab or confront them. Stay beside them, speak calmly, and gently steer them away from roads, stairs and water.

What to do after the jerking stops

Check whether they are breathing normally.

If breathing normally but still unresponsive: gently roll them onto their side, with the mouth angled slightly downward, so that saliva or vomit drains out and the airway stays clear. This is the recovery position. Either side works; in a visibly pregnant woman the left side is preferred, because it takes the weight of the womb off a major vein. Keep watching the breathing. Do not force stiff limbs into position.

If unresponsive and not breathing normally: call 108 or 112, start CPR and follow the operator’s instructions. CPR is not needed during the convulsion itself, and you should not give rescue breaths while someone is actively seizing.

As they come round they may be confused, exhausted, frightened or briefly aggressive. This is normal and not deliberate. Tell them where they are and what happened. Stay with them. Offer to call a family member. Nothing to eat or drink until they are fully alert.

When to call an ambulance

• The convulsion reaches five minutes, or is still going
• Another seizure starts before they have recovered from the first
• It is their first-ever seizure
• They are injured, having difficulty breathing, or not waking up as expected
• The seizure happens in water
• The person is pregnant
• The person has diabetes and does not regain consciousness
• Their own written seizure care plan says to call sooner

Why five minutes? The International League Against Epilepsy’s 2015 definition sets five minutes as the point at which a convulsive seizure is unlikely to stop by itself and treatment should begin. Continuing beyond roughly 30 minutes carries a risk of lasting brain injury. A convulsion that does not stop, or repeated seizures without recovery in between, is status epilepticus — a medical emergency.

108 or 112? 108 is India’s dedicated emergency ambulance number under the National Health Mission, and the one most people recognise. 112 is the single national emergency number, which routes calls to police, health, fire and disaster services. Either will get you help; 108 usually gets you an ambulance fastest.

First seizure: where should you go?

Go to the nearest hospital emergency department, even if the person now seems completely fine. Do not wait for a neurology appointment before getting that first assessment.

Use an ambulance if they are still unwell or any emergency sign above is present. They must not drive themselves. If they have fully recovered and the emergency staff say private transport is appropriate, a responsible adult should go with them.

Take with you: a witness if at all possible, the timing and a description of what happened, a list of current medicines, and any previous records. The witness account is frequently more useful diagnostically than the tests.

After the emergency assessment, arrange specialist follow-up — a neurologist for adults, or a paediatrician with seizure expertise for a child. The UK’s NICE guideline recommends this specialist appointment happens within two weeks of a suspected first seizure, which is a reasonable benchmark to ask for.

What tests might be done

Depending on the circumstances, doctors may check blood sugar, blood salts and heart rhythm, and may arrange an EEG (which records the brain’s electrical activity) or a brain scan such as MRI or CT.

Not everyone needs every test. Two things are worth knowing:

• A normal EEG does not rule out epilepsy. An EEG is a short recording and can easily miss abnormal activity happening at other times.
• Long-term medicine is not automatic after one seizure. Whether treatment starts depends on the cause and on the estimated risk of another episode.

If someone already has epilepsy

A familiar seizure that follows that person’s usual pattern, and is followed by their usual recovery, may not need an ambulance every time. Follow their written care plan — but the emergency criteria above still apply.

For day-to-day management:

• Take prescribed medicines consistently. Do not stop or change them without medical advice — stopping abruptly can trigger a prolonged seizure.
• Keep a seizure diary: date, time, duration, what it looked like, recovery, possible triggers.
• Get a review if seizures become more frequent, change in character, return after a seizure-free period, or continue despite treatment.
• Ask the treating doctor for a written action plan, including when to seek help.
• Give prescribed rescue medicine only if you have been trained and are following that person’s plan.

Missed and late doses are among the commonest reasons a controlled epilepsy stops being controlled. A simple weekly box removes the “did I take it this morning?” question, which matters more than any reminder app.

If seizures are not controlled on medication, that warrants specialist review. Further options exist, including surgery for some people.

Everyday safety at home

Until a doctor has assessed a first seizure: no driving, no swimming alone, no working at heights or with dangerous machinery. For people with diagnosed epilepsy these precautions should be discussed individually with their doctor, because they depend on seizure type and control.

Practical measures that cost little or nothing:

• Showers rather than baths, and do not lock the bathroom door.
• Supervision near water, including buckets and tanks.
• Care with open flames, pressure cookers and hot cooking surfaces.
• Regular sleep and medicines on time — sleep deprivation and missed doses are among the commonest triggers.
• Family members should know this first aid, and know where the care plan and rescue medicine are kept.

The bathroom deserves particular attention. A wet floor plus a sudden loss of consciousness is how most avoidable head injuries happen at home, and Indian bathrooms are usually wet-floor rather than tubs.

If you are out alone

Many people with epilepsy travel, work and live independently — and the single most useful thing you can do is make sure a stranger can work out what is happening. During a seizure you cannot speak for yourself, and the first few minutes often decide whether you get the right help or the wrong help.

This costs nothing. A card in your wallet with your name, the word “epilepsy”, your medicines and an emergency contact does the job. So does a note on your phone’s lock screen, which most Android and iPhone handsets allow without unlocking. Do that first. If you would rather wear something that cannot be left behind, an engraved band is the paid version of the same idea.

What to put on it: your name, the word “epilepsy”, the medicines you take and one emergency phone number. That is enough. A stranger reading it knows to call 108 and knows what to tell them when the ambulance answers.

The Indian picture

Epilepsy affects roughly 1% of the Indian population — studies have estimated more than 10 million people living with it.

The larger problem is not the illness but the gap in treatment. Indian reviews have estimated a treatment gap ranging from about 22% among urban middle-income groups to as high as 90% in villages, meaning most people with epilepsy in rural India are not on effective treatment. (These figures come from research published in 2010 and reviewed in 2014. They remain the most widely cited estimates, but they are over a decade old and the current position may differ.)

Behind much of that gap sit stigma and misinformation — the belief that seizures are caused by possession, black magic or a curse, which sends families to faith healers before doctors. So it is worth saying plainly:

If you remember nothing else from this article: time the seizure, keep them safe, nothing in the mouth, and call 108 if it reaches five minutes.

Related reading

• Burn first aid: what to do and what makes it worse

Sources

• Centers for Disease Control and Prevention. First Aid for Seizures. cdc.gov
• Fisher RS et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia, 2014. DOI: 10.1111/epi.12550
• Trinka E et al. A definition and classification of status epilepticus — Report of the ILAE Task Force. Epilepsia, 2015. DOI: 10.1111/epi.13121
• NICE. Epilepsies in children, young people and adults (NG217), 2022. nice.org.uk
• Ministry of Home Affairs, Government of India. Emergency Response Support System (112). mha.gov.in
• Government of India, Lok Sabha unstarred question on emergency ambulance services (Dial 108). eparlib.nic.in
• Satishchandra P, Santhosh NS, Sinha S. Epilepsy: Indian perspective. Ann Indian Acad Neurol, 2014;17(S1):S3–S11. PMC4001222

Medical disclaimer: This article is for education only and is not a substitute for professional medical advice, diagnosis or treatment. If you or someone you know has had a seizure, please see a doctor. Views are personal and do not represent any employer or institution.