What should you know about seizure-like episodes?

Seizure-like episodes can cause sudden changes in movement, awareness, sensation or behaviour, and they need medical assessment when new, repeated or associated with warning signs. An episode may involve staring, unresponsiveness, unusual movements, stiffening, shaking, loss of muscle control, temporary confusion or a memory gap. Similar events can also result from fainting, low blood glucose, sleep-related problems, medication effects or other conditions, so the appearance of an episode alone cannot confirm its cause.

A seizure is a burst of unusual electrical activity in the brain. It can affect one area or several areas, which helps explain why some people remain partly aware while others become unresponsive. Afterward, a person may feel tired, have a headache, experience muscle soreness or need time to think clearly. A first episode does not automatically mean epilepsy, and a person with epilepsy may have episodes that differ from one another. Possible triggers or underlying problems include missed prescribed medicine, fever, head injury, alcohol withdrawal, low blood glucose and infection. Meningitis can be serious when seizure-like activity occurs with fever, severe headache, neck stiffness, light sensitivity or a rapidly worsening illness.

Stay with the person and move nearby hard, sharp or hot objects away. If possible, ease them onto their side and cushion their head; loosen tight clothing around the neck. Note when the episode starts and ends, and observe changes in movement, breathing and responsiveness. Do not restrain their limbs, put anything in their mouth, give food or drink, or try to move them unless the surroundings are dangerous. After the movements stop, speak calmly and allow recovery in a safe position. If low blood glucose is known or suspected, do not give anything by mouth while the person is drowsy or unable to swallow safely.

Call emergency services if the episode lasts longer than five minutes, another episode begins before the person fully recovers, breathing remains difficult, or the person is seriously injured. Urgent help is also needed for a first seizure-like episode, an episode during pregnancy, or an event in someone with diabetes who may have low blood glucose. Seek immediate assessment for fever with severe headache or neck stiffness, a new weakness, persistent confusion, or a seizure after a significant head injury. Even when recovery is quick, arrange a clinical review for a first or unexplained event. Do not drive yourself if you remain confused, weak or unwell.

Ask what features of the event may help distinguish a seizure from fainting or another cause, and whether you need tests or specialist review. Share the exact timing, what happened before the event, changes in awareness or movement, injuries, recovery symptoms and any medicines or substances involved. If alcohol use has recently changed, mention it because withdrawal can be associated with seizures; Alcohol Use Disorder may need separate support. Ask how to reduce immediate risks at home, when it is safe to drive, and what an observer should record if another episode occurs.