The main types of seizure

Seizures are broadly grouped by where they start in the brain. Focal seizures begin in one area and may or may not affect awareness — the person might experience unusual sensations, brief confusion, or repetitive movements while remaining partly aware. Generalised seizures affect both sides of the brain from the outset. The best known is the tonic-clonic seizure, where the body stiffens, then jerks rhythmically, often with loss of consciousness. Others include absence seizures (brief lapses in awareness, common in children, easily mistaken for daydreaming) and myoclonic seizures (sudden brief muscle jerks).

Recognising a seizure

Not every seizure looks like the dramatic convulsions often shown on television. Signs can include a blank stare, lip-smacking or fumbling movements, sudden falls, confusion, or a brief pause in activity that passes within seconds. Knowing a person’s own typical pattern — captured in their care plan — helps carers recognise quickly when something is different from their usual seizure and may need a different response.

Common triggers

While seizures can happen without warning, some people notice patterns. Missed or delayed medication doses are the most common preventable trigger. Others include lack of sleep, illness or fever, alcohol, flashing or flickering lights (in a minority of people with photosensitive epilepsy), low blood sugar, and significant stress. Recording possible triggers over time, rather than assuming a single cause, gives the clearest picture.

Reducing stigma, building confidence

Epilepsy still carries unnecessary stigma, and misplaced fear can make bystanders freeze or act unsafely. Good awareness training replaces that fear with calm, practical confidence — for carers, family members, and the wider community the person moves through, including schools, workplaces and social settings.

When rescue medication is used

UK clinical guidance recommends rescue medication for three situations: convulsive status epilepticus (a tonic-clonic seizure lasting 5 minutes or more), repeated or cluster seizures (typically three or more seizures within 24 hours that each stop on their own), and prolonged seizures that last notably longer than the person’s usual pattern. The exact trigger point — often “give after 5 minutes” — is always specified in the person’s own written plan, since usual seizure length varies from person to person.

Buccal midazolam

Buccal midazolam is given into the buccal cavity — the space between the cheek and the gum — where it’s absorbed quickly through the lining of the mouth. It’s now the most commonly used first-line community rescue medication in the UK because it’s straightforward to administer, doesn’t require exposing the person, and works quickly.

Rectal diazepam

Rectal diazepam is administered rectally and remains an important option, particularly where buccal midazolam isn’t available, isn’t tolerated, or where an allergy or reaction rules it out. Some children are prescribed rectal paraldehyde as an alternative for the same reasons.

Who can give it, and how they’re trained

Rescue medication must only be administered by people who are named in the person’s care plan and who have completed formal, up-to-date training aligned with recognised standards (in the UK, typically the Epilepsy Nurses Association, ESNA, framework). Care Quality Commission guidance is explicit that care staff supporting rescue medication must be trained and assessed as competent — this isn’t a task to improvise, however calm and capable a carer feels.

The individual emergency management plan

Every person prescribed rescue medication should have a clear, individual written plan covering: how to recognise their seizures, exactly when to give the medication (the timing threshold), the correct dose and route, whether and when a second dose is appropriate, and — critically — when to call 999 regardless of whether medication has been given. This plan should be reviewed regularly and updated whenever anything changes.

Immediate response: Calm, Cushion, Call

For most seizures, the response is simple. Stay calm and stay with the person. Cushion their head if they’ve fallen, and clear away anything nearby that could cause injury — don’t try to hold them still or stop their movements. Never put anything in their mouth; this is a common myth and can cause real harm. Once jerking movements stop, gently roll the person onto their side into the recovery position and check that their breathing is returning to normal.

Timing matters most

Start timing the moment a seizure begins. This single piece of information — how long it lasted — is what tells a carer or paramedic whether this is a routine seizure or the start of a medical emergency. Note the start time as a habit, every time, even when a seizure seems to be following its usual pattern.

After the seizure (the post-ictal period)

Many people feel confused, exhausted, or want to sleep for anywhere from a few minutes to several hours after a seizure — this is normal and is called the post-ictal period. Stay with them, speak calmly, reassure them, and avoid rushing them back to activity before they feel ready. If breathing sounds difficult once the seizure has stopped, that’s a reason to call for emergency help even if the seizure itself was brief.

Monitoring and seizure diaries

Recording every seizure — date, time, how long it lasted, what it looked like, any possible trigger, and how long recovery took — builds a picture that’s far more useful to a neurologist or epilepsy specialist nurse than memory alone. Many people and care teams now use a seizure diary app or a simple shared logbook for this. Reviewing this record regularly can reveal patterns worth discussing at the next clinical review, such as a cluster around missed medication doses or poor sleep.

A note on SUDEP

Sudden Unexpected Death in Epilepsy (SUDEP) is rare but is something epilepsy teams take seriously, particularly for people with frequent tonic-clonic seizures. The strongest known protection is good seizure control — taking medication as prescribed, attending reviews, and following safety measures agreed with the epilepsy team. This is a sensitive topic and worth discussing openly with a specialist rather than searching for reassurance alone.

What this looks like day to day

• Named, trained carers — every carer supporting rescue medication is individually assessed as competent, with refresher training completed annually
• Living care plans — the individual emergency management plan is reviewed regularly with the epilepsy specialist nurse or neurologist, not left to go stale
• Shared seizure records — timing, triggers and recovery details are logged consistently so patterns are visible at every clinical review
• Clear escalation — every carer knows exactly when to give rescue medication and, separately, exactly when to call 999 regardless

Supporting the wider circle

Family members, school staff or workplace colleagues often want to help but aren’t sure how. Lifetouch Care can provide basic seizure-awareness briefings for the people around someone’s daily life — separate from formal rescue medication training — so a seizure at school, at work, or on a day out is met with calm, informed support rather than panic.