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Warning-sign checks

Bilateral tonic-clonic seizure: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    After a first suspected seizure, arrange prompt medical assessment even if emergency care was not required.

    A clinician may refer the person to a neurologist or an epilepsy specialist for further testing and review.

    Seek emergency help for a seizure lasting five minutes or longer, repeated seizures without recovery, persistent breathing difficulty, serious injury, a seizure in water, or failure to regain usual awareness.

    New one-sided weakness, a severe sudden headache, fever with neck stiffness, or signs of stroke also require urgent emergency assessment.

    And for anyone, someone who:

    • has had a seizure that will not stop, or does not wake up afterwards
    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who is bleeding heavily and it will not stop with firm pressure
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Contact the treating clinician sooner if seizures become more frequent, last longer than usual, change in pattern, or cause new injuries.

    New medicine side effects, missed doses, pregnancy, or plans for pregnancy also deserve timely discussion.

  3. 3

    Does any of this apply?

    Book an appointment

    Routine follow-up should address test results, seizure classification, medicine effectiveness, side effects, sleep, mood, work or school needs, driving, pregnancy planning, and safety.

    A seizure diary can record the date, duration, possible triggers, injuries, recovery time, and whether rescue medicine was used.

Every sign above is quoted from the sofidex article on Bilateral tonic-clonic seizure. If you are not sure, err upward — it is always reasonable to be checked.