Seizures are not uncommon towards the end of life. They can be frightening to see, but there is a lot you can do to prevent them, manage them and keep the person safe
What is a seizure (fit)
Seizures happen when there is a sudden burst of unusual electrical activity in the brain.
They can make someone become unresponsive, shake or jerk, stiffen, or behave in an unusual way for a short time.
What a seizure can look like
Seizures can look different from person to person. They might include:
- suddenly becoming unresponsive, staring blankly or rolling the eyes
- shaking, jerking or stiffening of the arms, legs, face or body
- new confusion, restlessness or unusual behaviour
- repeated movements such as lip-smacking or fumbling
- sometimes a warning beforehand such as an odd feeling, a strange taste or smell, or a change in mood
What to do if someone has a seizure
- Try to stay calm and note the time it starts - how long a seizure lasts guides what happens next
- Keep them safe. Move anything hard or sharp out of the way and put something soft under their head. Loosen anything tight around their neck
- Do not put your fingers or anything else in their mouth, and do not try to hold them still
- Once the movements stop, gently roll them onto their side (the recovery position) so they can breathe easily. Do this sooner if they are being sick or bleeding from the mouth or nose
- Stay with them and speak calmly. They may be confused or sleepy afterwards, which is normal
- If you have been given a rescue medicine (for example one given into the cheek) use it as instructed
- Don't give any food or drink until they are fully recovered
Red Flags — when to call 999
- it is their first ever seizure
- the seizure lasts more than 5 minutes, or longer than is usual for them
- one seizure follows another without them waking up in between
- they are having trouble breathing, or their lips or face look blue
- they are injured during the seizure
- there is no one confident to manage the seizure
Tell the 999 handler if the person has an advance care plan or emergency care plan - this may help avoid an unwanted hospital admission.
After a seizure
- Keep them somewhere safe and comfortable and stay with them until they are fully awake or settled to sleep.
- If you can, write down the time it started and stopped and what you saw
- Tell the person's GP or specialist nurse, even if no treatment was needed - they may want to review medicines or refer on.
Managing seizures day to day
- If the person takes a regular medicine to prevent seizures, it's important they keep taking it, even when they feel well -stopping suddenly can bring seizures back.
- If they start to have trouble swallowing, tell the team straight away. The medicine can usually be given another way - an injection, a syringe pump, or a medicine used between the cheek and gum.
- Some medicines can affect mood or behaviour. If you notice a change such as irritability, mention it — there are often alternatives.
Top Tips
- Keep any rescue medicine somewhere you can reach quickly, and ask your team to show you again how and when to use it before you need to.
- Keep the person's care plan and key phone numbers together and easy to find.
- Share this page with family, friends and anyone else who helps care for the person, so more than one person knows what to do.
- Ask the team about an advance care plan, and about driving - there are rules after a seizure, so the person should not drive until they have spoken to their team.
This short video from St John Ambulance shows you how to put someone in the recovery position.