• At the onset of the seizure, before the tonic phase begins, it is appropriate for an experienced person to insert an oral airway, padded tongue blade or other soft object between the teeth. Don't try to force a hard object between the teeth once the jaws are closed, as the teeth or object may break and fragments may be inhaled.

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  Protect the person from injury. Clear the area of furniture or other objects that may cause injury. Cradle the head with a pillow if it is on a hard surface, but don't restrain the person's movements.
• Turn the person onto one side with the head down. This allows drainage of saliva and prevents inhalation of vomit.
• The vast majority of seizures will end spontaneously after a minute or two, and no specific treatment is necessary. When seizures continue, or consciousness is not regained between seizures, status epilepticus is diagnosed and requires urgent management that may be started by the emergency medical service, but is best performed in a hospital.

Reviewed by Dr Andrew Rose-Innes, MD, Department of Neurology, Yale University School of Medicine, New Haven.

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