Posted on December 9, 2009, under Epilepsy.

What should a bystander do during a grand mal attack? The onset is often so sudden that it is difficult to do much at all in the early stage, though it may be possible to break the person’s fall. Parents or other relatives may recognize the warning signs that may occur if the generalized seizure follows a focal discharge, and so may have time to help the person to a chair or to a bed before the grand mal begins.

Don’t try to open the person’s clenched mouth. The tongue, if bitten, is bitten at the onset of the attack, so there is no point in trying to save it. If the bystander uses his own fingers to try to force the mouth open, they may well be bitten in the clonic phase. If he tries to force a spoon or pencil between the teeth, the person’s teeth may be damaged. These manoeuvres are still sometimes attempted by tradition, and sometimes, presumably, because it is assumed that the person’s blue colour and arrest of breathing are due to obstruction to the passage of air into the lungs. Attempts to ‘loosen the collar’ presumably result from the same thoughts. However, all of us have enough gaps between our teeth to allow passage of air around them as readers can readily show for themselves by clenching their teeth, pinching the nose, and breathing in. Obstruction to the airway may occur during a seizure, if the person is lying on his back. The tongue may then fall backwards into the pharynx, and, for this reason, it is worth turning someone suffering a grand mal seizure into a position halfway between lying on his or her side and face, and thumping the back so that the tongue and any dentures fall forwards. This position also has the advantage that if the person vomits, as occasionally happens, the contents of the stomach pass easily out of the mouth, and there is no danger of vomit entering the trachea and lungs.

If a grand mal seizure occurs in a public place, it usually happens that someone calls an ambulance—very often to the annoyance of the person with epilepsy, who is well on the way to recovery by the time the ambulance driver delivers him to the local hospital. There is no need to call an ambulance unless it is clear that repeated seizures are occurring.

There is usually little to be done during a partial seizure, except to stand by in a reassuring manner until seizure activity ceases. Occasionally gentle restraint may be necessary in the case of complex automatic behaviour.


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