First Seizure: What Happens Next?
An illustrated guide for patients and families.
For adults and the people who help them. Children need advice made for their age.
Read the guide online or print a copy. Bring the separate visit sheet to your appointment.
By Dr. Shailesh Male
If someone is having their first seizure, call 911. Do not drive to the hospital yourself. If you have already been checked, follow your discharge plan and keep your next visit.
On this page
What is a seizure?
A seizure is a sudden burst of abnormal electrical signals in the brain. It can change how you move, feel, act, or notice things. Some cause shaking and a fall. Others cause staring or odd feelings. Not every seizure causes shaking.
Does one seizure mean I have epilepsy?
Not always. Epilepsy means the brain has a lasting tendency to have seizures. A seizure may happen because of a short-term problem, such as very low blood sugar. This is called a provoked seizure. An unprovoked seizure has no clear short-term cause.
Doctors often diagnose epilepsy after two unprovoked seizures more than a day apart. Sometimes they can diagnose it after one seizure if the chance of more seizures is high, or if tests and symptoms show a known epilepsy pattern. You may need treatment after one seizure. If your team found a short-term cause, ask which parts of this guide apply to you. The risk numbers below are for unprovoked seizures.
Why did it happen?
Possible causes include low blood sugar, changes in blood salts such as sodium, a brain infection, a stroke, or a head injury. Some medicines, drugs, and alcohol withdrawal can cause seizures. An old brain injury or a problem with how the brain formed may raise the risk. Sometimes no cause is found.
Lack of sleep can make a seizure more likely in some people. But a seizure after poor sleep does not prove that sleep loss was the only cause. Tell your team about sleep, illness, alcohol, all medicines, and any drugs you use.
How will my team check what happened?
Fainting and other conditions can look like seizures. Tell your team what happened before, during, and after the event, including any earlier staring spells or lost time.
Ask a witness what they saw, whether you could answer, and how long the event and recovery took. Bring a video if one was safely taken. Helping comes before filming.
Your team will check your strength, speech, alertness, and other body functions. You may not need every test.
EEG, a test that records brain signals through small sensors on your scalp
What it can showCertain patterns can support a seizure diagnosis and help guide care.
What it cannot tell youA normal EEG does not rule out epilepsy. A short test may miss changes. Sometimes a longer test or a test with sleep is needed.
MRI, a detailed picture of the brain; or CT, a fast X-ray scan
What it can showScans may find an injury, bleeding, or another brain change. CT may be used when a quick scan is needed.
What it cannot tell youA normal scan does not rule out seizures or epilepsy. A scan does not record brain signals.
Blood tests
What it can showThese can look for problems such as low sugar or changes in blood salts.
What it cannot tell youThey usually cannot tell on their own whether the event was a seizure.
ECG, a recording of the heart's electrical signals
What it can showThis may find heart problems that can cause fainting.
What it cannot tell youIt does not record brain signals.
Other tests may help with specific concerns. A spinal tap takes fluid from the lower back to look for a brain infection. Not everyone needs it.
No single test gives every answer. Your team puts your story, exam, and test results together.
Will I need medicine?
Maybe. If a short-term problem caused the seizure, treating that problem is key. Some people also need seizure medicine. After an unprovoked seizure, you and your clinician weigh the chance of another seizure against the risks of medicine.
An old brain injury, certain EEG or scan findings, or a seizure during sleep may raise that chance. Starting medicine can lower the chance of another seizure over the next two years. Starting now, rather than after another seizure, has not been shown to improve the chance of staying seizure-free in the long run.
Ask about side effects, cost, other medicines, and missed doses. Some seizure medicines make hormonal birth control, such as the pill, work less well. Some raise the risk of birth defects. Tell your team if you are pregnant or planning a pregnancy. Do not stop or change prescribed medicine on your own. If prescribed a rescue medicine, used to stop a long seizure, ask for a written plan.
What happens next?
Some people never have another seizure. Among adults with a first unprovoked seizure, studies found that about 1 in 5 to almost 1 in 2 had another within two years. This is a group estimate, not a prediction for you.
Keep follow-up even if you feel well. Ask when to see a neurologist, a brain and nerve doctor. Find out when tests will happen, who will explain results, and whom to call. No call does not mean a normal result.
How can I stay safer?
Until your team helps you make a safety plan:
- Do not drive. Ask your clinician and your state or local driver licensing agency what you must do before driving again. Waiting times and reporting rules vary. There is no one legal waiting period for everyone. Commercial drivers face additional medical rules; ask about your license and type of work.
- Take showers instead of baths. Do not swim alone. Ask about safe water activities.
- Avoid ladders, heights, open flames, and dangerous machines. Ask about safer tasks at work and at home.
- Get regular sleep. Avoid recreational drugs and discuss alcohol with your team. If you drink heavily or take sedatives often, get medical help before stopping suddenly. Withdrawal can cause seizures.
- If you care for babies or young children, ask about safe bathing and carrying.
- Teach someone close to you seizure first aid. Follow your medicine plan.
What should someone do during a seizure?
- Stay calm and time the seizure. Clear hard or sharp objects away.
- Cushion the head if the person is on the ground. Remove glasses and loosen tight neckwear if safe.
- Gently turn them onto their side when safe. If shaking makes this hard, wait until it stops. Do not force their body.
- Do not hold them down or put objects in their mouth. No food, drink, or pills until fully awake.
- Stay until they recover and speak calmly. If they have a seizure plan, follow it. Give rescue medicine only if prescribed for them and you know how to use it.
When should we call 911?
Call 911 if:
- It is the person's first seizure.
- A seizure reaches 5 minutes, or another starts soon afterward, especially before the person recovers.
- The person has trouble breathing, is hard to wake, or is not returning to their usual self within 5 to 10 minutes after the seizure stops. Do not wait if they seem seriously unwell.
- There is a serious injury, or the seizure happens in water.
- The person is pregnant, or has diabetes and loses consciousness.
Also call 911 for new one-sided weakness, trouble speaking, or a sudden severe headache. Do not assume these are just part of recovery.
Call 911 for fever with a stiff neck, or confusion that gets worse instead of better.
If the person has a separate seizure later, recovers fully, and has none of the 911 warning signs on this page, contact the care team the same day. If you cannot reach them, get urgent medical assessment that day. Follow any stricter discharge plan. Call 911 for the warning signs on this page; do not wait for a call back.
Does this run in families? Do relatives need tests?
Sometimes genes, the instructions in our cells, play a part. A gene change may be passed down or start for the first time in you. Tell your team about relatives with seizures. A first seizure does not mean every well relative needs tests. A suspected genetic condition may call for a genetics specialist. Relatives with symptoms need their own evaluation.
Screening means testing people without symptoms. Guidance for screening healthy people does not apply to tests needed after a seizure.
Bring the visit worksheet to your appointment to record the event, test plans, medicines, questions, and follow-up.
Questions for my visit
- Was this a seizure? What else could explain it?
- What tests do I need, and who will explain the results?
- What is my chance of another seizure? Would medicine help me?
- What must I do about driving, work, water, and other daily tasks?
- When is my next visit, and whom should I call for help?
Use the visit worksheet to record event details, tests, medicines and follow-up. You can also write these questions on your own paper.