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First Aid for Generalized Tonic Clonic (Grand Mal) Seizures


In a generalized tonic clonic seizure the whole brain is affecting from the beginning. In (a, at right) there is a cry and loss of consciousness, arms flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to keep the airway clear.

Duringa generalized tonic-clonic seizure, the person suddenly falls to the ground and has a convulsive seizure. It is essential to protect him or her from injury. Cradle the head or place something soft under it, a towel or your hand, for example. Remove all dangerous objects. A bystander can do nothing to prevent or terminate an attack. At the end of the seizure, make sure the mouth is cleared of food and saliva by turning the person on his or her side to provide an open airway and allow fluids to drain. If the person assisting remains calm, the person having the seizure will be reassured when he or she regains consciousness.

Breathing almost always resumes spontaneously after a convulsive seizure. Failure to resume breathing signals a complication of the seizure such as a blocked airway, heart attack or severe head or neck injury. In these unusual circumstances, CPR must start immediately. If repeated seizures occur, or if a single seizure lasts longer than five minutes, the person should be taken to a medical facility immediately. Prolonged or repeated seizures may suggeststatus epilepticus(nonstop seizures), which requires emergency medical treatment.

When providing seizure first aid for generalized tonic clonic (grand mal) seizures, these are the key things to remember:

  • Keep calm and reassure other people who may be nearby.
  • Don't hold the person down or try to stop his movements.
  • Time the seizure with your watch.
  • Clear the area around the person of anything hard or sharp.
  • Loosen ties or anything around the neck that may make breathing difficult.
  • Put something flat and soft, like a folded jacket, under the head.
  • Turn him or her gently onto one side. This will help keep the airway clear. Do not try to force the mouth open with any hard implement or with fingers. It is not true that a person having a seizure can swallow his tongue. Efforts to hold the tongue down can injure teeth or jaw.
  • Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
  • Stay with the person until the seizure ends naturally.
  • Be friendly and reassuring as consciousness returns.
  • Offer to call a taxi, friend or relative to help the person get home if he seems confused or unable to get home by himself.


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This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.


1. Convulsions-You are on this page...

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Dr. Raymond Rybicki

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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