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Patient Instructions

You have Epilepsy. People with epilepsy have seizures. A seizure is a sudden brief change in the electrical activity in your brain. The doctor gave you a physical examination and did some tests to find out why.

Your doctor sent you home with some medicines to help you avoid having more seizures if tests showed you were at continued risk of seizures. After you get home, your doctor may still need to change the dose of your seizure drugs or add new medicines. This may be because your seizures are not controlled, or you are having side effects.

You should get plenty of sleep and stick to as regular of a schedule as possible. Try to avoid too much stress.

Make sure your home is safe to help prevent injuries when a seizure takes place:

• Keep your bathroom and bedroom doors unlocked. Keep these doors from being blocked.
• Take showers only. Do not take baths because of the risk of drowning during a seizure.
• When cooking, turn pot and pan handles toward the back of the stove.
• Fill your plate or bowl near the stove instead of taking all of the food to the table.
• Replace all glass doors either with safety glass or plastic.

Most people with seizures can have a very active lifestyle. Plan ahead for the possible dangers of a certain activity. Avoid any activity where loss of consciousness would be dangerous until it is clear that seizures are unlikely to occur.

• Some safe activities include jogging, aerobics, cross-country skiing, dancing, tennis, golf, hiking, and bowling. Games and playing in gym class or on the playground are generally okay.
• There should always be a lifeguard present when you go swimming.
• Wear a helmet during bike riding, skiing, and other similar activities.
• Ask your doctor about participation in contact sports.
• Avoid activities where having a seizure would put you or someone else in danger.

Wear a medical alert or ID bracelet. Tell family members, friends, and the people you work with about your seizure disorder.

Driving your own car is generally safe and legal once the seizures are controlled. State laws vary. You can get information about your state laws from the Department of Motor Vehicles. Find out more at the Epilepsy Foundation.

Never stop taking any seizure medicines without talking with your doctor. (People with uncontrolled seizures should NOT drive.) Do not stop taking your seizure drugs just because your seizures have stopped.

Tips for taking your seizure medicines:

• Do not skip a dose.
• Get your refills a week before you run out.
• Keep seizure medicines in a safe place, away from children.
• Store medicines in a dry place, in the bottle that they came in. Throw away all old bottles.

If you miss a dose:

• Take it as soon as you remember.
• If it is within a few hours of your next dose, skip the dose that you forgot and take your next dose. It is OK to take it a little early. After that, go back to the schedule. Do not take a double dose.
• If you miss more than one dose, talk with your doctor or nurse. Since mistakes are unavoidable and you may miss several doses at some point, it may be useful to have this discussion ahead of time rather than when it happens.

Drinking Alcohol or doing illegal drugs can cause seizures.

• Do not take your seizure drugs when you drink alcohol.
• Using alcohol or illegal drugs will change the way your seizure medicines work in your body.
• If you drink alcohol, drink small amounts, and do not drink too often.

Your doctor or nurse will tell you when you need to be tested for blood levels of your seizure drug. Seizure drugs have side effects. If you started taking a new drug recently, or your doctor changed the dose of your seizure drug, these side effects may go away. Always ask your doctor about the side effects you may have and how to manage them.

If you miss a dose, take it as soon as you remember. If it is already time for your next dose, skip the dose you forgot and go back to your schedule. Do not take a double dose. If you miss more than one dose, talk with your doctor or nurse.

Once a seizure starts, there is no way to stop it. Family members and caregivers can only help make sure you are safe from further injury. They can also call for help, if needed.

When a seizure starts, family members or caregivers should try to keep you from falling. They should help you to the ground, in a safe area. They should clear the area of furniture or other sharp objects. Caregivers should also:

• Cushion your head.
• Loosen tight clothing, especially around your neck.
• Turn you on your side. If vomiting occurs, turning you on your side helps make sure you do not inhale vomit into your lungs.
• Stay with you until you recover, or professional medical help arrives. Meanwhile, caregivers should monitor your pulse and rate of breathing (vital signs).

Things to avoid:

• DO NOT restrain (try to hold down) the person.
• DO NOT place anything between the person's teeth during a seizure (including your fingers).
• DO NOT move the person unless they are in danger or near something hazardous.
• DO NOT try to make the person stop convulsing. They have no control over the seizure and are not aware of what is happening at the time.
• DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.
• DO NOT start CPR unless the seizure has clearly stopped and the person is not breathing or has no pulse.

Call your doctor if you have:

• Seizures that have been happening more often.
• Side effects from medications.
• Unusual behavior that was not present before.
• Weakness, problems with seeing, or balance problems that are new.

Call 911 if:

• This is the first time the person has had a seizure.
• A seizure lasts more than 2 to 5 minutes.
• The person does not wake up or have normal behavior after a seizure.
• Another seizure starts before the person has returned to awareness after a previous seizure.
• The person had a seizure in water.
• The person is pregnant, injured, or has diabetes.
• The person does not have a medical ID bracelet (instructions explaining what to do).
• There is anything different about this seizure compared to the person's usual seizures.

Focal seizure - discharge; Jacksonian seizure - discharge; Seizure - partial (focal) - discharge; TLE - discharge; Seizure - temporal lobe - discharge; Seizure - tonic-clonic - discharge; Seizure - grand mal - discharge; Grand mal seizure - discharge; Seizure - generalized - discharge

Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz C, ed. Textbook of Clinical Neurology. 3rd edition. Saunders. 2007: Chap 52.

Updated by: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.