Recognising Seizure Activity for Student Nurses
Learn how seizure activity may present, what to observe during an episode and how to assess, communicate and escalate concerns safely.
What might seizure activity look like?
The appearance of a seizure depends on which areas of the brain are affected. Student nurses should recognise that presentations can vary considerably.
Jerking or stiffening
Rhythmic limb movements, sudden stiffening or other involuntary movements may occur.
Reduced responsiveness
The person may become unresponsive or appear unaware of their surroundings.
Staring or unusual behaviour
Some seizures may involve staring, repetitive movements, altered sensations or unusual behaviour rather than convulsions.
Observe carefully
What you see before, during and after a suspected seizure can provide valuable information for the clinical team.
What should you observe?
- What time did the episode begin?
- What was the patient doing immediately beforehand?
- Did awareness or responsiveness change?
- Did the body stiffen?
- Were there rhythmic or repetitive movements?
- Did movements begin in one area or affect both sides?
- Were the eyes open, closed or deviated?
- Were there changes in breathing or skin colour?
- Did urinary incontinence occur?
- How long did the episode last?
If it is safe to do so, note the time the suspected seizure begins and ends.
Protect the patient from harm
During convulsive seizure activity, the immediate priorities are patient safety, observation and appropriate escalation.
Stay with the patient
Call for appropriate assistance and maintain observation.
Reduce injury risk
Remove nearby hazards where this can be done safely and protect the patient from avoidable injury.
Observe and time
Record the duration and characteristics of the seizure where possible.
Follow local emergency procedures
Obtain appropriate registered or emergency support according to the clinical situation and local policy.
Assess systematically after seizure activity
Airway
Assess airway patency and identify any immediate airway concern.
Breathing
Assess respiratory rate, breathing pattern, SpO₂ and any signs of respiratory compromise.
Circulation
Review pulse, blood pressure, perfusion and other relevant observations.
Disability
Assess consciousness, responsiveness, pupils and blood glucose according to local practice.
Exposure
Look for injury, fever, signs of infection or other relevant clinical clues.
Escalate
Communicate deterioration or ongoing concerns promptly to the appropriate clinical team.
What happens after a seizure?
Following some seizures, patients may enter a recovery period often described as the postictal phase.
Drowsiness
The patient may remain sleepy or less responsive for a period after the seizure.
Confusion
Disorientation or difficulty recalling what happened may occur.
Fatigue or headache
Patients may feel exhausted, sore or experience other symptoms during recovery.
Why might a patient develop a seizure?
Seizure activity can occur in many clinical situations. Identifying the cause requires appropriate medical assessment.
Brain-related causes
Epilepsy, stroke, intracranial pathology or other neurological conditions may be relevant.
Biochemical disturbance
Abnormal glucose or electrolyte disturbances can contribute to seizure activity.
Acute deterioration
Infection, hypoxia, toxic causes or other severe illness may also be associated with seizures.
When should seizure activity cause particular concern?
- A suspected first seizure or unexplained seizure activity.
- Prolonged seizure activity or repeated seizures without appropriate recovery.
- Persistent reduced consciousness after the episode.
- Airway or breathing compromise.
- Cyanosis or significant oxygenation concerns.
- Significant injury during the seizure.
- New focal neurological abnormalities.
- Abnormal blood glucose or other concerning observations.
- Seizure activity in a patient who is otherwise acutely deteriorating.
Putting recognition into practice
Example
A patient suddenly becomes unresponsive and develops generalised stiffening followed by rhythmic jerking movements.
You call for assistance, note the time, reduce nearby hazards and observe the episode without attempting to restrain the patient.
The movements stop, but the patient remains drowsy and confused.
You reassess using ABCDE, obtain relevant observations including blood glucose according to local practice, and communicate the episode promptly to the appropriate clinical team.
The key is the sequence: recognise → protect → observe → reassess → escalate.
What information should you communicate?
- When the episode started and how long it lasted.
- What the patient was doing immediately beforehand.
- Whether consciousness or awareness changed.
- The movements or behaviours you observed.
- Any changes in breathing or skin colour.
- The patient's condition immediately afterwards.
- Current observations and NEWS2 where applicable.
- Blood glucose or other relevant findings.
- Whether this represents a change from the patient's known history.
Example escalation
“Mr Jones had a witnessed episode beginning at approximately 14:20. He became unresponsive, stiffened and then developed rhythmic jerking of both arms and legs. The movements lasted approximately two minutes. They have stopped, but he remains significantly drowsy and confused compared with earlier.”
Objective observations like these can be extremely useful to the clinician reviewing the patient.
Seizure assessment errors to avoid
- Assuming every seizure involves whole-body convulsions.
- Failing to record how long the episode lasted.
- Trying to restrain convulsive movements.
- Putting an object into the patient's mouth.
- Leaving the patient without appropriate observation.
- Assuming prolonged reduced consciousness is simply postictal.
- Forgetting blood glucose and wider ABCDE assessment.
- Focusing on naming the seizure instead of recognising deterioration.
Recognise → protect → assess → communicate → escalate
Notice the pattern
Recognise changes in movement, awareness, behaviour or responsiveness that may represent seizure activity.
Protect and reassess
Reduce immediate injury risk, observe the event and reassess the patient systematically using ABCDE.
Describe what happened
Report the duration, observed features, recovery and current clinical condition clearly.
Continue building neurological assessment confidence
Recognising neurological change early and communicating exactly what has changed are important skills when caring for an acutely unwell patient.
Explore Clinical Confidence →