Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many types of seizures, some of which have subtle or mild symptoms instead of convulsions. Seizures of all types are caused by disorganized and sudden electrical activity in the brain.

Convulsions can be unsettling to watch. Despite their appearance, most seizures are relatively harmless. They usually last from 30 seconds to 2 minutes. However, if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, this is a medical emergency.

If a person has recurring seizures, and no causes can be identified, that person is said to have epilepsy. Epilepsy can usually be controlled well with medication.

Pay attention to:

• Which arms or legs are shaking
• Whether there is any change in consciousness
• Whether there is loss of urine or stool
• Whether the eyes move in any direction

• Alcohol use
• Barbiturates, intoxication or withdrawal
• Brain illness or injury
• Brain tumor (rare)
• Choking
• Drug abuse
• Electric shock
• Epilepsy
• Fever (particularly in young children)
• Head injury
• Heart disease
• Heat illness (see heat intolerance)
• Illicit drugs, such as angel dust (PCP), cocaine, amphetamines
• Low blood sugar
• Meningitis
• Poisoning
• Stroke
• Toxemia of pregnancy
• Uremia related to kidney failure
• Very high blood pressure (malignant hypertension)
• Venomous bites and stings (see snake bite)
• Withdrawal from benzodiazepines (such as Valium)

• Brief blackout followed by period of confusion
• Drooling or frothing at the mouth
• Eye movements
• Grunting and snorting
• Loss of bladder or bowel control
• Sudden falling
• Teeth clenching
• Temporary halt in breathing
• Uncontrollable muscle spasms with twitching and jerking limbs
• Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing

The person may have warning symptoms before the attack, which may consist of:

• Fear or anxiety
• Nausea
• Vertigo
• Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)

1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
5. Look for a medical I.D. bracelet with seizure instructions.
6. Stay with the person until he or she recovers, or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child acetaminophen (Tylenol) once he or she is awake, especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath. See fever convulsions.

• DO NOT restrain the person.
• DO NOT place anything between the person's teeth during a seizure (including your fingers).
• DO NOT move the person unless he or she is in danger or near something hazardous.
• DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is 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.

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 awaken or have normal behavior after a seizure.
• Another seizure starts soon after a seizure ends.
• 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.

People with epilepsy should always take any prescribed medication and wear a medical alert tag.

Keep fevers under control, especially in children.

Pollack CV. Seizures. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006:chap 100.