Timing a seizure sounds simple, but three different periods often get mixed together: an aura or warning, the active seizure, and the recovery period afterwards.
What should the first-aid timer measure?
For first aid, note when the seizure starts and when it finishes. NHS guidance specifically tells witnesses to record the start and finish time. The recovery period afterwards should be noted separately rather than added to the seizure duration.
For a convulsive seizure, start timing when the seizure is clearly underway — for example, when the person becomes unresponsive, falls, stiffens or begins convulsing. Do not wait for the first jerk if a tonic phase has already begun. Stop the seizure-duration clock when the active seizure activity ends. Confusion, sleepiness, headache, agitation or a slow return to normal afterwards are part of recovery and are useful to record, but they are not simply added onto the seizure time.
What about an aura?
An aura is not always a separate warning before a seizure. In epilepsy, what someone calls an aura can itself be a focal seizure. So if a person has a reliable, recognised aura that clearly forms the beginning of their usual seizure sequence, record when it began and tell clinicians.
But do not turn every vague feeling before an event into extra seizure minutes, and do not include the whole postictal recovery period. A clearer record separates the sequence: aura or warning → observable seizure activity → recovery. The 2025 ILAE classification also emphasises describing seizures by their chronological sequence of signs and symptoms.
A clearer way to write it down
Instead of writing “20-minute seizure”, a witness might record:
- 14:02 — person reports their usual rising feeling or aura
- 14:03 — becomes unresponsive and stiff
- 14:04 — jerking begins
- 14:06 — active seizure activity stops
- 14:06–14:22 — confused and sleepy during recovery
That gives clinicians much more useful information because it distinguishes the seizure itself from what happened before and afterwards.
When should 999 be called?
NHS guidance says to call 999 for an ambulance if it is the person’s first seizure, the seizure lasts longer than usual for them, it lasts more than 5 minutes when their usual duration is not known, they do not regain full consciousness or have repeated seizures without regaining consciousness, they are seriously injured, or they have difficulty breathing afterwards. Follow the person’s individual care plan where one exists.
Basic first aid during a convulsive seizure
- Protect them from injury and move nearby hazards away.
- Cushion their head if they are on the ground.
- Loosen tight clothing around the neck.
- Do not restrain them.
- Do not put anything in their mouth.
- After convulsions stop, turn them onto their side if appropriate and stay with them until they recover.
Sources
NHS — What to do if someone has a seizure (fit)
International League Against Epilepsy — Updated classification of epileptic seizures (2025)
This article provides general first-aid information and does not replace an individual emergency care plan or medical advice.