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Harvard Commentaries
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Reviewed by the Faculty of Harvard Medical School

Medical Myths Medical Myths

The Right Way To Handle a Seizure

October 10, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

Many people believe that putting an object, such as a spoon, in the mouth of someone who is having a seizure will be helpful in protecting the person from biting the tongue or even swallowing it. I have seen this approach on television and in movies, generally in a rather dramatic but misguided attempt to be helpful.

What Are Seizures?

Seizures are electrical outbursts in the brain that may lead to involuntary movements of all the limbs with little or no awareness, or they may lead to milder symptoms such as "spacing out" or twitching in one limb. Biting of the tongue and urinary incontinence are common. Most of the time, the cause of epilepsy" (a condition in which people are prone to seizures) is unknown, but onset of this disease may follow any brain injury (for example, that caused by trauma, infection, tumor, stroke, vascular abnormalities, alcohol use or other toxin exposure, genetic disease or surgery).

Treatment Of Seizures

Treatment of epilepsy includes a variety of medications or, in rare cases, surgery to remove the area of the brain from which the seizures arise. It may take some time to identify the best medication, often by trying one medication after another. If the medication is not effective or is not taken properly, intermittent seizures may continue despite treatment.

If the jaw is clenched tight, it will be difficult if not impossible to place an object between the teeth, and there will be a real risk of damaging the teeth, injuring the gums or mouth or, worse yet, finding that the object has disappeared down the person's throat. This could damage the esophagus or the windpipe and could even obstruct breathing. A spoon seems like a particularly dangerous choice in that regard.

Finally, a person who is trying to help prevent tongue biting could be injured themselves by getting bit. When persons having a seizure bite the tongue, it typically heals quickly, so the benefits of preventing this injury are generally outweighed by the risks.

What You Can Do

If jamming an object between the teeth is a bad plan, what is a good one? Some helpful interventions should be advised in advance. A person known to have frequent seizures can be reminded to wear a protective helmet and mouth brace, to avoid driving, to wear a medical alert bracelet and to be monitored closely by his or her health providers.

If a seizure does occur, move furniture away from the person, loosen clothing around the neck and try to get the person into a lying position on his or her side. Try to protect the person's head from injury by placing a soft object under his or her head, but avoid the temptation to restrain the person. It may be helpful to reassure and calm the person as well as others nearby — most seizures last a short time (seconds to minutes), leaving the person sleepy or confused, but the victim is back to normal soon after.

Finally, you can call the person's doctor or family for advice about how to proceed — most people with epilepsy can be managed at home without a visit to the hospital or doctor's office. Describing what you saw just before, during and after the seizure may prove quite helpful to the person's caregivers.

The Bottom Line

Despite the urge to be helpful, there are times when it's best just to get out of the way. There is some element of truth to this when confronted by a person having a seizure. Although there are ways to be helpful, putting a spoon in the person's mouth is not one of them.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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