Patient information · Neurology
After a first seizure
what happens next, and the legal duty nobody mentions
A first seizure is frightening and does not necessarily mean epilepsy — around half of people who have one never have another. What it does mean is prompt assessment, some immediate practical precautions, and a legal obligation about driving that must be acted on the same day.
Call 999 if a seizure
- lasts more than five minutes, or a second follows without recovery in between
- occurs in someone who has never had one before
- results in injury, or happens in water
- occurs in pregnancy, or in someone with diabetes
- is followed by difficulty breathing, or failure to regain consciousness
- occurs with a high fever, severe headache or neck stiffness
A seizure lasting more than five minutes is status epilepticus and needs emergency treatment. Anyone having a first seizure should be assessed the same day, and referred to a first-seizure clinic to be seen within two weeks. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What to do if you see one
- Note the time it starts. Duration determines whether an ambulance is needed.
- Protect them from injury — move hard objects away, cushion the head, loosen anything tight around the neck.
- Do not restrain them, and do not put anything in the mouth. You cannot swallow your tongue, and objects break teeth and cause injury.
- When the jerking stops, roll them onto their side into the recovery position and check breathing.
- Stay with them until they are fully alert. Confusion and drowsiness afterwards can last an hour or more and is normal.
- Be calm and reassuring as they come round — they will be disorientated and may be frightened or embarrassed.
You must stop driving today, and tell the DVLA
This is a legal requirement and it is regularly missed. After a first unprovoked seizure you must stop driving immediately and notify the DVLA. For a car or motorcycle licence, driving is normally barred for six months after a first seizure, and for twelve months if epilepsy is diagnosed — longer for bus, coach and lorry licences. Failing to declare it is a criminal offence, invalidates your insurance, and carries a fine of up to £1,000 as well as liability if you have a collision. We can advise on your specific situation, but the duty to inform the DVLA is yours.
What is investigated
- A detailed account from someone who witnessed it — the single most useful piece of information. If anyone filmed it, bring the video; it is genuinely diagnostic.
- Blood tests — glucose, sodium, calcium, magnesium, kidney and liver function, full blood count, and a pregnancy test where relevant.
- ECG — important, because cardiac causes of collapse are mistaken for seizures and are dangerous to miss.
- EEG — records brain electrical activity. A normal EEG does not exclude epilepsy, and an abnormal one does not confirm it.
- MRI brain to look for a structural cause.
Things that provoke seizures
- Alcohol — particularly withdrawal after heavy drinking, which is a common trigger
- Sleep deprivation, which is the most consistent provoking factor of all
- recreational drugs, particularly stimulants
- certain medicines, and abrupt withdrawal of others
- very low blood sodium or glucose
- infection, fever, and head injury
- In some people, flashing lights — though photosensitivity affects a minority
Safety while things are being sorted out
Do
- Shower rather than bath, and never lock the bathroom door
- Tell someone at work, and anyone you live with, what to do
- Prioritise regular sleep — this matters more than most people realise
- Use the back rings on the hob and turn pan handles inwards
- Consider a shower seat, and avoid swimming alone
Avoid
- Driving, until the DVLA confirms you may
- Baths, swimming alone, and heights or ladders
- Alcohol binges, and cutting down abruptly if you drink heavily
- Operating machinery, or working at height, until reviewed
- Cycling in traffic until you have been advised
Does it mean epilepsy?
Not necessarily. Epilepsy is usually diagnosed after two or more unprovoked seizures, or after one where the investigations show a high risk of recurrence. A provoked seizure — from alcohol withdrawal, very low sodium or an acute illness — is not epilepsy, and treating the cause is what matters. Medication is not always started after a first seizure; that decision balances recurrence risk against side effects, and it is yours to make with a neurologist.
Why come to us. After emergency assessment, the wait for a first-seizure clinic can be weeks — weeks of uncertainty, no driving, and no explanation. We can see you quickly, take the full blood panel and perform an ECG in-house with results the same visit, arrange MRI and EEG through our CQC-registered partners, advise on DVLA notification and provide supporting letters for work, and refer to neurology without a long wait. Seven days a week.
Seen quickly, with bloods and ECG the same visit
MRI and EEG arranged fast, DVLA advice, letters for work.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.