Loss of Consciousness in Generalized Seizures

Clinical Manifestations

• Generalized tonic-clonic seizures typically present with full-body rhythmic jerking movements and loss of consciousness that coincides with the onset of tonic-clonic movements, prolonged tonic-clonic movements, post-ictal confusion, tongue biting, and aching muscles after the event, according to the American Heart Association 1
• The European Society of Cardiology recommends distinguishing features from syncope, including loss of consciousness coinciding with the onset of movements, symmetrical and synchronous movements, and longer duration of loss of consciousness in seizures 3
• The American College of Radiology suggests that first aid providers should activate EMS for individuals with first-time seizure, seizures lasting >5 minutes, multiple seizures without return to baseline mental status, seizures with traumatic injuries, or difficulty breathing 2

First Aid and Management

• The American Heart Association recommends that during a seizure with loss of consciousness, first aid providers should help the person to the ground, place the person in the recovery position, clear the area around them, and stay with the person throughout the seizure 3
• The European Heart Journal suggests important cautions, including not restraining the person having a seizure and not putting anything in the mouth or giving food, liquids, or oral medicines during a seizure or when consciousness is decreased 1
• The American College of Cardiology recommends that first aid providers should activate EMS for individuals with seizures in special populations, such as infants <6 months or pregnant individuals 2