Seizure Precautions for Patients with Known Seizure Disorders
For patients with known seizure disorders, implement environmental safety measures including padded bed rails, supervision during bathing/swimming, avoiding heights and dangerous machinery, and educating caregivers on proper seizure response—while the primary focus should remain on optimizing medication adherence and achieving seizure freedom with antiepileptic drugs. 1
Environmental Safety Measures
Immediate Seizure Response Protocol
When a seizure occurs, caregivers and first aid providers must:
- Help the person to the ground and place them on their side in the recovery position to reduce aspiration risk if vomiting occurs 1
- Clear the area around the person to prevent traumatic injury from erratic head, body, and extremity movements 1
- Stay with the person throughout the seizure and during the postictal period 1
Critical Actions to Avoid (Harm Recommendations)
- Never restrain the person during seizure activity 1
- Never put anything in the mouth during or after a seizure 1
- Never give food, liquids, or oral medicines to someone experiencing a seizure or with decreased responsiveness after a seizure 1
When to Activate Emergency Medical Services
Call 911 immediately for: 1
- First-time seizure
- Seizures lasting >5 minutes (status epilepticus)
- Multiple seizures without returning to baseline mental status between episodes
- Seizures occurring in water
- Seizures with traumatic injuries, difficulty breathing, or choking
- Seizure in an infant <6 months of age
- Seizure in pregnant individuals
- Failure to return to baseline within 5-10 minutes after seizure activity stops
Medication Adherence: The Primary Intervention
The Critical Importance of Adherence
Poor adherence to antiepileptic drugs occurs in 30-50% of patients with epilepsy and represents the primary cause of treatment failure and inadequate seizure control. 2, 3 This is far more important than environmental precautions alone.
High-Risk Groups for Non-Adherence
Patients at highest risk include: 4
- Age <25 years (significant independent risk factor)
- Patients experiencing adverse effects from AEDs (significant independent risk factor)
- Patients requiring multiple daily doses (each additional dose increases non-adherence risk)
Practical Strategies to Improve Adherence
Switch to once-daily dosing regimens whenever possible: 5
- Extended-release formulations or drugs with longer half-lives achieve 52.3% success rate in improving seizure control in non-adherent patients
- Particularly effective in patients without MRI abnormalities (higher success rate)
- Significantly reduces the complexity barrier to adherence
Implement adherence aids: 4
- Pill organizers
- Smartphone reminders
- Medication calendars
- Regular pharmacy counseling
Optimize medication regimens: 6
- Aim for monotherapy whenever possible (70% of patients can achieve seizure freedom with a single AED)
- Use maximum tolerated dose before adding second agent
- Select drugs with low potential for interactions and simple titration schedules
- Balance adverse effects against seizure control
Monitoring and Follow-Up
At every follow-up visit: 7
- Question patients specifically about seizure occurrences
- Assess for adverse effects that may drive non-adherence
- Review medication-taking behavior and barriers
- Consider serum drug levels if control is inadequate to distinguish non-adherence from true treatment failure
Common Pitfalls to Avoid
Assuming environmental precautions alone are sufficient without addressing medication adherence—the latter is the primary determinant of seizure control 2, 3
Prescribing complex multi-dose regimens when once-daily formulations are available—this directly increases non-adherence risk 4, 5
Failing to identify and address adverse effects that drive patients to skip doses—this is a significant independent risk factor for non-adherence 4
Not recognizing that most seizures are self-limited (1-2 minutes) and do not require emergency intervention unless they meet the specific criteria listed above 1
Attempting to restrain patients or place objects in their mouth during seizures—these actions cause harm rather than help 1