Joseph I. Sirven, MD, FAAN, responds:

Actually, it's not usually family members or friends who need to know. They are probably familiar with how a seizure typically plays out. It's more often bystanders who overreact or panic, especially if the seizure is accompanied by convulsions.

For those who are unfamiliar, seizures generally last less than one minute and may include a lack of responsiveness, sudden movements, convulsions, and changes in language, sensation, or consciousness, depending on the areas of the brain affected.

There are three types of seizure situations that require a visit to the emergency room (ER).

It's a First Seizure

If this is the first seizure the person has ever experienced, he or she needs to visit the ER right away, regardless of the length and severity of the episode.

The Seizure Lasts Longer Than Five Minutes

When people with epilepsy have seizures that last too long or when multiple seizures occur close together, they can't recover on their own and need medical attention to stop the seizures and get stabilized. This may require an oral medication or an intravenous injection.

There Are Problems Post-Seizure

If the seizure lasts less than five minutes, pay close attention to the person once the seizure has stopped to see if there are any problems that require more attention. Is the person breathing correctly? Are his lips turning blue? Is his pulse irregular? Is she injured or drowsy, nauseated, or vomiting? If the answer to any of these questions is yes, take the person to the ER.

No ER Visit Required

If the person is waking up, improving, and answering questions correctly after the seizure has stopped, there is no need to visit the ER.

Dr. Sirven is a professor and chairman of neurology at the Mayo Clinic in Scottsdale, AZ, specializing in epilepsy, a Fellow of the American Academy of Neurology, and a member of the Neurology Now editorial advisory board.