Major epileptic fits come on suddenly, although sometimes there may be warning symptoms. Epileptics usually carry a card or bracelet warning of their condition. In grand mal epilepsy the person loses consciousness and may fail to the ground; then the body stiffens and starts to jerk, bladder and bowel control may be lost; breathing may become noisy or stop altogether, resulting in blue lips and congestion of the face. The seizure may last for several minutes.

The most important thing is to prevent injury, and remove the person from danger. Do not try to restrain the person while convulsions continue, and do not put anything in the mouth. A bitten tongue (which heals quite quickly) is preferable to choking on objects placed in the mouth. Once the convulsions subside and the body loses its rigidity, place the person in the recovery position (see Unconsciousness). He or she should regain consciousness in a few minutes, but may be dazed and confused. Stay with the person until he or she is fully recovered. Advise the person to see a doctor if it is a first attack