Status epilepticus

What is status epilepticus?

It is a seizure that lasts 30 minutes or longer, or a series of seizures without consciousness being regained inbetween.

Status epilepticus can be convulsive (see tonic clonic seizures) or non-convulsive (see other seizure types such as absences and partial seizures).

Why is convulsive status epilepticus a medical emergency?

During a long convulsive seizure, the body struggles to circulate oxygen efficiently. When this happens, the brain does not get enough oxygen and, over a long period of time, this can lead to brain damage.

In rare cases status epilepticus can be fatal. For more information, see our SUDEP page.

When should I call for an ambulance?

Call an ambulance if…

• You know it is the person's first seizure.
• The seizure continues for more than five minutes.
• One seizure follows another without the person regaining consciousness between seizures.
• The person is injured during the seizure.
• You believe the person needs urgent medical attention.

Medical treatment

The following information is about the treatment of status epilepticus in the UK. The practice in other countries may vary.

When status epilepticus occurs, a doctor will usually give an injection of the drug diazepam at the scene of the seizure or in hospital. If diazepam is not suitable, other drugs can be used.

Diazepam can also be squirted from a tube into the person's back passage (anus), by a trained, competent and willing person. The person does not have to be medically qualified, but they must have received permission from the person concerned or that person's legal guardian. This is called rectal diazepam. The aim is to treat the person before 20 minutes of convulsing have elapsed.

While rectal diazepam can be extremely effective in stopping seizures, many people with epilepsy feel uneasy at the thought of having it given to them. It can also raise issues surrounding privacy, dignity and the law. (Local Education Authorities and Social Services Departments have their own rules on whether their staff may administer rectal diazepam.)

Some epilepsy clinics and centres are now using an alternative drug, midazolam, which is given inside the cheek or nose. This drug is not licensed to be used for the treatment of epilepsy in the UK, but some medical consultants can prescribe it to individual patients if they believe the drug would be of benefit to them.