Status epilepticus

You have status epilepticus if

• you have a seizure that lasts 30 minutes or longer, or
• you have a cluster of shorter seizures for 30 minutes or more, with little or no recovery in between.

Any type of seizure can become status epilepticus. Status epilepticus is a medical emergency because the longer a seizure lasts, the less likely it is to stop on its own. It’s also less likely to stop with emergency medicines. Status epilepticus can lead to brain damage, or even death.

Epilepsy Action has more information about seizure types.

Convulsive status epilepticus

During a long convulsive tonic-clonic seizure, your body struggles to circulate oxygen around your body. When this happens, your brain doesn’t get enough oxygen. Over a long period, this can lead to brain damage and death.

Epilepsy Action has more information about tonic-clonic seizures.

Non-convulsive status epilepticus

If you have a long seizure that is non-convulsive, for example a focal (partial) seizure, you may still need emergency medicines after five minutes. This is to prevent non-convulsive status epilepticus, which can cause brain damage. But, because you will still be breathing, it is not as dangerous as convulsive status epilepticus.

Epilepsy Action has more information about focal seizures.

Calling for an ambulance

For all types of seizure, call for an ambulance if…

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

Treatment for status epilepticus

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

When a person has status epilepticus, a medical professional will usually give them an injection of the drug diazepam, either at the scene of the seizure or in hospital.  Where diazepam is not suitable, other drugs, such as buccal midazolam, can be used. (See below.)           

Diazepam can also be given rectally (into the back passage). It doesn’t need to be given by a medically qualified person. However, it’s usual for some training to be given to people who may need to provide the drug. This training is usually given by a medically qualified person.

It’s essential for the person who needs emergency medication to have an individual care plan. This should show when, and how much, rectal diazepam is to be used, and what to do afterwards. If you would like a care plan template, please send an email asking for this to the Epilepsy Helpline. 

Rectal diazepam can be extremely effective in stopping seizures, but many people with epilepsy feel uneasy at the thought of being given medication this way.  It can also raise issues surrounding privacy, dignity and the law. (Local Education Authorities and Social Services Departments have their own rules as to whether their staff may give rectal diazepam.)

Some epilepsy clinics and centres are using an alternative drug. This is called midazolam. It is given by a dropper, inside the person’s cheek or nose. It’s not licensed to be used for epilepsy in the UK at the moment. However, some medical consultants prescribe it to individual patients, if they believe the drug would be helpful to them.

Further information

The following information about emergency treatment for epilepsy is available from Epilepsy Action. You can find further details about them in our online shop.

• Rectal diazepam individual care plan
• Buccal midazolam training DVD for parents and carers