The following information is about emergency treatment for seizures for anyone caring for someone with epilepsy in the UK. If you are looking for information in another country, please contact your local epilepsy organisation
Many people have seizures that last for less than 5 minutes and stop without any treatment. However, some people have seizures that last longer than 5 minutes. Seizures that last longer than 30 minutes can cause damage to the brain, or even death. This is also the case for a cluster of shorter seizures that last for 30 minutes or more. In both cases, this is known as status epilepticus. Seizures lasting for more than 5 minutes need treating before they turn into status epilepticus.
What type of seizures turn into status epilepticus?
Any type of seizure can become status epilepticus.
Epilepsy Action has more information about seizure types
Tonic-clonic (convulsive) status epilepticus
During a long convulsive seizure [tonic-clonic seizure], the body struggles to circulate oxygen. When this happens, the 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
Other types of status epilepticus
Other types of seizure can also turn into status epilepticus, so also need treating if they last more than 5 minutes.
Non-convulsive status epilepticus
Some people with epilepsy, particularly people with learning disabilities or an epilepsy syndrome, have a different type of status epilepticus. They may just appear to be vacant. Or they might have some minor twitches in their faces or rolling of their eyes. These can be symptoms of non-convulsive status epilepticus. The only clues to this will be changes in their brainwave patterns that can be seen on an electroencephalogram (EEG). It’s important that you are aware of this, as it can last for weeks, if not treated.
A syndrome is a group of signs and symptoms that, added together, suggest a particular medical condition.
If status epilepticus is 30 minutes, why are seizures treated after 5 minutes?
Seizures are treated after 5 minutes because the longer a seizure lasts, the less likely it is to stop on its own. Research shows that emergency medicines (see below), given when a seizure has lasted 5 minutes, can prevent status epilepticus.
What should I do if someone I am caring for has a seizure of 5 minutes or longer?
That depends on how long their seizures normally last. If their seizures always last for a little longer than 5 minutes and end by themselves, you may not need to do anything. But if the person you care for has had longer seizures in the past that needed emergency medicines, they should have an epilepsy care plan. This should tell you exactly what to do in an emergency. If they don’t have an epilepsy care plan, their epilepsy nurse or specialist should be able to write one with you.
Should I call an ambulance if someone has a seizure that lasts for more than 5 minutes?
Yes, you should call an ambulance for all types of seizure if:
- You know it is the person’s first seizure or
- The seizure continues for more than 5 minutes (unless this is usual for the person) 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
How are seizures that last for more than 5 minutes treated?
They are usually treated with emergency medicines.
Midazolam is given by a dropper, between the person's gums and cheek. This can be given by anyone who has been trained to do it, as well as healthcare professionals.
If diazepam is given by a medical professional, they will usually give it by injection. But it can be given by other people with the right training. They will usually give it rectally (into the back passage).
Other medicines used to treat seizures that last a long time and status epilepticus
If someone has a long seizure or status epilepticus when they are in hospital, it’s likely that they will be treated with different medicines. And these are more likely to be given by injection or a drip.
Should I be trained to use emergency medicines?
Everyone who might need to give another person emergency medicines should have some training. This is usually given by a healthcare or medical professional. Special Products and Shire Pharmaceuticals have online videos on how their versions of midazolam are given.
Epilepsy care plan
Should I have written information about what and how to use emergency medicines?
Yes, it’s essential for anyone who might need to give emergency medicine. This information should be in the person with epilepsy’s individual care plan. It should show when, and how much, emergency medicine is used, and what to do afterwards. Their doctor or epilepsy nurse should write their epilepsy care plan with them. This will give them the chance to give their informed consent to their treatment.
If you would like a care plan template for either rectal diazepam or midazolam, please send an email asking for this, and including your name and address, to the epilepsy helpline.
If you would like to see this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Helpline freephone on 0808 800 5050.
Epilepsy Action would like to thank Dr Amanda Freeman, consultant paediatrician at Queen Alexandra Hospital, Portsmouth, UK for her contribution to this information.
Dr Amanda Freeman has no conflict of interest to declare.
This information has been produced under the terms of The Information Standard.
- Updated December 2015To be reviewed December 2018