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Treatment and care for seizures that last more than 5 minutes and for status epilepticus

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. But some people have seizures that last too long. These are known as status epilepticus and need treating urgently. This is to try and stop them before they cause long-term damage. The sooner the seizure is treated the easier it will be to get it to stop.
By the time a seizure is lasting for 30 minutes or more, it is much more difficult to stop. If a tonic-clonic or cluster of tonic-clonic seizures last longer than 30 minutes, this can cause damage to the brain, or even death.

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

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.

Emergency medicines

Midazolam: 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.

Diazepam: 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.

For more information about informed consent go to the NHS Choices website
website: nhs.uk

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.

This information has been produced under the terms of The Information Standard.

  • Updated December 2015
  • Currently under review
Code: 
F084.03

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.

Comments: read the 9 comments or add yours

Comments

I first took a fit in my sleep and my bowels and bladder opened av be like this for 8 years av got Medstead but lately am having more fits and lasting longer lasting week a took 5 1 right after another paramedics were with me for the last 2 my heart stopped 3 times am getting really worried about stay myself most of the time lights or even a dog barking puts me into a fit wat sort of epilepsy do u think I have the doctor told me but my mind just goes blank

Submitted by Lisa Marie lambe on

Hi Lisa 

It is very understandable that that is a worry for you. We can’t say what type of epilepsy you have. Maybe you could ask the doctor to write it down for you?

I do hope you’re getting the treatment you need. It would be good to make sure you talk to your GP about how you’re feeling. But the GP might also think it would be good to ask Adult services for a care assessment. You might be able to get some more support that way. And we have information on our website about safety. There are some ideas in there that may help you to feel a bit more reassured in your home.

If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Helpline freephone 0808 800 5050.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

I see that you have said you don't need to call emergency in the case of focal seizures.

My daughter has a rare genetic disorder, and it isn't uncommon for kiddos to have epilepsy/seizures.

My daughter is turning fove, and siddenly she had two seizures in a row. They both presented differently. She vomitted, then seized, but aspirated her vomit and passed out. She was taken to ER and admitted. They said it was febrile. A month later (3 days ago), I went to her school and she was seizing. It lasted 30 min. I called for help, they gave diazepam. She stopped breathing and became unresponsive. This seizure was not accompanied by fever. No sickness.

So, the PICU neuro said she has focal seizures, and due to the extreme outcome and closeness of the seizures, is considering her epileptic.

So my question to you- when you said earlier that focal seizures aren't emergent- did you mean all of them? Also, do you have tips for parents of nonverbal kids with seizures? I worry she will seize over night, aspirate, and leave us.

Submitted by Brittany on

Hi Brittany

Your daughter’s experience sounds really distressing.

I can’t find anywhere in our information that says not to call for an ambulance after a focal seizure. The advice we give, is the same as for tonic-clonic seizures. If a seizure lasts more than 5 minutes then you may need to call an ambulance. Some people may have a care plan with more specific information about when a seizure is an emergency. If you don’t yet have a care plan for your daughter, you might find it helpful to get one.

If I have missed something on our website please feel free to get back to us.

We have information for carers of people with epilepsy and a learning disability And we have epilepsy information in Easy Read.

Depending on what happens for your daughter when she has a seizure you might find our information on bed alarms useful. These can offer a level of reassurance and hopefully help you get a better night’s sleep.

I hope this information helps a bit.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

Just an update saw my neurologist about 4 weeks ago he agreed for me to try and reduce my medication which I did over a few weeks . Unfortunatly I had another full on 2nd seizure nocturnal last weekend!!! im devestated !! ive just managed to get myself a new job due to start this weekend and I just havnt felt myself all week. Im back on the meds..

Just a question should my hubby always ring the ambulance when I have a seizure he was worried because I was going blue but he just waited 10 mins and I came round, Ive not even told the docotor Ive had another one. should I.

Ive got another MRI scan in feb. checking against my first one.

Im really fed up.

Submitted by marie scholes on

I have a 28 yr old son who was diagnosed with epilepsy at age 15. The seizures got progressively worse until age 21 when he was hospitalized to be evaluated to see if he was a candidate for brain surgery. It was determined that he was a candidate.
But with a change in medications and lots of prayer things turned around. He was 5 yrs seizure free and 3 yrs medication free. Then suddenly the seizures started coming back. He lived alone out of state.
He ended up on life support in January due to seizures. Status epileotus seizures I believe because he was home alone all day.
He has 2 different kinds of seizures. Tonic Clinic and partial complex seizures.
I'm concerned about any possible brain damage

Submitted by Deneen on

Hi Deneen

It’s great that your son was seizure free for that length of time. But it does seem that things are a lot more difficult now.

Here is our information about seizures that last a long time. I’m afraid there is a danger of brain damage when someone has been in a seizure for 30 minutes or more.

I wonder if your son has seen a specialist or is back on epilepsy medicine?

I am guessing you are in the US. You might find it useful to be in touch with the Epilepsy Foundation.

I really hope things settle down for him soon.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by rich on

Hi
My father is 58 years old and on February 9,2017 he had first seizure but no one was there at the time of seizure and so doctor diagnosed it with mild brain stroke and given medication for it and after two and half month he got another seizure and this time luckily I was there with him,he was biting his own tounge and saliva was coming out of his mouth and he was making some weird noise from mouth too, his whole body was stretched and stiffen and he was unconscious too and this whole thing last for about 15 minutes, we took him to hospital and we came to know that it is seizure not a brain stroke,
But I am still confused about this diagnosis, from the symptoms he had which I mentioned above is it really a seizure? He had no past history or in family too no one had seizure before..

Please let me know what it is exactly ,can a seizure last for 15 minutes?
PS he was unconscious for about 1 hour during and after seizure

Submitted by Khyati on

Hi

Here is all our information about diagnosing epilepsy. It sounds very possible that what your father had was a tonic-clonic seizure.

It is possible to have a seizure that lasts a long time. And often people can take quite a while to come round fully from a seizure.

You might be interested in our information under What is epilepsy? As you can see for most people there is no known cause when they are diagnosed with epilepsy. It does come out of the blue and only rarely runs in the families.

I hope that helps. But if you feel it would be useful to talk this through, then feel free to give us a ring on our freephone helpline number. It’s 0808 800 5050.

Regards

Cherry, Epilepsy Action Helpline Team

Submitted by rich on

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