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Emergency treatment for seizures that last a long time

The following information is about emergency treatment for seizures in the UK. If you are looking for information in another country, please contact your local epilepsy organisation

Many people have seizures that only last for a short time. Their seizures usually stop by themselves, and they don’t need emergency treatment.

Some people have seizures that last for longer than 30 minutes. Or they have one seizure after another, lasting for 30 minutes or more, without recovering in between. This is called status epilepticus. Status epilepticus is a medical emergency because it can lead to brain damage or even death.

Research shows that emergency medicines, given when a seizure has lasted five minutes, can stop seizures turning into status epilepticus. Two emergency medicines are midazolam and diazepam. Midazolam is given buccally (in the cheek or nose). Diazepam is given rectally (in the back passage).

Epilepsy Action has more information about seizures and status epilepticus. 

Epilepsy care plan

If you have epilepsy, you should have an epilepsy care plan. This is recommended by the National Institute for Health and Clinical Excellence (NICE). NICE is the independent organisation that provides national guidance on treatments and care for people using the NHS in England and Wales. The guidance is for healthcare professionals, patients and their carers to help them make decisions about treatment and healthcare.

If you have had long or repeated seizures in the past, and have been prescribed emergency medicine, details about this should in your care plan. Your care plan should also give instructions on when and how to use the medicine.

More information about NICE is available at www.nice.org.uk.

Your doctor or epilepsy nurse should write your epilepsy care plan for you. You, and your family or carers should also be involved in writing your epilepsy care plan. This will give you the chance to give your informed consent to the treatment.

Epilepsy Action has an example of a care plan, provided by Lancashire Teaching Hospitals NHS Trust. You or your healthcare professional may wish to download a copy of this.  

Consent

It’s important that the person who has a history of status epilepticus is involved as much as possible when a treatment plan is being written. This will give them the chance to give their informed consent.

Some people with epilepsy and learning disabilities are not able to make decisions about how they are treated. This means they can’t give informed consent. Each country in the UK has rules that say who should make important treatment and care decisions on behalf of people who can’t give consent. 

Mental Capacity Act 2005

The Mental Capacity Act 2005 is a law which covers people in England and Wales. It provides clear legal guidelines for making decisions for people over the age of 16 who can’t make decisions for themselves.

The Act says that people should be able to understand what the medical treatment is, what it will do, and why it is being proposed for them. They also need to be able to understand the benefits and risks of the treatment, and whether other treatments could be used instead.

The Act says that the person should understand what will happen to them if they don’t have the treatment. They should also be able to remember information long enough to make a decision. And, most importantly, they should have a choice of what happens to them, without being put under any pressure.

Adults with Incapacity (Scotland) Act 2000

In Scotland, the Adults with Incapacity (Scotland) Act 2000 allows doctors to authorise medical treatment, if the person doesn’t have the capacity to consent themselves.

People with learning disabilities who can’t consent to treatment may also have a Welfare Guardian appointed under this Act. This guardian is able to consent to medical treatment on behalf of the person with a learning disability.

Consent in Northern Ireland

There is no specific law to protect people who can’t give consent to their treatment. Therefore, the Mental Capacity Act, which covers England and Wales, is used as guidance.

Further information

Epilepsy Action has the following DVD about emergency treatment of seizures. You can find further details about them in our online shop.

  • Buccal midazolam training DVD for parents and carers

Pay it forward

This resource is freely available as part of Epilepsy Action’s commitment to improving life for all those affected by epilepsy.

On average it costs £414 to produce an advice and information page – if you have valued using this resource, please text FUTURE to 70500 to donate £3 towards the cost of our future work. Terms and conditions. Thank you

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Epilepsy Action would like to thank Dr Amanda Freeman, Consultant Paediatrician at Queen Alexandra Hospital, Portsmouth, UK for her contribution to this information.

Dr Freeman has received sponsorship for educational events from Viropharma, which makes a version of buccal midazolam.

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

  • Updated December 2012
    To be reviewed December 2014

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