We exist to improve the lives
of everyone affected by epilepsy

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. 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.

Emergency medicines

Midazolam
Midazolam is given by a dropper, inside the person’s cheek or nose. 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. You can order a USB containing a video of how midazolam is given from our online shop.

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.

Code: 
F084.02

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 2015
    To be reviewed December 2018

Comments: read the 18 comments or add yours

Comments

my granddaugher has absene sezures since she was born shes 8 now .about 2 monthd ago they strated lasting 5 to 15 mins she hasnt made it thougfh a day of school in a month does this happen often .its like someone turned her off. it very scarey.we dont know what to do the doctor uped her meds it didnt help shes taking alot of daizopan,sorry the spelling so bad

Submitted by KATHY WEEBER on

Hi Kathy
Firstly I apologise we missed your comment on this page. Unfortunately we had some technical problems with our computers at the beginning of the year.

It’s understandable you are so worried and scared for your granddaughter. I hope since this post her seizures are responding well to her medicine.

Absence seizures usually only last for a few seconds, so if her seizures are lasting longer it could be that her epilepsy has changed and she is now having a different type of seizure. It can take a few weeks for a new dose of epilepsy medicine to take full effect, but if she’s been on the increased dose for a while and is still having seizures it would be a good idea to go back to the specialist and ask them to review her treatment again.

Current treatment guidelines recommend that if your seizures haven’t been controlled after trying two epilepsy medicines, or after two years, you should be referred to a specialist epilepsy centre. So if either of these apply to your granddaughter, and she’s not being seen by a specialist epilepsy centre, you or her parents could ask for her to be referred to one. At a specialist epilepsy centre they can look again at her diagnosis and epilepsy medicines, and make sure she’s getting the best treatment.

It’s important for your granddaughter’s education and wellbeing to attend school as much as possible. If she is still having problems in school, it would be best to ask for a meeting with her teacher, to see what support can be put in place. Because of your granddaughter’s epilepsy the school must make sure that there are arrangements in place to support her. They should also make sure that school staff are properly trained to provide this support.

The information gathered at the meeting with the school can be recorded in an individual healthcare plan (IHP). This is a very individual document for your granddaughter. It should make it clear what specific support she needs, when it should be done and who is responsible for making sure that she gets the support she needs.

If we can be of any more help, please feel free to contact us again, you can do this directly either by email helpline@epilepsy.org.uk or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Best wishes
Grace
Epilepsy Action Advice and Information Team

Submitted by Grace, Epilepsy... on

My son had his 1st seizure a few days ago. It completely through us as parents he is 2yrs old and had no temp or knocks etc his seziure lasted 40mins the ambulance gave him diazipam to get him out the seziure. They did him a ct scan and blood test all to which was normal we are now waiting on a eeg and in the meantime the doctor has prescribed him with midazolam in a suringe form. In yo proffession opion would you say this is the start of epilepsy?
Thankyou laura

Submitted by laura on

Hi Laura
It must have been a very worrying and anxious time for you when whey your son had his seizure. I hope he is making a good recovery.

Having one seizure doesn’t necessarily mean he has epilepsy. Anyone can have a one-off seizure, but this doesn’t always mean they have epilepsy. When he has had all his tests, and you next see his doctor they might  be able to explain what is happening. But it’s worth knowing that for around 6 in 10 children with epilepsy, no cause is found. They just seem to have been born with the potential to have seizures.

As your son’s seizure lasted for 40 minutes the doctors have given you the midazolam in case another seizure happens. The cause for the seizure isn’t the main issue when someone is having a seizure lasting 40 minutes. The doctor’s concern is to make sure you are prepared to stop any possible future seizures.

If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards
Diane
Epilepsy Action Advice and Information Team

Submitted by Diane, Epilepsy... on

The statement on your site that midazolam can be given by anyone who has been trained to give it is incorrect. Midazolam is a prescription only medicine and also a controlled drug so it is only available for use by certain medical professionals or other medical professionals practicing under the terms of a Patient Group Direction (PGD).
Regards
David Howarth

Submitted by David howarth on

Dear David

Thank you for your comment.

This medicine is only available on prescription but it is possible for people such as parents, carers and teachers to be trained to administrate it in line with the individuals’ epilepsy care plan.

The training is usually given by a healthcare or medical professional.

If you would like to discuss this further please phone the Epilepsy Action Helpline freephone 0808 800 5050. Our advice and information officers are here Monday to Friday, 8.30am until 5.30pm.

Regards

Diane

Epilepsy Action Advice and Information Team

Submitted by todd at Epileps... on

My wife has had uncontrollable epilepsy since birth. As she has gotten older the condition has worsened. Now at almost 60 she is have a terrible syndrome that starts when she tries to sleep. They are mini attacks with rolling eyes a tightness in the throat and last for about 20 seconds. They occur every couple of minutes and only stop if we get up and stop trying to sleep.

Can these be brought on by the brain entering Theta or Delta patterns?

If so do you know if there is a treatment that can target this condition? It hoes on for up to 6 nights and is wrecking our lives now. Her specialist seems stumped and is over prescribing drugs (Tegratol) that are doing nothing to help she is also on Keppra and Perampanel. She also had targeted brain surgery which did nothing to help and left her with permanent head pain in the temple.

Submitted by James. on

Hi James

That sounds like a scary experience.

We have information on epilepsy and sleep but as advisors on epilepsy, we don’t have the knowledge to answer your medical question on brain patterns.

If your wife’s epilepsy doctor isn’t sure if its epilepsy or not, maybe they could arrange for her to have a sleep EEG or refer her to a sleep clinic.

Regards

Diane

Epilepsy Action Helpline Team

 

 

Submitted by todd at Epileps... on

We had to go to A&E in the end 7 night without sleep now. As I type she is in Neurology. They are doing an EEG but not what we had hoped for as they are doing it in the afternoon. I fear the symptoms will not be present at that time. The sleep clinic idea would be perfect but it will have to be soon.

Submitted by James. on

I have had fairly well controlled epilepsy for 60 years, usually of a complex focal nature (having said that it has manifested itself earlier in life as simple partial seizures earlier in life and in more dramatic forms at times of tension, stress and during hot weather).
During the last 5 years I have experienced longer seizures which I can only describe as a form of "non convulsive, complex focal form of status epilepticus". These seizures have lasted up to an hour and I gather can be quite dangerous even if not as dangerous as the more dramatic "convulsive" seizures.
Non convulsive seizures of this kind are very difficult to assess let alone treat, so I would be grateful for any kind of advice.

Submitted by Robert Wilks on

Hi Robert

Thank you for your question.

It sounds like a distressing experience. If you have been diagnosed with non convulsive status epilepticus the best way to help is to find the right treatment. Unfortunately this isn’t always easy or possible but hopefully if you are seeing an epilepsy specialist they can make sure you are receiving the best treatment possible.

The NICE guideline says people suspected of having non-convulsive status should have an EEG to confirm the diagnosis. It would also be good if you agreed some kind of a plan with your specialist. It may be your specialist prescribes clobozam or midazolam to help stop your prolonged seizures.

If you haven’t got a medical diagnosis for your symptoms, it would be advisable to talk to your family doctor. Keeping a diary or getting someone to record when it happens would be of help to the doctor.

If we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards

Diane

Epilepsy Action Helpline Team

Submitted by Diane-Epilepsy ... on

Hello my 19 yr old sons has epilepsy and mild autism, he usually vomits then goes disorientated or sleeps then has a tonic clonic seizure hours after or sometimes straight away last time it was 10 hours then he slept was still unsteady then had another seizure 6hrs later is this status epilepticus or just 2 episodes, would giving him midazolam straight after vomit stop seizures progression thanks

Submitted by Debi Haines on

Hi Debbie

If your son has midazolam you should have written information in his individual care plan about when and how to use this medicine.  
It should show when, and how much, emergency medicine is used, and what to do afterwards. Your son’s doctor or epilepsy nurse should have written his care plan with you. If you don’t have a care plan, talk to his epilepsy nurse or specialist. If you would like a care plan template please send an email asking for this, and including your name and address.

A status seizure is when seizures last longer than 30 minutes or someone has a cluster of shorter seizures that last for 30 minutes or more. Cluster seizures that become an emergency is when one tonic-clonic seizure follows another without the person regaining consciousness between seizures.

Your son may go blue during his seizure. This can be very frightening for anyone watching the seizure happen, but it's not uncommon during a convulsive seizure. It's known as cyanosis and often affects the area around the mouth and, we understand, the nails. It happens when the oxygen is taken up by the vital organs, such as the brain and heart, rather than the less important ones, such as the lips and nails. So mouth to mouth is something that isn't commonly needed for people with epilepsy. By moving someone into the recovery position after the seizure has stopped aids their breathing. Again your son’s doctors may be able to tell you more about this.

If it will help to talk to our helpline team about your son’s care, please feel free to contact us again, either by email helpline@epilepsy.org.uk or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards

Diane
Epilepsy Action Helpline Team

Submitted by Diane@Epilepsy ... on

Hi I am 28 and in the past month have had several seizures where it starts in my legs they shake uncontrollably and gets worse over time and moves upto my upper body and arms the last time it happened last 48 minutes the paramedics gave me 20mg intravenous diazepam which slowed the jerky shaky body spasms down.
Do you have idea what this is as the hospital kept me for 5 days gave me 20mg of diazepam sent me home and my doctor has since prescribed diazepam too

Submitted by Claire kingdon on

Hi Claire

We’ve just replied to you by email. Hope it helps.

Regards

Cherry  

Epilepsy Action Helpline Team

Submitted by Cherry-Epilepsy... on

Hi my wife was diagnosed with epilepsy at 18 and now 44, it is poorly controlled and has numerous seizures but 2 years ago she had her 1st cluster tonic clonic and went into status and again a few months later, she has also had complex partial clusters and simple partial clusters l now have to administer midazalum but it I extremely difficult during a complex partial to tell if she is having a cluster as it just looks like she's sleeping, how do l know whether to give the drug? She is also having at least 1or 2 complex partials daily as well as TC weekly and a few simple partials thrown in, do you think the increase in seizures could be down to her going into status a few times and causing a imbalance in the brain, she was assessed for brain surgery ,9 months ago but rejected because the seizures are coming from both sides of the brain

Submitted by Brian Harkness on

My partner was diagnosed with epilepsy in July this year. After one particular violent seizure the paramedics recommended that I get rescue medication. I spoke to his epilepsy nurse but she didn't think that it was appropriate. He had a seizure 2 weeks later and ended up in a coma for 4 days . he was in critical care at the hospital for 8 days. If I had rescue medication would this have happened????

Submitted by Rachel scott on

Hi Rachel
That must have been a very distressing experience for you and your partner. I can understand you want answers about what happened.

We’re not medically trained, so it’s not possible for us to say if rescue medicine would have helped in your partner’s situation. Have you had a chance to speak to your partner’s epilepsy nurse or his consultant about what happened? They may be able to explain why they didn’t think rescue medicine was appropriate at the time.

If you have concerns about his treatment you could also speak to the Patient Advice and Liaison Service (PALS) at the hospital. They can offer advice and help resolve problems. You can find out more about PALS on the NHS choices website.

If you’d like to talk anything through you can also call our Epilepsy Action Helpline free on 0808 800 5050.

Best wishes
Grace
Epilepsy Action Helpline Team

Submitted by Grace, Epilepsy... on