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. For a DVD that shows how midazolam is given, contact Epilepsy Action.

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 6 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