In the final part of our first aid for seizures blog series, our Helpline and Information Officer Stuart Macgee looks at first aid for more complicated epilepsy.
Most people with epilepsy come out of seizures themselves and the following information will not apply to them.
However, if they are showing signs of the below types of seizures this is what you should do.
Serial seizures
Serial seizures are seizures occurring one after another without full recovery in between.
A serial seizure becomes a medical emergency if it goes on for between five and 15 minutes depending on the type of seizure.
If there is no emergency medication or care plan in place, call an ambulance.
Cluster seizures
Cluster seizures are a grouping of seizures, which occur in a certain time frame, such as time of the month for women, or when feeling unwell or at times of extreme stress.
The person always returns to full consciousness and their breathing returns to normal between each seizure.
Sometimes people are prescribed additional (booster) medication to take around those times seizures are more likely.
Emergency medication (usually buccal midazolam or rectal diazepam) can also be prescribed to stop a cluster of seizures.
If a person experiences a cluster of seizures for the first time, always seek medical advice.
Prolonged seizures
A prolonged seizure is a seizure lasting two minutes longer than usual, or five minutes in total. Some people may have been prescribed emergency medication for this.
There will be a protocol or care plan giving clear instructions on how and when to give emergency medication.
This will have been signed by the doctor and the person with epilepsy, or their legal guardian. The care plan should be reviewed and signed each year by the doctor.
Only people who are trained and authorised to do so can give emergency medication.
The protocol will give details on what to do if the medication does not stop the seizure and when to dial 999.
If a protocol and emergency medication are not in place, you should call an ambulance after a seizure has lasted for five minutes or more (or two minutes longer than is normal for that individual).
Status epilepticus
A prolonged seizure without medical intervention can turn into status epilepticus which is always a medical emergency.
It happens when:
- a person has a tonic-clonic seizure lasting five minutes or more
- a person has a focal seizure lasting 10 minutes or more
- a person has an absence seizure lasting 10-15 minutes or more
Status epilepticus is rare. It is more likely to happen if someone has uncontrolled seizures.
It is more common in people with tonic-clonic seizures, although it can happen with other types of seizures such as focal seizures with impaired awareness or absence seizures.
Status epilepticus can be more difficult to detect with non-convulsive seizures.
If untreated, status epilepticus can be life threatening and cause permanent damage to the brain.
Emergency medication must be given to stop the seizure. This is either done by a carer if it has been prescribed, or by a medical professional.
If no emergency medication has been prescribed call an ambulance.
Also, call an ambulance if a person’s emergency medication has been given and it has not worked. The care plan will detail exactly when to dial 999.
You will need to tell the ambulance crew and hospital what medication you gave the person, the dose and the time it was given.
For more information, please check out our first aid for seizures factsheet by clicking here.
If you want to talk to someone about anything that we have covered over the last few weeks regarding first aid for seizures, please call our freephone confidential helpline on 0808 800 2200 or email us at contact@epilepsyscotland.org.uk.
