Our Training Manager, Nicola Milne looks at status epilepticus, when a seizure becomes a medical emergency and provides information on what is emergency medication.

Most seizures are short, will stop on their own and do not require any medical intervention.

However, seizures can become a medical emergency if:

• a tonic-clonic seizure lasts for five minutes or more
• a focal seizure lasts 10 minutes or more
• an absence seizure lasts 10-15 minutes or more

This is called status epilepticus.

Status epilepticus

Status epilepticus is more likely to happen if you have uncontrolled seizures.

It is more commonly linked to tonic-clonic seizures (convulsive status) but can also occur in any type of seizure, such as focal impaired awareness (complex partial) or absence seizures (non-convulsive status).

If the seizures are non-convulsive, status epilepticus may be more difficult to detect.

During convulsive status epilepticus, the body struggles to circulate oxygen which can eventually leave the brain starved of oxygen.

Without intervention, this could lead to permanent brain damage or even death.

Emergency medication will usually stop a prolonged seizure or series of seizures and should be given long before a medical emergency arises to prevent the person going into status epilepticus. This person’s epilepsy specialist will decide what medication is to be given and when.

What is emergency medication?

Emergency medication is usually midazolam, which can be given buccally (ie into the area between the inside of the cheek and gum) or sometimes into nasal cavity (the nose).

If given buccally, midazolam will be absorbed through the lining of the mouth.

Avoid putting the medication between the teeth as the person may accidentally bite the dosing syringe during a seizure making it difficult to administer the medication.

This could also lead to the medication getting into the stomach. If it does, it will take a lot longer to be absorbed and could fail to stop the seizure.

If given into the nasal cavity, you should drip the medication into each nostril, alternating sides, until the full dose is administered.

Occasionally, diazepam is used and given rectally (into the anus) using a specially prepared tube.

Both are benzodiazepines, which get absorbed into the blood stream and act by reducing the brain’s excitability and suppressing seizure activity.

Midazolam clears quicker out of the system so the sedative effect is shorter than that of diazepam.

Care plan

Emergency medication needs to be prescribed. This comes with an emergency care plan, also called an emergency protocol.

This is a document drawn up by a doctor or epilepsy specialist nurse, providing information on the person’s usual seizure types and pattern.

It will also state the dosage, when and how the emergency medication should be given and when to call an ambulance.

Some care plans include a list of people who can administer this medication, but usually anyone with current training and consent can give it.

The care plan must be signed and dated by a doctor. It may also be signed by the person receiving the medication or someone who can sign on their behalf, ie a legal guardian.

Anyone administering emergency medication should have been trained on the correct administration of emergency medication by an epilepsy specialist nurse or a training provider such as Epilepsy Scotland.

Emergency medication can also be given by medical staff including most paramedic staff should it be necessary to call an ambulance.

For more information on emergency medication please check out our factsheet by clicking here.

If you would like to be trained on the correct administration of emergency medication, please email our Training Manager, Nicola Milne at nmilne@epilepsyscotland.org.uk.