This page covers emergency medication for status epilepticus – epileptic seizures that last for more than five minutes.
What is status epilepticus?
Most epileptic seizures do not last long and usually stop by themselves without the need for treatment.
If a seizure lasts for five minutes or more, it is known as status epilepticus, which is a medical emergency.
If status epilepticus lasts for 30 minutes or longer, it can cause brain damage or lead to death.
Convulsive status epilepticus is when:
- A tonic-clonic seizure lasts for five minutes or longer
- One tonic-clonic seizure follows another without the person becoming conscious again between seizures
Both of these situations call for urgent treatment.
Any type of seizure can develop into status epilepticus. But tonic-clonic seizures progressing into status epilepticus are the most serious.
Non-convulsive status epilepticus occurs when non-convulsive seizures such as absence seizures or focal onset seizures last too long.
Also, people with Lennox-Gastaut syndrome may experience tonic seizures that go on too long.
Non-convulsive status epilepticus can be harder to spot. People may seem confused or less responsive, and their speech or behaviour may be affected.
It can also be a serious risk, depending on what’s causing the seizure. Diagnosis usually requires an EEG test.
Emergency medication for status epilepticus
In the UK, the two main emergency medications for status epilepticus are:
- Buccal midazolam
- Rectal diazepam
The dosage of each of these drugs is decided according to your child’s age.
Midazolam is a liquid rescue medication. It is the most commonly used emergency medication for seizures.
It is generally preferred to diazepam because it’s released into the area in the mouth between the cheek and the gums known as the ‘buccal cavity’.
The advantages of midazolam are:
- It is easier and more dignified to give buccal midazolam than give a drug in the rectum (the bottom)
- There’s a much better chance your child will get the right amount of the drug
- It does not cause prolonged drowsiness – normally only two to four hours
Very occasionally, midazolam can cause breathing difficulties. If this happens, call 999.
If a child in your care has been prescribed Buccal midazolam you will receive training on how to administer it.
Diazepam is a rectal rescue medication – it’s given in the bottom.
Rectal diazepam is available in pre-prepared rectal tubes of four different strengths.
The drug’s packaging includes Information on how to give it, but a nurse will usually talk this through with you.
There are disadvantages to diazepam:
- If the child is no longer a baby, or is in a wheelchair, it may be difficult to get them in a position to give the drug
- Having constipation, or having the bowels opened, may lead to an incorrect dose being given
- There is a loss of privacy and dignity
- Some adults may fear accusations of abuse when giving drugs rectally
- Drowsiness may continue for 12 hours or more
Very rarely, breathing difficulties may occur. If this does happen, call an ambulance immediately.
Care plan and individualised emergency management plan
The National Institute for Health and Care Excellence (NICE) recommends that everyone with epilepsy should have a care plan.
A care plan is an agreement between the person with epilepsy, healthcare professionals involved in their care and, when appropriate, their family or carers.
NICE also recommends that a care plan should include an individualised emergency management plan for status epilepticus.
This should include details of which emergency medication is to be used, how and when it is to be given, and who is trained to use it.
We’ve developed a 'seizure observation and treatment' form, which you can use in the event that your child has needed emergency medication.
Seizure observation and treatment form
You should be shown how to give your child their prescribed emergency medication, along with any other adults who will be looking after your child, including teachers at school.
Usually, an epilepsy specialist nurse or community nurse will show you how to do this.
For this reason, you should share details of your child’s individualised emergency management plan with your child’s school, so that it can be added their individual healthcare plan.
Find out more about individual healthcare plans (IHPs).
NICE guidelines for paramedics and in hospital settings
NICE’s guideline NG127, Epilepsies in children, young people and adults, published 27 April 2022, includes guidelines for the treatment of status epilepticus by paramedics and in hospital settings.
Read the full NICE guidance, which also includes guidance for the treatment of repeated seizures or cluster seizures, and prolonged seizures, by paramedics and in hospital settings.
Training courses
Young Epilepsy runs training courses that cover epilepsy, seizure types, status epilepticus and how to give emergency medication, with practical sessions using a dummy.
For details contact: training@youngepilepsy.org.uk
