Immediate Treatment for Seizures
The immediate treatment for a patient experiencing seizures should focus on ensuring safety by helping the person to the ground, placing them in the recovery position, and clearing the area around them to prevent injury. 1
Initial Management
Safety Measures (First Priority)
- Help the person to the ground if they are standing
- Place the person on their side in the recovery position
- Clear the area around them of any objects that could cause injury
- Stay with the person throughout the seizure 1
Do NOT:
- Restrain the person
- Put anything in the person's mouth
- Give food, liquids, or oral medicines during a seizure or when the person has decreased responsiveness 1
When to Activate Emergency Medical Services
Immediately call EMS if any of the following occur:
- First-time seizure
- Seizure lasting >5 minutes
- Multiple seizures without return to baseline mental status between episodes
- Seizure occurring in water
- Seizure with traumatic injuries
- Difficulty breathing or choking during seizure
- Seizure in an infant <6 months of age
- Seizure in pregnant individuals
- Person does not return to baseline within 5-10 minutes after seizure stops 1
Medication Management for Ongoing Seizures
If the seizure does not self-resolve within 5 minutes (status epilepticus):
First-line treatment: Benzodiazepines
- Lorazepam IV is preferred for non-self-limiting seizures 1
Second-line options (if seizures persist after benzodiazepines):
Valproate may be particularly effective with fewer adverse effects like hypotension compared to phenytoin 1, 2.
Post-Seizure Management
After the seizure has stopped:
- Continue to monitor vital signs and neurological status
- Position the patient in the recovery position to prevent aspiration if vomiting occurs
- Assess for potential causes of the seizure 1, 2
Identifying and Treating Underlying Causes
Simultaneously search for treatable causes of seizures, including:
- Hypoglycemia
- Hyponatremia
- Hypoxia
- Drug toxicity
- CNS or systemic infection
- Ischemic stroke or intracranial hemorrhage
- Withdrawal syndromes 2
Important Considerations
Febrile Seizures in Children
- Antipyretics (acetaminophen, ibuprofen) are not effective for stopping a seizure or preventing subsequent febrile seizures 1
Diagnostic Workup for First-Time Seizures
Essential laboratory tests include:
- Serum glucose
- Serum sodium
- Complete metabolic panel (if altered mental status)
- Toxicology screen (if suspected substance use)
- EEG for diagnosis of seizure type 1, 2
Common Pitfalls to Avoid
- Delayed recognition of status epilepticus: Seizures lasting >5 minutes represent a medical emergency requiring immediate intervention 1
- Improper physical management: Never restrain the person or put objects in their mouth 1
- Premature administration of oral medications: Do not give oral medications until swallowing has been assessed 1
- Overlooking non-convulsive status epilepticus: Consider in any patient with unexplained confusion or altered mental status 1
Most seizures are self-limiting and resolve within 1-2 minutes. The primary goal is to prevent injury during the seizure and identify any underlying causes that require specific treatment 1, 2.