What medication is given to a seizure patient?

Clarification: "Epsilon" is Not a Seizure Medication

I believe there may be a misunderstanding in your question—"epsilon" is not a recognized medication used for seizure management. You may be referring to one of the following commonly used antiepileptic medications:

Most Likely Intended Medications

Benzodiazepines (First-Line for Active Seizures)

Benzodiazepines are the immediate first-line treatment for any actively seizing patient, with lorazepam specifically recommended due to superior efficacy (59.1% seizure termination) and longer duration of action compared to other benzodiazepines 1.

• Lorazepam 4 mg IV at 2 mg/min should be administered immediately for active seizures, with 65% efficacy in terminating status epilepticus 2, 1
• Alternative benzodiazepines include IM midazolam or intranasal midazolam when IV access is unavailable 1
• Benzodiazepines have Level A (strongest) evidence as first-line treatment for generalized convulsive seizures 1

Second-Line Agents (If Seizures Continue After Benzodiazepines)

If seizures persist after adequate benzodiazepine dosing, immediately escalate to one of these second-line agents 1:

Levetiracetam (Keppra)

• Dose: 30 mg/kg IV over 5 minutes (approximately 2000-3000 mg for average adults) 1
• Efficacy: 68-73% seizure control 2, 1
• Advantages: Minimal cardiovascular effects (0.7% hypotension, 0.7% arrhythmias), no cardiac monitoring required, preferred for elderly patients 1

Valproate (Depakote)

• Dose: 20-30 mg/kg IV over 5-20 minutes 2, 1
• Efficacy: 88% seizure control with 0% hypotension risk 1
• Advantages: Superior safety profile compared to fosphenytoin, but contraindicated in women of childbearing potential due to teratogenicity 1

Fosphenytoin (Cerebyx)

• Dose: 20 mg PE/kg IV at maximum rate of 50 mg/min 2, 1
• Efficacy: 84% but 12% hypotension risk requiring continuous ECG and blood pressure monitoring 1
• Note: Traditional agent, widely available, but higher cardiovascular toxicity 1

Phenobarbital

• Dose: 20 mg/kg IV over 10 minutes 1
• Efficacy: 58.2% as initial agent 1
• Caution: Higher risk of respiratory depression 1

Critical Management Principles

Immediate Actions During Active Seizure

• Check fingerstick glucose immediately and correct hypoglycemia—a rapidly reversible cause 1
• Protect the patient from injury: help to ground, place in recovery position (on side), clear area around them 2
• Stay with the patient and monitor continuously 2
• Never restrain the patient or put anything in their mouth—this causes harm 2

When to Activate Emergency Medical Services

Activate EMS immediately for 2:

• First-time seizure
• Seizure lasting >5 minutes (status epilepticus)
• Multiple seizures without return to baseline between episodes
• Seizure in infant <6 months or pregnant individual
• Seizure with traumatic injury, difficulty breathing, or choking
• Patient not returning to baseline within 5-10 minutes after seizure stops

Refractory Status Epilepticus (Third-Line)

If seizures continue despite benzodiazepines and one second-line agent, initiate continuous EEG monitoring and anesthetic agents 1:

• Midazolam infusion: 0.15-0.20 mg/kg IV load, then 1 mg/kg/min continuous infusion (80% efficacy, 30% hypotension risk) 1
• Propofol: 2 mg/kg bolus, then 3-7 mg/kg/hour infusion (73% efficacy, requires mechanical ventilation) 1
• Pentobarbital: 13 mg/kg bolus, then 2-3 mg/kg/hour infusion (92% efficacy but 77% hypotension risk) 1

Common Pitfalls to Avoid

• Never use neuromuscular blockers alone (like rocuronium)—they only mask motor manifestations while allowing continued electrical seizure activity and brain injury 1
• Do not skip to third-line agents until benzodiazepines and a second-line agent have been tried 1
• Antipyretics (acetaminophen, ibuprofen) do NOT stop or prevent febrile seizures in children 2
• Do not give oral medications during or immediately after a seizure when patient has decreased responsiveness 2

If you meant a different medication, please clarify the name and I can provide specific guidance on that agent.