What to do if someone is experiencing an epileptic seizure?

From the Guidelines

If someone is having a seizure, the most crucial step is to keep them safe by helping them to the ground, placing them on their side in the recovery position, and clearing the area around them, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When a seizure occurs, it is essential to remain calm and focus on preventing injury. The recovery position is vital in preventing choking if the person vomits during the seizure.

• Never put anything in their mouth or try to restrain their movements, as this can cause more harm.
• Time the seizure, and if it lasts longer than 5 minutes, or if the person doesn't regain consciousness, or if they have another seizure shortly after, or if they're injured, pregnant, or have other concerning conditions, call emergency services immediately, as advised by the guidelines 1. After the seizure ends, stay with the person until they're fully alert and oriented, speaking calmly and reassuringly as they may be confused.
• The guidelines emphasize the importance of activating EMS for individuals with first-time seizure, seizures lasting >5 minutes, or other specific conditions 1.
• For someone with known epilepsy who has rescue medication, it is crucial to administer it according to their prescription if the seizure is prolonged or as directed by their healthcare provider.

From the FDA Drug Label

Status Epilepticus General Advice Status epilepticus is a potentially life-threatening condition associated with a high risk of permanent neurological impairment, if inadequately treated The treatment of status, however, requires far more than the administration of an anticonvulsant agent. It involves observation and management of all parameters critical to maintaining vital function and the capacity to provide support of those functions as required. Ventilatory support must be readily available The use of benzodiazepines, like lorazepam injection, is ordinarily only an initial step of a complex and sustained intervention which may require additional interventions (e.g., concomitant intravenous administration of phenytoin). Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected. Furthermore, patients who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy Any health care professional who intends to treat a patient with status epilepticus should be familiar with this package insert and the pertinent medical literature concerning current concepts for the treatment of status epilepticus.

Key Steps to Take:

• Ensure ventilatory support is readily available
• Observe and manage all parameters critical to maintaining vital function
• Seek and correct any correctable acute cause of status epilepticus, such as hypoglycemia or hyponatremia
• Provide adequate maintenance antiepileptic therapy to patients susceptible to further seizure episodes
• Consider consulting with a neurologist if the patient fails to respond to treatment 2

From the Research

Immediate Response to a Seizure

• If someone is having a seizure, it is crucial to act quickly and follow established protocols to minimize harm and prevent further complications 3, 4, 5.
• The first step is to ensure the person's safety by clearing the surrounding area of any objects that could cause injury and turning them onto their side to prevent choking 3.
• If the person is in status epilepticus, which is a life-threatening condition where the seizure lasts longer than 5 minutes or two or more seizures occur between which the person doesn't return to normal awareness, immediate medical attention is required 3, 4, 6.

Medication Administration

• Benzodiazepines, such as lorazepam, diazepam, and midazolam, are commonly used as first-line treatments for status epilepticus due to their effectiveness in rapidly stopping seizures 3, 4, 6.
• If intravenous access is not available, rectal diazepam or nasal/buccal midazolam can be administered as an alternative 3, 4.
• For refractory status epilepticus, other medications like fosphenytoin, valproate, and levetiracetam may be used, with the choice of drug depending on various factors including the patient's medical history and the severity of the seizure 5, 7.

Ongoing Care and Monitoring

• After the seizure has stopped, it is essential to monitor the person's vital signs and level of consciousness closely, as they may be at risk of further seizures or other complications 3, 5.
• An electroencephalogram (EEG) may be necessary to rule out nonconvulsive seizure activity, especially if the person does not awaken after treatment 3.
• In cases of refractory status epilepticus, continuous EEG monitoring is crucial to recognize recurrence of seizure activity, as most seizures will be nonconvulsive 3.