Management of Seizures Lasting Longer Than 5 Minutes at Home
For a seizure lasting longer than 5 minutes at home, administer rectal diazepam (0.5 mg/kg, maximum 20 mg) after ensuring the person is in a safe environment. 1
Immediate Actions When Seizure Reaches 5 Minutes
First Priority: Safety Measures
- Place the person on their side in the recovery position to reduce aspiration risk if vomiting occurs 1
- Clear the area of objects that could cause injury during seizure movements 1
- Help the person to the ground if not already there to prevent fall-related injuries 1
- Stay with the person throughout the entire episode to monitor for complications 1
Second Priority: Medication Administration
- Administer rectal diazepam at 0.5 mg/kg (maximum 20 mg) as soon as the seizure reaches 5 minutes duration 1
- Rectal diazepam is specifically recommended for home administration when IV access is unavailable and is highly effective 1, 2
- Buccal or intranasal midazolam are equally effective alternatives if available, though rectal diazepam remains the standard home rescue medication 2, 3
Why Each Answer Option Is Correct or Incorrect
Option A (Ensure Safe Environment) - Necessary But Insufficient
While ensuring a safe environment is absolutely critical and should be done immediately, it is not sufficient as the sole intervention for a seizure lasting >5 minutes 1. Seizures lasting beyond 5 minutes are unlikely to stop spontaneously and require emergency anticonvulsant medication 4.
Option B (Wait Another 5 Minutes) - Incorrect and Dangerous
Waiting another 5 minutes is contraindicated and increases morbidity risk 2, 4. The longer a seizure continues, the more difficult it becomes to terminate and the greater the risk of neurological complications, including neuro-disability, learning difficulties, and de-novo epilepsy (up to 22% morbidity) 2. Mortality and morbidity increase significantly with ongoing seizure activity, especially after 60 minutes 4.
Option C (Give Rectal Diazepam) - CORRECT
This is the recommended intervention 1. Rectal diazepam at 0.5 mg/kg (maximum 20 mg) is the appropriate home rescue medication for seizures lasting >5 minutes 1. Studies demonstrate 75-87% efficacy in stopping seizures within 10 minutes 5, 6. If the first dose fails, a second dose can be administered after 10 minutes 6.
Option D (Give Oral Valproate) - Incorrect and Dangerous
Oral anticonvulsants like valproate are maintenance medications, not acute seizure treatments 1. They should never be given orally during a seizure or when consciousness is impaired due to high aspiration risk 1. Oral medications are ineffective for stopping acute seizures and pose a choking hazard 1.
Critical Actions to Avoid During Seizures
- Never restrain the person - this causes musculoskeletal injuries without stopping seizure activity 1
- Never put anything in the mouth (fingers, bite blocks, tongue blades) - this causes dental trauma, airway obstruction, or injury to the rescuer 1
- Never give food, liquids, or oral medicines during or immediately after a seizure due to aspiration risk 1
When to Call Emergency Services After Giving Rectal Diazepam
Even after administering rectal diazepam, activate emergency medical services if 1:
- The seizure continues beyond 10 minutes after medication administration
- Multiple doses are needed
- The person does not return to baseline within 5-10 minutes after the seizure stops
- This is a first-time seizure
- The seizure is accompanied by traumatic injury or difficulty breathing
Evidence Quality Note
The recommendation for rectal diazepam is supported by high-quality guideline evidence from the American Academy of Pediatrics and American Heart Association 1, with robust supporting research demonstrating 81-87% efficacy rates 6, 3. The evidence consistently shows that benzodiazepines (diazepam, midazolam, lorazepam) are first-line treatments for seizures lasting ≥5 minutes, with rectal diazepam being the most practical option for home administration 2, 4, 3.