Status epilepticus is considered a medical emergency and requires prompt medical attention. The longer a seizure lasts, the less likely it will resolve of its own accord. Very long seizures are dangerous, and can increase the chance of long term damage or death. This makes it very important to identify and treat status epilepticus as promptly as possible. 

Convulsive status epilepticus

Convulsive status epilepticus is said to occur when:

  • a tonic-clonic seizure lasts for 5 minutes or longer
  • a person goes into a second seizure without recovering consciousness from the first one
  • a person has repeated seizures for 30 minutes or longer.

This type of status epilepticus requires immediate emergency treatment in a hospital. Call for an ambulance if you suspect a person is experiencing this because medical treatment needs to commence as soon as possible. Depending on the cause and any other complications or conditions, this will usually include the provision of emergency medication, oxygen, breathing support and other fluids. At times the person may be put into an induced coma, through use of anaesthetics, to stop the seizure. In addition, an EEG (electroencephalogram) may also be used to monitor the seizure activity and the person’s response to treatment.

Non-convulsive status epilepticus

Non-convulsive status epilepticus includes continuous absence seizures and focal impaired awareness seizures. This type is more subtle, and often less easy to recognise than convulsive episodes. Non-convulsive status epilepticus can present in various ways, including loss of speech, automatisms, confused behaviour, and alteration of awareness (consciousness). 

It is possible for non-convulsive status epilepticus to progress to convulsive status epilepticus. During a non-convulsive status epilepticus episode, excessive electrical discharges are taking place in the brain and prompt medical attention should be sought.

It is generally recommended to call an ambulance if a non-convulsive seizure occurs for longer than 5 minutes.

First aid and emergency medication

As per any seizure, until an ambulance arrives, appropriate first aid practices should be followed.

Some people who have experienced, or are at risk of, status epilepticus may be prescribed emergency medication by their doctor. This medication can assist in stopping or reducing the seizure activity until medical support arrives. However, anyone who has a duty of care to administer emergency medication should undertake appropriate training so that they feel confident and capable if the need arises. Epilepsy New Zealand can assist in developing Seizure Management Plans, Emergency Medication Management Plans and individualised training to families, carers, teachers and others in the community. 


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