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What to do when an epilepsy or seizure emergency occurs? Feature Article

Seizure-related critical conditions

Epilepsy is a condition that is characterized by recurrent seizures. For the most part, seizures can be managed well with anti-epileptic drugs (AEDs). However, it is important to think about and be aware of critical conditions or emergencies that may be associated with seizures. For this issue of the Northeast Regional Epilepsy Group (NEREG) newsletter, Sloka Iyengar, PhD- clinical researcher at NEREG based in Overlook Hospital interviewed Dr. Olgica Laban - Grant– Associate Director of Northeast Regional Epilepsy Group and Board certified epileptologist (American Board of Psychiatry & Neurology, American Board of Psychiatry and Neurology with special qualifications in Neurophysiology, American Board of Clinical Neurophysiology with added competency in Epilepsy Monitoring). Dr. Olgica Laban-Grant’s primary research interest is in the area of epilepsy in women.

SI- What are the main conditions one should talk about when considering seizure-related critical conditions? In his lecture, Dr. Lancman mentioned breakthrough seizures, status epilepticus, seizure clusters and Sudden Unexpected Death in people with Epilepsy (SUDEP). Could you tell us a bit more about them? 

OL – Sure – I will go through these conditions individually except for SUDEP because this topic was addressed in much greater detail in two previous newsletters (issues number 1 and 2). 

Breakthrough seizures – when an individual with epilepsy experiences freedom from seizures, and then suddenly has a seizure, such seizures are known as ‘breakthrough seizures’. 

Seizure clusters - are seizures that occur in groups, one after another.
Possible reasons for breakthrough seizures and seizure clusters are numerous and frequently remain unclear. It is important though to try to find possible cause. Sleep deprivation, non-compliance to anti-epileptic drugs (AED), stress, illnesses, medications or supplements that may decrease seizure threshold and hormonal changes are some of possible causes. 

Status epilepticus (SE) – is a life-threatening condition, and is characterized by a continuous seizure lasting more than 30 minutes, or two or more seizures without full recovery of consciousness between any of them. However, any seizure that lasts more than 5 minutes is treated as possible status epilepticus because spontaneous termination becomes less likely in seizures lasting over 5 minutes. The longer the seizure continues, the more difficult it is to control the seizure with AEDs. SE is a medical emergency, and time is of the essence in SE management, or as some like to say time is brain. Delay in management of SE could result in brain damage and even death. If you suspect SE, you should call 911 or take the person to the hospital immediately. Any seizure type may be seen in SE. Sometimes SE is not associated with any visible signs except alteration in mental status (the person’s responsiveness or level of alertness is different)– this is called subclinical status epilepticus and is difficult to recognize. 

SI – Who should work to educate themselves about seizure-related emergencies? 

OL – Sometimes epilepsy can be embarrassing to talk about, but it is of utmost importance to educate as many people in your life about epilepsy, and how they can be of assistance. Besides the individual with epilepsy, caregivers, and the healthcare providers (physician, aide, and nurse) should all be aware of possible emergency situations related to seizures. If you have a child with epilepsy, teachers, the school nurse, coaches, babysitters, basically anyone who is taking care of your child should be informed.

SI – In light of these conditions, how should people with epilepsy prevent and prepare for emergencies? 

OL – It is important to develop an emergency plan and to educate as many people around you about when and what steps should be taken. They should be aware of first aid in seizures, but also be able to recognize the type of seizures or pattern of seizures that is usual for that certain individual with epilepsy. It is important to take AED’s as prescribed by your physician because withdrawal of AED’s is a common cause of emergencies in epilepsy. 

Medications that may prevent seizure clusters or prolonged seizures are known as ‘rescue medications’. These medications act very fast and can break seizure clusters. Rescue medications can be especially helpful in patients who have an aura. Medications for seizure clusters can be given via a variety of routes e.g. per rectum, sublingual (under the tongue), intravenous and intramuscular. Intranasal (through the nose) medications are being investigated. While use of intravenous and intramuscular medications is limited to health care providers, other types of rescue medications, such as rectal and sublingual medication, and hopefully soon intranasal rescue medications may be available to individuals with epilepsy and care givers. You should discuss with your physician if or what type of these rescue medications should be available to you and your caregivers. Together with your physician develop a plan for when these medications should be given and when EMS should be called. 

SI –What information should be in my seizure preparedness plan? 

OL- This is example of some of the information that may be provided:




Doctor’s phone 

Emergency contact name and phone number

Description of symptoms/behaviors during typical seizure: (list specific characteristics of your seizures, for example, falling, jerking limbs, etc.). 

Seizure first aid instructions (

Detailed instructions developed with your health care provider about when and how to apply rescue medication, and when to contact 911.

For example: Please apply following rescue medication________, if my seizure lasts longer than____, or occur at frequency over_______ and contact my physician. (If you wear a VNS, include instructions to swipe it once over the implant.) 

Please call 911 if the seizure is prolonged (lasts longer than ___), is associated with breathing difficulties, causes injury, occurs in water, becomes a series of seizures or under following circumstances 

Thank you Dr. Laban for answering these questions for us!  More information about these can be found at this link, and in Dr. Lancman and his coauthors’ book What you need to know if epilepsy has touched your life: A Guide in Plain English.” 


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