Most seizures stop spontaneously. However, sometimes a person may experience a prolonged seizure or a series (cluster) of seizures. Status epilepticus is the term used to describe seizures that last for 30 minutes or more, or happen one after the other with or without allowing a period of recovery between seizures. A person is considered to be in impending status if the seizure has lasted more than 5 minutes or have more then 3 seizures within 20 minutes with or without recovery (a cluster).
Both focal and generalized seizures may progress to status epilepticus. The most serious type is convulsive or generalized tonic clonic status epilepticus; however, all status is a medical emergency and requires immediate treatment.
The incidence of status epilepticus is highest in children and those over 60 years of age. It has been suggested that up to 70% of children with epilepsy beginning in the first year of life will experience at least one episode of status epilepticus.
Non convulsive status epilepticus is much harder to recognise. Even though non convulsive status epilepticus is not life threatening, treatment is still important. A person may exhibit a change in the level of consciousness, behaviour and cognitive processes. The person may appear confused or disoriented, the eyes may be partially closed and the person appears to be in a trance like state. If untreated these episodes may last for days or weeks.
Amnesia is common, but this may be punctuated by short patches of recall.
Prolonged seizures or clusters of seizures require fast and effective action. Intranasal or buccal midazolam is now widely used in the acute treatment of all kinds of seizures. In order to protect the person having the seizures and the family/staff administering the medication, it is important to have guidelines for the administration of midazolam.
Every person who has midazolam prescribed should have an emergency management plan and the family/staff need to be trained in how and when to use the medication according to that plan.
For further information about training for the Administration of midazolam please visit our Training page.
Please CLICK HERE to download this Fact Sheet.
‘Epilepsy: A Resource for Teachers’ (Copyright 2002 Epilepsy Queensland Inc. Author: Anne Little). To be reviewed May 2017.