During a seizure lasting under 5 minutes: Note the time, look for epilepsy identification, protect the person from injury by cushioning their head, loosening tight clothing and removing nearby hazards; do not restrain them or put anything in their mouth NICE CKS. When the seizure stops, check their airway, place them in the recovery position, stay with them until recovered, and assess and manage injuries NICE CKS.
Call 999 if this is their first seizure, another seizure occurs shortly after the first, they are seriously injured, they have difficulty breathing after the seizure stops, or they remain unrousable NICE CKS.
For convulsive status epilepticus, repeated or cluster seizures, or prolonged seizures: Secure the airway, give oxygen if available, and assess cardiac and respiratory function NICE CKS. Use the person’s emergency management plan if immediately available; otherwise, give the recommended benzodiazepine: buccal midazolam or rectal diazepam, using the age-specific doses in the guideline NICE CKS. Consider buccal midazolam for repeated or cluster seizures or prolonged seizures NICE CKS. Call 999 if seizures do not respond promptly to the first benzodiazepine dose; follow the emergency plan or give a second dose if the seizure has not stopped within 5–10 minutes NICE CKS. Call 999 even if treatment stops the seizure when it was prolonged or recurrent before treatment, recurrence risk is high, monitoring is difficult, or this was the person’s first seizure NICE CKS.
After convulsive status epilepticus, repeated or cluster seizures, or prolonged seizures, arrange specialist review to agree an individualized emergency plan if one is needed and recurrence is a concern NICE CKS.