A seizure is considered an emergency when it lasts a long time or when seizures occur close together and the person doesn't recover between seizures. Just like there are different types of seizures, there are also different types of emergencies.

Convulsive status epilepticus

This term is used to describe the more common form of emergency situation that can occur with prolonged or repeated tonic-clonic (also called convulsive or grand mal) seizures. Most tonic-clonic seizures end normally in 1 to 2 minutes, but they may have post-ictal (or after-effects) symptoms for much longer. This makes it hard to tell when a seizure begins and ends. 

A person would be at risk for status if… (Joe, change wording to say, Status epilepticus occurs when….

  • The active part of a tonic-clonic seizure lasts 5 minutes or longer
  • A person goes into a second seizure without recovering consciousness from the first one
  • If a person is having repeated seizures for 30 minutes or longer

This type of status epilepticus requires emergency treatment by trained medical personnel in a hospital setting. EEG testing may be needed to monitor the seizures and how a person responds to treatment. This situation can be life-threatening and getting treatment started fast  is vital. The outlook for this type of status may vary depending on the cause of the emergency and if other medical problems or complications occur.

Nonconvulsive status epilepticus

This term is used to describe long or repeated absence or complex partial seizures.

  • The person may be confused or not fully aware of what is going on, but they are not ‘unconscious’, like in a tonic clonic seizure.
  • These situations can be harder to recognize than convulsive seizures. Symptoms are more subtle and it’s hard to tell seizure symptoms from the recovery period.
  • There is no consistent time-frame on when these seizures are called an emergency. It depends in part on how long a person’t typical seizures are and how often they occur.

When nonconvulsive status epilepticus occurs or is suspected, emergency medical treatment in a hospital setting is needed. EEG testing may be needed to confirm the diagnosis first. People with this type of status are also at risk for convulsive status epilepticus, thus quick treatment is required.

Acute repetitive seizures or clusters

Seizures of any type may occur in groups or clusters over a number of hours or days. A person usually recovers between seizures and the clusters will end on their own.

People can be at risk for repeated clusters or status epilepticus if:

  • Seizure clusters last longer than normal.
  • Seizures occur closer together.
  • Person doesn’t recover as well between seizures or clusters.
  • If rescue medicines given to stop the clusters don’t work

If a person can recognize seizure clusters or acute repetitive seizures easily enough, they can often be treated outside of a hospital setting. Ideally, this early treatment will prevent the need for hospital treatment. However, if out-of-hospital treatments don’t work and seizures continue or complications occur, emergency medical treatment will be needed.

Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD on 8/2013
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