Unless your doctor has advised otherwise, a seizure in a child with epilepsy which ends after a couple of minutes does not usually require a trip to the emergency room.
However, if it lasts more than five minutes without any sign of slowing down, is unusual in some way, or if a child has trouble breathing afterwards, appears to be injured or in pain, or recovery is different from usual, call for 911 for emergency help.
It is always good to discuss in advance with your doctor what to do should your child have a prolonged seizure.
Some children have convulsive seizures that are prolonged -- several minutes -- or seizures that sometimes occur in clusters.
New treatments are available that parents or caregivers can administer orally, rectally, or by injection to bring this type of seizure to an end. Ask your doctor whether these treatments may be appropriate for your child.
Seizures which produce body jerking, staring spells, or a state of confusion can also occur in clusters and fail to stop in the usual way.
Managing Prolonged or Cluster Seizures
Take whatever action your doctor has suggested. This could include application of in-home therapy or going to the emergency room after a certain amount of time has passed.
If you have no specific directions from the doctor, call for emergency aid if the seizure continues for more than five minutes and shows no sign of slowing down, or if another seizure begins shortly afterwards.
Prolonged or clustered seizures sometimes develop into non-stop seizures, a condition called status epilepticus.
Status epilepticus is a medical emergency. It requires hospital treatment to bring the seizures under control. If your child has had episodes of non-stop seizures that had to be treated in the emergency room, you will want to have a plan of action ready in case they occur again.
Managing Status Epilepticus
Ask the doctor if there are any new treatments you can use at home or school to stop a seizure from developing into status.
Call an ambulance. Do not attempt to transport an actively seizuring child in your car unless an ambulance is not available.
Be aware of where the nearest hospital is, how long it takes to get there. If you live a long way from the hospital, you may plan to call earlier than you would if it were closer. If there are several hospitals nearby, ask your doctor in advance which one to call.
Consider arranging for standing orders prepared by the doctor to be kept in the emergency room so the seizure can be managed as your doctor directs. Ask for a copy for yourself if you and your child travel out of town.
Leave detailed written instructions with babysitters or adult caregivers. If you have been instructed in the use of in-home therapy, make sure that a responsible caregiver also receives instruction.
Fortunately, most seizures, even those that are prolonged, end without injury. The important thing is to work with your doctor so that you have a plan to follow when they occur.
Managing Partial Seizures
A child who has partial seizures that affect his emotions or sense of the world around him may be intensely frightened by the episodes.
One little girl who had partial seizures in the area of the brain that controls vision (the occipital lobe) would "see" blobs of color that looked like monsters, a terrifying experience.
Children with this type of epilepsy need lots of reassurance -- and an adult who keeps track of how often the seizures occur. If they become prolonged and frequent, emergency treatment may be necessary.
Managing complex partial seizures requires gentle monitoring during the seizure, keeping hazards out of the way, reassuring the child in a calm voice, and keeping track of how long the seizure lasts.
Prolonged confusion and clusters of complex partial seizures may also require at home therapy as prescribed, or emergency treatment.