A prolonged seizure, also known as status epilepticus, represents a serious medical event that differs considerably from typical, briefer seizure episodes. It signifies a continuous state of abnormal brain electrical activity that does not resolve on its own, posing a greater risk to an individual’s health. Understanding the characteristics of this condition is important for recognizing when immediate action is necessary.
Understanding Prolonged Seizures
A prolonged seizure, also known as status epilepticus, is typically defined as a single seizure lasting longer than 5 minutes, or multiple seizures occurring without the individual regaining full consciousness between episodes for more than 5 minutes. This timeframe is particularly significant for convulsive seizures, which involve rhythmic jerking motions. While most seizures cease within a few minutes, a seizure extending beyond this 5-minute threshold indicates that the brain’s natural mechanisms for stopping seizure activity have failed.
The duration of 5 minutes distinguishes a prolonged seizure from more common, self-limiting seizures, which often resolve within one to three minutes. For non-convulsive prolonged seizures, such as absence status epilepticus or focal impaired awareness status epilepticus, the defined duration can be longer, sometimes 10 to 15 minutes. The longer a seizure continues, the more difficult it becomes to stop with treatment, and the risk of adverse outcomes increases.
Immediate Actions During a Prolonged Seizure
Immediate actions are crucial for safety during a prolonged seizure. The first step involves remaining calm and timing the seizure from its beginning. Observing the duration helps determine if the seizure falls into the prolonged category.
Protecting the individual from injury is a primary concern. Gently guide them to the floor if they are standing or falling, and clear the surrounding area of any hard or sharp objects. Place something soft and flat, like a folded jacket or cushion, under their head. Avoid restraining the person or attempting to put anything in their mouth, as this can cause injury.
Turn the person gently onto their side, with their mouth facing the ground, to help keep their airway clear and prevent choking on saliva or vomit. Once movements subside, assist them into a safe, comfortable position. Call emergency medical services immediately if:
- The seizure lasts longer than 5 minutes.
- Another seizure occurs soon after the first.
- They have trouble breathing or waking up.
- They are injured during the seizure.
Medical Interventions for Prolonged Seizures
Once medical professionals arrive or the individual reaches a hospital, the focus shifts to stopping the prolonged seizure and addressing its underlying cause. The primary goal of treatment is the immediate termination of the seizure, as early intervention can improve long-term outcomes. Benzodiazepines are the first-line medications used to stop prolonged seizures.
These medications, such as lorazepam, diazepam, and midazolam, work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that calms brain activity. They can be administered through various routes, including intravenously for rapid effect in a hospital setting. For out-of-hospital use or when intravenous access is difficult, other forms like rectal gel, nasal spray, or intramuscular injection are available. For example, intravenous lorazepam might be given in a dose of 4mg, with a second dose considered if the seizure persists after 5 minutes.
If benzodiazepines do not stop the seizure, or if it continues beyond 10 minutes, other anticonvulsant medications may be administered. These can include medications like fosphenytoin, levetiracetam, or valproic acid, which are given intravenously. Throughout this process, medical staff continuously monitor the patient’s vital signs, brain activity (often with an electroencephalogram or EEG), and overall neurological status to assess treatment effectiveness.
Potential Health Consequences
Prolonged seizures can lead to various short-term and long-term health consequences due to the sustained abnormal electrical activity in the brain. One of the most significant risks is brain injury, which can manifest as cognitive impairment, including difficulties with memory, attention, problem-solving, and language abilities. The likelihood of such damage increases with the duration of the seizure, particularly if it extends beyond 30 minutes for convulsive types.
Beyond direct brain effects, prolonged seizures can also cause systemic complications. Respiratory issues, such as aspiration of vomit or saliva, can occur if the airway is not kept clear, potentially leading to pneumonia. There is also a risk of physical injuries, including bruises, cuts, broken bones, or head trauma from falls during the seizure. While relatively rare, prolonged seizures carry a higher risk of mortality compared to shorter seizures.