What should I do if I have a seizure?

Introduction

Seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, and levels of consciousness. Managing seizures effectively is crucial to minimize risks and improve the quality of life for individuals experiencing them. This synthesis provides an overview of the key insights from multiple research papers on what to do if you have a seizure.

Key Insights

Immediate Antiepileptic Drug (AED) Therapy:
- Immediate AED therapy after a first unprovoked seizure can reduce the risk of recurrence within the first two years but does not improve long-term prognosis for seizure remission .
- The decision to start AED treatment should be individualized, weighing the risk of recurrence against potential adverse effects .
Emergency Department (ED) Management:
- EDs play a crucial role in managing acute seizures but often face challenges such as noncompliance with AEDs and lack of communication with primary care providers.
- Benzodiazepines, particularly lorazepam, are recommended for rapid seizure cessation in status epilepticus, with rectal diazepam as an alternative when intravenous access is not available .
Seizure Management in Specific Settings:
- In school settings, having a seizure emergency treatment plan, including the use of rectal diazepam gel, can empower school personnel to manage seizures effectively and reduce the need for emergency department visits.
Post-Stroke Seizure Management:
- Post-stroke seizures are common, especially in older adults, and the decision to start AED treatment should consider individual risk factors and patient preferences.
- New-generation AEDs like lamotrigine, gabapentin, and levetiracetam are preferred due to their safety profile and fewer interactions with other medications.
Rescue Therapies:
- Rescue therapies, including benzodiazepines and other seizure-abortant medications, are essential for managing prolonged or repetitive seizures and status epilepticus .
- These therapies can be administered by caregivers or by patients themselves if they can perceive the onset of a seizure.

Conclusion

Managing seizures effectively involves a combination of immediate AED therapy, appropriate emergency department management, and tailored treatment plans for specific settings and conditions. Immediate AED therapy can reduce short-term recurrence but does not affect long-term remission. Emergency departments and schools need to be prepared with effective seizure management plans, including the use of benzodiazepines for rapid seizure cessation. Post-stroke seizure management should prioritize new-generation AEDs for their safety and efficacy. Rescue therapies play a crucial role in managing acute seizure episodes and preventing prolonged or severe clinical events.

What should I do if I have a seizure?

Summary

Introduction

Key Insights

Conclusion

Sources and full results

Evidence-based guideline: Management of an unprovoked first seizure in adults

Immediate antiepileptic drug treatment reduces seizure risk within the first 2 years in adults with an unprovoked first seizure, but may not improve quality of life.

Seizures and Seizure Care in an Emergency Department

Emergency departments play a significant role in epilepsy and seizure care, but they need to focus on non-emergency aspects like AED compliance, psychosocial issues, and effective communication with primary care providers.

Management of Acute Seizure Episodes

Rectal diazepam gel effectively reduces seizure frequency and recurrence, improves patient and family quality of life, and is cost-effective in managing acute seizure episodes.

Management of Seizures following a Stroke

Post-stroke seizure treatment in elderly patients should be individualized, with new-generation drugs like lamotrigine, gabapentin, and levetiracetam providing high long-term seizure-free periods and fewer side effects.

Should People Be Treated After a First Seizure

Seizures in children should be treated after a first seizure, but the frequency of seizures should be based on the severity of the seizure and the potential benefits of anticonvulsant therapy.

Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy

Anticonvulsants in patients with a first tonic-clonic seizure reduce the risk of relapse, but long-term remission probability remains unaffected.

Emergency Management of Seizures in the School Setting

Implementing a seizure emergency treatment plan in schools can reduce time to treatment and the need for emergency department visits, with diazepam rectal gel being a common choice.

Overview: Definitions and Classifications of Seizure Emergencies

Seizure emergencies, defined as seizure activity lasting 5 minutes or longer, require immediate treatment and early intervention to reduce seizure activity and potential complications.

Rescue Therapies for Seizures

Rescue therapies for seizures can help prevent prolonged or severe clinical events and aid in managing seizure emergencies.

Management of seizures in critically ill patients

Individualized treatment for seizures in critically ill patients is crucial, considering factors like structural cortical injuries and medications with epileptogenic potential.

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