Generalised convulsive status epilepticus is defined as a generalized convulsion lasting 30 minutes or longer or when successive convulsions occur so frequently over a 30-minute period that the patient does not recover consciousness between them.
However, it is difficult to get the exact insight about its onset and duration. As we know a seizure lasting for 5 minutes or more may cause neuronal damage and hence poor neurological outcome. So the usual practice is to start the seizure management if the duration is 5 minutes or more.
First line treatment in the community:
General protective measures.
- E.g. put the child in a recovery position, ensure the head is protected, release any tight clothing, and move away from a dangerous position.
- Do not put anything in the mouth.
- Keep the head in slightly lower position if vomiting.
- Do not panic and keep an eye on time.
- Use intranasal midazolam (Insed or Midaspray 0.2 to 0.5 mg/kg, each spray contains 0.5 mg) as first-line treatment prescribed by your doctor, if seizure continues for 5 minutes because upto 90% of convulsions stop within 5 minutes without any treatment.
If intravenous access is established in the hospital and resuscitation facilities are available, administer intravenous lorazepam.
Depending on response to treatment, the person's situation and any personalised care plan, call an ambulance, particularly if:The seizure is continuing for over five minutes after the emergency medication has been administered.
If this is the first episode requiring emergency treatment, there are concerns or difficulties monitoring the person's airway, breathing, circulation or other vital signs.Treatment in hospitalABCs (Airway, Breathing and circulation) before starting any pharmacologic intervention. Place patients in the lateral decubitus position to avoid aspiration of emesis and to prevent epiglottis closure over the glottis.