Emergency medication for the prevention of status epilepticus in the community

25th February 2019

More often than not, a person’s seizure will last for a similar amount of time and stop by itself. However, sometimes a seizure will last longer than 5 minutes or another seizure will occur straight after leaving the person with no time to recover. If this lasts for 30 minutes or more, a diagnosis of status epilepticus can be made. 

Status epilepticus can be incredibly serious, especially if the seizure a convulsive (tonic-clonic) seizure. It’s important that you seek medical help as the person needs urgently emergency management. There are two common emergency medications that are used to treat a person who is in danger of going into ‘status’.

Buccal midazolam

Buccal midazolam is a benzodiazepine, these medications can be used to treat a number of conditions, including prolonged seizures. Midazolam should be placed in between the gums and the cheek (the buccal cavity) allowing it to be absorbed into the bloodstream and finally the brain where it will stop the seizure.  

Rectal diazepam

Diazepam is also a benzodiazepine and it works in a similar manner. It is absorbed through the rectal mucosa into the bloodstream where it is transported to the brain.

How do these medications work?

Both midazolam and diazepam are sedatives which have a calming effect on the brain which can help to stop a seizure. The seizure should slow down or stop completely in a relatively short period of time (within 10 minutes). If it has been administered and the seizure does not appear to be responsive to the medication, then an ambulance should be called immediately if one hasn’t already.

Do they need to be administered by a healthcare professional?

A person does not need to be a medical professional in order to administer either of these medications. Both buccal midazolam and rectal diazepam can be administered by anyone who has been trained to do so. Quite commonly, family members, friends, teachers and many others will be trained to administer these medications for people with epilepsy in their care. If a person have experienced status epilepticus before, it’s likely that they will have been prescribed emergency medication to minimise the risk of it happening again.

It’s possible that the person will need to go to the hospital and receive further treatment regardless of whether emergency medication has been administered or not.

At National Epilepsy Training, we provide training for both buccal midazolam and rectal diazepam. Alternatively, we can provide a combined course that will train attendees on both medications. They are suitable for both healthcare professionals and other members of the public who may have a need to administer either of these emergency medications. To book, call us on 01706 373075 or email admin@nationalepilepsytraining.co.uk.