A seizure lasting more than five minutes or two or more seizures with incomplete recovery in between is an emergency.
A seizure that lasts more than five minutes, or at least two seizures without full recovery in between, can cause brain damage or worse in children and newborns. Call 911 and get emergency treatment immediately.
Prolonged seizures, known as status epilepticus, are very serious and life-threatening, according to Jeetendra P. Sah, M.D., child neurologist at Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine.
Long-term consequences of status epilepticus can include permanent injury or excessive death of nerve cells (neurons) in the brain and permanent alteration of the neuronal networks in the brain. The brain damage can have long-term effects on behavior, can impair ability to learn and can cause intellectual disability.
Status epilepticus can cause death if left untreated.
A child with status epilepticus usually has convulsions during their seizures. The median age for convulsive status epilepticus is about 3 years. In rare cases, children can have seizures without convulsions.
Immediate treatment is important — within five minutes if possible. EMTs can administer medication to treat the seizure before transporting the child to the emergency department at a hospital.
“The longer a seizure has been going on, the harder it is to stop,” Dr. Sah said.
Causes of, and diagnosing and treating status epilepticus in children
Status epilepticus is the most common neurological condition requiring children to be hospitalized.
Causes of status epilepticus in children include a prolonged fever, infection, a head injury, lack of oxygen, a stroke, intoxication or some abnormality in the child’s metabolism. An abnormality in the central nervous system also could cause status epilepticus. Status epilepticus also could be related to underlying epilepsy.
Parents of children with status epilepticus should consider an individualized seizure action plan, according to Dr. Sah. Forms for creating a plan are available on the Epilepsy Foundation website.
Treatment for status epilepticus typically begins with a type of drug called benzodiazepines. If you or emergency medical personnel administered benzodiazepines, be sure to tell providers in the emergency department.
“Many times, patients come through the emergency room who already have had treatment either at home or by emergency medical services. It’s really important to know which medicines have been given,” said Dr. Sah, an assistant professor of neurology at the University of Louisville School of Medicine.
Norton Children’s Neuroscience Institute
If a child already has been treated with benzodiazepines and receives more at the hospital too soon, it could cause breathing difficulties.
To determine the etiology or cause of status epilepticus, doctors first will check to see if the child has a fever or infection. They may do a blood test and toxicology screen to check for drugs or other chemicals. They also may want to know what medications are in the home.
Nonconvulsive status epilepticus cannot be identified without an electroencephalogram (EEG) — a noninvasive test that monitors brain waves.
In infants less than 4 weeks old, most seizures are not accompanied by convulsions. They are usually caused by a lack of oxygen, a bleed in the brain, stroke or a central nervous system infection, according to Dr. Sah.
The treatment for neonatal seizures and status epilepticus, according to Dr. Sah, is usually anti-seizure medications called phenobarbital or levetiracetam.