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Seizure lasting for 30 min is what seizure

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"status epilepticus"[MeSH Terms]

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status epilepticus seizure 5 minutes definition ILAE

A seizure lasting 30 minutes is status epilepticus, specifically prolonged convulsive status epilepticus if there are convulsions.
In modern practice, treatment is started much earlier: a generalized tonic-clonic seizure lasting more than 5 minutes, or repeated seizures without regaining consciousness between them, is treated as status epilepticus. A 30-minute seizure is a medical emergency. ILAE definition
If this is happening now, call emergency services immediately.

Status epileptic basic to know

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"status epilepticus"[MeSH Terms]

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ILAE status epilepticus definition 5 minutes first line benzodiazepine guideline

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Status epilepticus: basics to know

Status epilepticus (SE) is a neurological emergency in which:
  • A seizure lasts 5 minutes or longer, or
  • Repeated seizures occur without recovery of consciousness between them.
The older definition used 30 minutes, but treatment must begin at 5 minutes because seizures become harder to stop and can cause injury. ILAE timing definition

Main types

  1. Convulsive status epilepticus
    • Continuous generalized tonic-clonic seizure: stiffening and rhythmic jerking, usually with loss of consciousness.
    • Most urgent and visible form.
  2. Non-convulsive status epilepticus
    • Persistent seizure activity without major jerking.
    • May present with confusion, staring, reduced responsiveness, coma, eyelid twitching, or abnormal behavior.
    • Often requires an EEG to diagnose.
  3. Focal status epilepticus
    • Persistent focal symptoms such as repeated twitching of one limb, abnormal sensation, or impaired awareness.
    • A continuous focal motor seizure may be called epilepsia partialis continua.

Common causes

  • Missed or low antiseizure medication levels
  • Stroke, head injury, brain infection, brain tumor
  • Low blood glucose, low sodium, hypoxia, kidney or liver failure
  • Alcohol or sedative-drug withdrawal, intoxication, poisoning
  • Fever and infection in children
  • Eclampsia in pregnancy

Why it is dangerous

Long seizures can lead to:
  • Hypoxia and aspiration
  • Acidosis, hyperthermia, low blood sugar
  • Abnormal heart rhythms and low blood pressure
  • Brain injury and death

Basic emergency management

At the scene:
  • Time the seizure.
  • Protect the person from injury and place them on their side when possible.
  • Do not put anything in their mouth.
  • Do not restrain them.
  • Call emergency services if seizure lasts 5 minutes, repeats without waking, occurs in pregnancy, follows injury, or it is the first seizure.
In hospital:
  1. ABC approach: airway, breathing, circulation, oxygen, monitoring, IV access, bedside glucose.
  2. First-line medicine: a benzodiazepine, such as lorazepam, midazolam, or diazepam.
  3. Second-line antiseizure medicine if it continues: commonly levetiracetam, fosphenytoin/phenytoin, or valproate.
  4. Identify and treat the cause, such as hypoglycemia, infection, stroke, or withdrawal.
  5. Persistent seizures despite first- and second-line treatment are refractory status epilepticus and usually need ICU care, anesthetic treatment, and continuous EEG monitoring. NICE emergency treatment guidance
Key exam line:
Status epilepticus is a seizure lasting ≥5 minutes, or recurrent seizures without return to baseline consciousness.
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