Which medication would the nurse administer for treatment of any type of seizures?

Most people’s seizures last the same length of time each time they happen and usually stop by themselves. However, sometimes seizures do not stop or one seizure follows another without the person recovering in between. When a seizure goes on for 5 minutes or more it is called status epilepticus (or ‘status’ for short).

Status during a tonic clonic (convulsive) seizure is a medical emergency and needs urgent treatment with emergency medication.

Treatment

The two emergency medications used to prevent status in the community (outside of the hospital setting) are midazolam and diazepam:

• Buccal (oromucosal) midazolam – is given into the buccal cavity (the side of the mouth between the cheek and the gum).
• Rectal diazepam – is given rectally (into the bottom).

Both these drugs are sedatives. Sedative drugs have a calming effect on the brain and can stop a seizure. Although it is rare, these emergency drugs can cause breathing difficulties so the person must be closely watched until they have fully recovered.

For people who have gone into status before, their doctor may prescribe midazolam or diazepam so that a carer can give it to them. Specialist training is needed to give emergency medication. It is also important that every individual who is prescribed diazepam or midazolam has a written plan (or protocol) about when they are given the medication.

A protocol includes specific information relating to a person’s medical condition. It is usually completed with or on behalf of someone with epilepsy and can include details about their medication, for example the dose, when to give it, and when to call for emergency help. You can download a sample protocol here. (Protocol by kind permission of Veriton Pharma Ltd)

Information booklets

We have produced two information booklets on emergency medication. These were updated in December 2020. Each booklet costs £1.20 (including p&p) and you can order them through the online shop.

• Emergency Medication – using buccal midazolam to treat prolonged seizures
• Emergency Medication – using rectal diazepam to treat prolonged seizures

As well as information about status epilepticus (‘status’) and how it is treated, the booklets cover issues such as protocols for emergency medication, training in giving emergency medication, correct dosage and a step by step illustrative guide on how to give buccal midazolam and rectal diazepam.

The booklets are designed to inform and support carers who give emergency medication to their family member. They are also designed for staff in residential care homes, nursing staff and anyone who is responsible for giving emergency medication within their workplace. They are ideal to be used alongside training in giving emergency medication and within the context of a written protocol or care plan for the individual with epilepsy.

Training

Epilepsy Society can provide training in giving emergency medication.

Information produced in December 2020

Some people don’t like the idea of using a medicine rectally. It can be socially embarrassing, especially in public, and hard to use. There are now better options than rectal Diastat for most people. If your health care provider has prescribed a rectal rescue medicine, talk with them about whether a different option is available for your seizures.

An oral rescue medicine may be recommended by a health care provider. Oral medicines can be pills, liquids, or patches. Rescue medicines can be given by mouth in 1 of 3 ways.

Oral

If a prescription just says, “take by mouth,” it usually means swallowing the medicine with water. The medical abbreviation P.O. (per os) may be on the prescription.

• An oral rescue medicine should only be given if the person is awake and alert and is not at risk for choking on the pill or water.
• If the medicine is in a tablet form, you may be told to chew it before swallowing. Chew medicine first only if your provider recommends it.
• One medicine, clonazepam, may come as a wafer that can dissolve on the tongue. Another form of benzodiazepine is being developed to dissolve in the mouth too.

Sublingual

This means that the medicine is placed under the tongue where it will dissolve and be absorbed into the bloodstream. The person should not drink or eat anything until the medicine is gone.

Buccal

This means that the medicine can be placed in the mouth between the cheek and the gum. The medicine dissolves and is then absorbed into the bloodstream. Usually, medicines that can be taken under the tongue can also be placed between the cheek and the gum. The person should not drink or eat anything until the medicine is gone.

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