Seizure Management Guidelines

Indications for Benzodiazepines

• Benzodiazepines like lorazepam are first-line treatment for active seizures lasting ≥5 minutes or for status epilepticus, as stated by the American College of Emergency Physicians 3
• The American Heart Association recommends that seizures are usually self-limited and resolve spontaneously within 1-2 minutes, and emergency intervention is needed for seizures lasting >5 minutes 1, 2

Monitoring and EMS Activation

• The American Heart Association recommends staying with the patient and monitoring for return to baseline mental status within 5-10 minutes after seizure cessation 1, 2
• Activate EMS if the patient does not return to baseline within 5-10 minutes, or if another seizure occurs, as recommended by the American Heart Association 1, 2

Second-line Anticonvulsants

• If the patient has a recurrent seizure, then benzodiazepines would be appropriate as first-line treatment, according to the American College of Emergency Physicians 4, 5
• If seizures become refractory, second-line agents include valproate, levetiracetam, fosphenytoin, or phenobarbital, as recommended by the American College of Emergency Physicians 4, 5

Prophylactic Anticonvulsants

• There is lack of evidence to support or refute loading with anticonvulsant medication after a single resolved seizure to prevent early recurrent seizures, as stated by the American College of Emergency Physicians 3

Safety Considerations

• The American Heart Association explicitly states as a Class 3 Harm recommendation: "Nothing should be put in the mouth and no food, liquids, or oral medicines should be given to a person who is experiencing a seizure or who has decreased responsiveness after a seizure" 1, 2