Overview: definitions and classifications of seizure emergencies

Seizure emergencies are potentially life-threatening events that are under-recognized. Status epilepticus is associated with considerable rates of morbidity and mortality. Experts currently believe that any episode of seizure activity lasting 5 minutes or longer should be considered status epilepticus. Treatment should be initiated as early as possible; evidence has shown that once seizures persist for 5 to 10 minutes, they are unlikely to stop on their own in the subsequent few minutes. Prehospital treatment with benzodiazepines has been shown to reduce seizure activity significantly compared with seizures that remain untreated until the patient reaches the emergency department. The consequences of delayed treatment of status epilepticus include a serious risk of subsequent prolonged seizure activity or epileptogenesis, memory deficits, and learning difficulties. The importance of timely intervention in generalized tonic-clonic status epilepticus must be emphasized. Recent research has found that emergency department personnel fail to recognize the condition in children in 34% of cases.