“Not all seizures require emergency room treatment.”
It can be unnerving to see a coworker, friend, or loved one experience a seizure, especially if you’ve never seen one before. As you watch the sudden change in behavior, your first instinct might be to take the person to the ER—or even call 911. However, this isn’t always the case.
“Not all seizures require emergency room treatment,” says Padmaja Kandula, MD, neurologist at Weill Cornell Medicine and NewYork-Presbyterian. “If someone has a longstanding history of seizure disorder or epilepsy, not every seizure needs [a trip] to the emergency room.”
When It’s Not an Emergency
The following examples of a seizure do not need emergency treatment:
Aura: People with a seizure disorder sometimes experience an “aura,” which is itself a seizure, but is not an emergency. This is when the person experiences strange smells or tastes. These symptoms should be noted and relayed to a doctor later, but they do not require immediate medical treatment.
Absence seizure: This is a type of seizure that involves a brief lapse in awareness. “People look absent. They stare and don’t pay attention,” says Dr. Kandula. “Keep them out of harm’s way so they don’t wander off, [but] that may not require going to the emergency room.”
Seizure under two minutes: If a patient has a short seizure (under two minutes) and recovers fine—meaning they can talk and move around and have not injured themselves—they likely do not need to go to the ER.
When It Is an Emergency
In some cases, a seizure may require emergency medical treatment, such as:
First seizure: If this is someone’s very first seizure, getting emergency care is always recommended. “You do not know what is causing the seizure [and] you do not know how long the seizure may last,” says Dr. Kandula. (Here are health problems that can cause an isolated seizure.)
Seizure clusters: If someone experiences more than one seizure within 24 hours, emergency treatment is recommended. “The emergency room is the best place to assess whether you might need more monitoring or even a hospital stay just for observation,” says Dr. Kandula.
Status epilepticus: This refers to a continuous seizure that lasts longer than five minutes, or two or more seizures without full recovery. “The chances are that it may not end on its own, and that is an emergency,” says Dr. Kandula. “It’s best to proceed to the emergency room. They’re best equipped to handle the problem.”
Thankfully, many treatment options for epilepsy are available to prevent or reduce the frequency or severity of seizures. For many patients, these treatments (along with lifestyle tweaks to manage epilepsy) can significantly improve quality of life and keep them out of the emergency room altogether.
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Not all seizures require emergency room treatment.
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If someone has a longstanding history of seizure disorder, or epilepsy,
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not every seizure needs to go to the emergency room.
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Somebody who has a known diagnosis of a seizure disorder or epilepsy
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has a aura, or a seizure with just a strange taste or smell,
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that should be recorded to tell their doctor later,
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and a thought seizure, which is seen in childhood,
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where people look absent, they stare, and they don't pay attention,
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keep them out of harm's way so they don't wander off.
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That may not require going to the emergency room.
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If the patient has a seizure that's under two minutes
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and they have recovered, or are getting close to recovering
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and able to talk and move around and have not injured themselves,
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that may not require going to the emergency room.
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However, if somebody has another seizure shortly thereafter within the next few hours,
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that does constitute going to the emergency room.
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If you've had what we call cluster, or more than one seizure
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during a 12- to 24-hour timeframe,
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the emergency room is the best place to assess whether you might need more monitoring
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or even a hospital stay just for observation.
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The first seizure should always go to emergency services
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for the very facts that you do not know what is causing the seizure.
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You do not know how long the seizure may last.
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The one emergency situation everyone should know is what we call status epilepticus.
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Most seizures end in two minutes, but if a seizure is going on to five minutes,
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the chances are that it may not end on its own, and that is an emergency.
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And in that case, you might need medication that goes through the bloodstream
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or intravenous medication, so it's best to proceed to the emergency room.
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They're best equipped to handle the problem.
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Overview of the management of epilepsy in adults. Waltham, MA: UpToDate. (Accessed on December 13, 2019 at https://www.uptodate.com/contents/overview-of-the-management-of-epilepsy-in-adults.)
Types of seizures. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on December 13, 2019 at https://www.cdc.gov/epilepsy/about/types-of-seizures.htm.)