Administration of emergency medication for seizures

Emergency medication

There are 3 different medications used, however you will only be asked to use 1 of them. The medications used are midazolam, diazepam and paraldehyde.

Midazolam and diazepam are both benzodiazepine medications. They have a sedative action (makes your child sleepy) and muscle relaxant (muscles go floppy) and are used to control acute epileptic seizures in children. Diazepam is given rectally but midazolam is given via the buccal cavity (between the gums and cheek) in the mouth. When administered either through the rectal or buccal route, the medication is absorbed directly into the bloodstream.

Paraldehyde has a sedative effect and is sometimes used if benzodiazepines are not effective. This medication is given rectally.

Caution - Buccal midazolam

There are currently 2 different strengths of midazolam on the market 10mg/1ml and 5mg/1ml. We will always write the dose in mgs on the care plan.

Why is emergency medication given?

If your child’s seizure lasts for 30 minutes or longer (this is called ‘status epilepticus’), the risk of complications increases. Most seizures can be stopped by early administration of emergency medication. Emergency medication prevents seizures developing into ‘status epilepticus’.

When is emergency medication given?

Most seizures stop by themselves within 5 minutes and do not need emergency medication. If a seizure lasts for longer than 5 minutes, emergency medication may be given as directed by the paediatrician and written in your child’s individualised care plan.

How soon will the emergency medication work?

Often the seizure may start to be controlled within 5 minutes of giving the emergency medication, however it can take up to 10 minutes.

What are the possible side effects?

After your child has been given emergency medicines, they will be drowsy and their breathing may be affected. These effects can last several hours.

Occasionally confusion or agitation can occur.

When should I call an ambulance?

• When giving the first dose of emergency medication
• If you are unsure or worried about your child
• If the seizure has not stopped after 5 minutes of giving the medication
• If you are concerned about your child’s breathing when the seizure has stopped
• If your child has another seizure in the next 24 hours
• If an overdose of the medication has been given

What should I do when the seizure has stopped?

Put your child in the recovery position and monitor their breathing for an hour. Your child may be drowsy for several hours and will need adult supervision until they are fully recovered.

Who can give the emergency medication?

Parents and those with parental responsibility can give emergency medication once they have received training from the paediatric epilepsy nurse or another approved medical professional.

Parents and those with parental responsibility will be asked to identify the settings where emergency medication may need to be given, for example school or nursery. Training for these settings can be arranged by contacting the paediatric epilepsy nurses on the number at the end of this page.

Where should I store the medication?

The medication needs to be stored in a secure but accessible cupboard in the house or with a responsible adult when out.

Unlicensed medicine usage in children

Many medicines for children have only been tested on adults and have not been licensed for use with children; however, they have been used effectively for years.

Rectal diazepam is not licensed for children less than 1 year old and rectal paraldehyde is not licensed for children of any age.

Buccolam is licensed for use in children under 18 years of age.

Epistatus either in a multi-dose bottle or a 10 mg pre-filled syringe is only licensed for use in people over 18 years of age.

If you are concerned about your child receiving an unlicensed medicine then please discuss this with your child’s paediatrician or the paediatric epilepsy nurse.

Contact information

If you require further support or information then please contact:

Paediatric Epilepsy Nurses

Gloucestershire Royal Hospital

Tel: 0300 422 5715

Monday to Friday, 9:00am to 5:00pm

NHS 111

Tel: 111