• If you or a loved one has epilepsy, knowing seizure first aid can help prevent complications and keep you or them safe.
• Administering rescue medications can seem overwhelming, but remaining calm and knowing the steps to take can make a difference.
• Many organizations offer training programs and seizure first-aid certification to help you or your loved ones become more confident in administering aid.

If you or a loved one has epilepsy, you likely have a seizure action plan in place. This plan usually includes using rescue medications to help stop seizures in an emergency. These are not the same as daily antiepileptic drugs (AEDs) that are used to control the number or frequency of seizures.

Being able to recognize the signs of a seizure emergency and knowing how to use rescue medications can help protect the brain and body from injuries and also reduce the risk of cognitive problems after a seizure.

Administering Rescue Medication

Rescue treatments can be used to treat and stop seizures quickly. They can be given as pills or nasal sprays or applied rectally. If you’re prescribed one of these rescue therapies, your doctor should explain how to use them. This article provides an overview of using these medications.

Oral Medications

Oral rescue medications are used to treat breakthrough seizures quickly. For some, using rectal rescue treatments can be uncomfortable or embarrassing in public — so oral medications offer a safe alternative. Rescue medications should not be used every day in place of AEDs, especially because they can become less effective when taken too often.

The most commonly prescribed oral rescue medications are benzodiazepines:

• Lorazepam (Ativan)
• Diazepam (Valium)
• Midazolam (Versed)
• Clonazepam (Klonopin)

Oral rescue medications can be given in three ways — orally, sublingually, or buccally. Oral medications are those that can be swallowed, either whole or chewed if they come in tablet form. Before taking medication orally, a person should be alert and awake and able to safely swallow the pill and water. If you or a loved one have been prescribed clonazepam in a wafer form, place the wafer on the tongue and let it dissolve.

If a medication is given sublingually, it should be placed under the tongue so it can dissolve. Do not eat or drink until the medicine is completely dissolved and gone. Most medicines that are given sublingually can also be given buccally, meaning that the pill can be placed between the gum and cheek to dissolve.

Some rescue medications are prescribed in a liquid form — such as diazepam (Diazepam Intensol). You use the dropper given by the pharmacy to measure out the correct dose, then drop it between the cheek and gum. If necessary, the liquid can also be mixed with soft food or another liquid to be swallowed.

Intranasal Medications

Many oral medications also come in a nasal-spray formula. Nasal sprays offer another alternative to rectal medications and work quicker than oral medications. The two formulations available are midazolam (Nayzilam) and diazepam (Valtoco). Dosing and administration depend on the medication.

Nasal sprays come in single-dose packages, so do not test the sprays because they cannot be reused. To give midazolam, administer one spray into one nostril.

The dosing for diazepam depends on the person’s weight — this will affect how many sprays are given. For the 5- or 10-milligram (mg) dose, administer one spray into one nostril. For the 15- or 20-mg dose, administer one spray in each nostril for a total of two sprays.

If the person’s seizures continue after they’ve received the first dose of a nasal spray, they may be given a second dose. If they were given diazepam, wait at least four hours before giving the second dose. If midazolam was used, a second dose may be administered after 10 minutes if needed. If only one spray was used, be sure to use the opposite nostril when administering the second dose.

Rectal Medications

Rectal diazepam (Diastat AcuDial) is approved by the U.S. Food and Drug Administration (FDA) for treating refractory epilepsy in adults and children ages two and older. This medication comes in a gel that is measured using the AcuDial system to administer the correct dose. Rectal diazepam is approved specifically to be used by caregivers and family members of those with epilepsy because it is easy to use.

Per the Epilepsy Foundation, here are steps to administer rectal diazepam:

1. Position the person on their side so they face you.
2. Confirm that the dose is correct on the medication packaging.
3. Remove the cap and seal pin from the syringe.
4. Place some lubricating jelly onto the syringe tip.
5. Move the person’s clothing and position the upper leg forward to visualize the rectum.
6. Move the person’s buttocks gently and insert the syringe tip into the rectum.
7. Administer the medication by pushing the syringe plunger for three seconds.
8. Count to three again, after the medication has been dispensed, and then remove the syringe.
9. Press the person’s buttocks together and count to three to prevent the medication from leaking out.
10. Place the person’s clothes back, then observe following the health care provider’s instructions.

After giving the rectal diazepam, stay with the person for four hours to make sure they do not have an adverse reaction. If the medication was given to a child, note any symptoms they experience.

Seizure First Aid

Seizure first-aid training is a useful skill to have if you or a loved one has epilepsy. Knowing what to do when someone has a seizure will keep them safe and prevent injuries.

Rescue Aid for Grand Mal Seizures

Grand mal seizures (also known as generalized tonic-clonic seizures) are what most people think of when they hear about seizures. During one of these seizures, a person may shake or jerk, fall, or cry out. Along with giving rescue medication, seizure first-aid steps that can be taken include the following:

• Gently ease the person onto the floor in a safe place and turn them on their side to open up their airway, helping them breathe.
• Place a folded jacket or another flat, soft object under their head.
• If they are wearing glasses, remove them.
• Ensure that the area is clear of anything sharp or hard.
• Check for ties, scarves, or anything around their neck and loosen them.
• Begin timing the seizure — if it lasts longer than five minutes, call 911.

There are many different types of seizures, so the kind of aid given can vary. If you are unsure of the kinds of aid to give, ask your health care provider.

Things To Avoid While Administering Aid

Knowing what not to do while giving first aid during a seizure is just as important as knowing what to do. This helps to keep a person safe and avoid complications. According to the Centers for Disease Control and Prevention (CDC):

• Do not try to give rescue breathing (mouth-to-mouth) while a person is having a seizure, as they will typically start breathing on their own again.
• Do not try to restrict the person’s movements or hold them down.
• Do not put anything in the person’s mouth during a seizure — this can lead to mouth or jaw injuries.
• Do not give the person water or food until they are fully awake — this can be a choking hazard.

Some of these actions may seem instinctual when you see a person having a seizure, but they can end up doing more harm than good.

When To Call 911

In many cases, seizures do not require emergency help. The CDC states that 911 should be called only under one or more of the following circumstances:

• It’s the person’s first seizure.
• The seizure lasts more than five minutes.
• The person is injured during the seizure.
• The person has another health condition, such as heart disease, diabetes, or is pregnant.
• After the seizure stops, the person has trouble waking up or breathing properly.
• There is another seizure after the first one.
• The seizure occurs in water.

The above situations are considered medical emergencies, and the person should be seen by a health care professional or taken to the emergency room as soon as possible.

Resources for Seizure First Aid

If you or your loved one would like to learn more about seizure first aid, there are several resources available.

The American Red Cross has an app to download onto your phone that provides step-by-step instructions for first aid and advice to follow when a person has a seizure. The Epilepsy Foundation also offers courses, videos, and information online for seizure first-aid training and certification. Some live training sessions are also available if you prefer to learn in person.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, more than 107,000 members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Have you or a loved one ever administered seizure first aid? Do you have any tips for giving seizure first aid effectively? Share your experience in the comments below, or start a conversation by posting on your Activities page.