Editing Seizure (section)

==Management==
Management of seizures depends on the clinical context, including whether the seizure is isolated or part of an ongoing epileptic disorder, and whether it is provoked or unprovoked.

=== First aid during a seizure ===
Basic first aid during a tonic-clonic seizure focuses on ensuring the person's safety and preventing injury:<ref name="Asadi-Pooya2022">{{Cite journal |last1=Asadi-Pooya |first1=Ali A. |last2=Hosseini |first2=Seyed Ali |last3=Hashemizadeh Fard Haghighi |first3=Leila |last4=Asadi-Pooya |first4=Hanieh |year=2022 |title=Seizure first aid for people with epilepsy: opinions and knowledge of caregivers and healthcare professionals |url=https://pubmed.ncbi.nlm.nih.gov/36130455 |journal=Seizure |volume=102 |pages=1–5 |doi=10.1016/j.seizure.2022.09.007 |issn=1532-2688 |pmid=36130455 |via=PubMed}}</ref>
*Protect the person: Gently guide them to the ground if they are standing, and remove sharp or dangerous objects nearby.
*Do not restrain movements: Allow the seizure to occur without attempting to hold the person down.
* Do not place objects in the mouth: This can cause choking or injury.
* Turn onto the side: Once convulsions stop, or if vomiting occurs, gently roll the person onto their side into the recovery position to maintain an open airway and prevent aspiration.
* Stay calm and reassure: Stay with the person until they have regained full awareness.
For nonconvulsive seizures (such as absence seizures or focal impaired consciousness seizures), active physical first aid is often unnecessary. In these cases, observers should ensure the person is safe from harm, gently guide them away from danger if needed, and offer support and reassurance as they regain awareness.

=== Emergency medical treatment ===
If a convulsive seizure lasts longer than five minutes, or if repeated seizures occur without full recovery between events, the situation is classified as status epilepticus, a medical emergency requiring rapid intervention.<ref>{{Cite journal |last=Al-Mufti |first=Fawaz |last2=Claassen |first2=Jan |date=2014-10-01 |title=Neurocritical Care: Status Epilepticus Review |url=https://linkinghub.elsevier.com/retrieve/pii/S0749070414000529 |journal=Critical Care Clinics |language=English |volume=30 |issue=4 |pages=751–764 |doi=10.1016/j.ccc.2014.06.006 |issn=0749-0704 |pmid=25257739}}</ref> In emergency care, the first-line therapy for status epilepticus is the administration of a [[benzodiazepine]] to terminate the seizure, with most guidelines recommending [[lorazepam]], [[midazolam]] or [[diazepam]]. Early benzodiazepine treatment is associated with better seizure control and improved outcomes.<ref name="Abou-Khalil2022" />

If seizures persist despite benzodiazepine administration (second-line therapy), an intravenous antiseizure medication is given. Recommended options include [[fosphenytoin]], [[valproate]], or [[levetiracetam]], depending on patient-specific factors and institutional protocols.<ref name="DeWaele2013">{{cite journal |display-authors=6 |vauthors=De Waele L, Boon P, Ceulemans B, Dan B, Jansen A, Legros B, Leroy P, Delmelle F, Ossemann M, De Raedt S, Smets K, Van De Voorde P, Verhelst H, Lagae L |date=December 2013 |title=First line management of prolonged convulsive seizures in children and adults: good practice points |url=https://biblio.ugent.be/publication/4182539 |journal=Acta Neurologica Belgica |volume=113 |issue=4 |pages=375–380 |doi=10.1007/s13760-013-0247-x |pmid=24019121 |s2cid=17641491 |hdl-access=free |hdl=1854/LU-4182539}}</ref> In cases of refractory status epilepticus (seizures continuing despite first- and second-line treatments), patients typically require intensive care unit management. This involves continuous EEG monitoring and administration of anesthetic agents such as propofol or continuous infusion of midazolam.<ref name="Abou-Khalil2022" />

Prompt recognition and treatment of status epilepticus are critical to prevent permanent neuronal injury, systemic complications, and death.

=== Management of provoked seizures ===
If a seizure is provoked by an acute reversible cause, treatment focuses on addressing the underlying condition. Long-term antiseizure medications are typically not needed once the acute cause has been resolved, unless seizures recur.

=== Management after unprovoked seizures ===
After a first unprovoked seizure, management depends on assessing the risk of recurrence. Antiseizure medication may be considered after a single event if risk factors for epilepsy are identified, such as epileptiform abnormalities on EEG or structural lesions on MRI. In other cases, careful observation may be appropriate.

=== Long-term management of epilepsy ===
{{See also|Epilepsy#Management}}
Long-term management applies to individuals diagnosed with epilepsy. The goals are seizure control, minimizing adverse effects, and optimizing quality of life.'''<ref name="Abou-Khalil2022" />'''

It is recommended to start with one anti-seizure medication.<ref name="Abou-Khalil2022" /><ref name="Liu2017" /> Another may be added if one is not enough to control the seizure occurrence.<ref name="Liu2017" /> Approximately 70% of people can obtain full control with continuous use of medication.<ref name="WHO2012">{{cite web |date=October 2012 |title=Epilepsy |url=https://www.who.int/mediacentre/factsheets/fs999/en/ |url-status=live |archive-url=https://web.archive.org/web/20160311001129/http://www.who.int/mediacentre/factsheets/fs999/en/ |archive-date=11 March 2016 |access-date=24 January 2013 |series=Fact Sheets |publisher=[[World Health Organization]]}}</ref> The type of medication used is based on the type of seizure.<ref name="Abou-Khalil2022" /><ref name="Liu2017" />

Anti-seizure medications may be slowly stopped after a period of time if a person has just experienced one seizure and has not had any more.<ref name="Abou-Khalil2022" /> The decision to stop anti-seizure medications should be discussed between the doctor and patient, weighing the benefits and risks.

In severe cases where seizures are uncontrolled by at least two anti-seizure medications, brain surgery can be a treatment option.<ref name="Abou-Khalil2022" /><ref name="Liu2017" /> Epilepsy surgery is especially useful for those with focal seizures where the seizures are coming from a specific part of the brain.<ref name="Liu2017">{{Cite journal |last1=Liu |first1=Gerald |last2=Slater |first2=Nicole |last3=Perkins |first3=Allen |date=2017-07-15 |title=Epilepsy: Treatment Options |url=https://pubmed.ncbi.nlm.nih.gov/28762701 |journal=American Family Physician |volume=96 |issue=2 |pages=87–96 |issn=1532-0650 |pmid=28762701}}</ref> The amount of brain removed during the surgery depends on the extent of the brain involved in the seizures. It can range from just removing one lobe of the brain ([[Anterior temporal lobectomy|temporal lobectomy]]) to disconnecting an entire side of the brain ([[hemispherectomy]]).<ref name="Abou-Khalil2022" /> The procedure can be curative, where seizures are eliminated.<ref name="Abou-Khalil2022" /> However, if it is not curative, it can be palliative, reducing the frequency of seizures but not eliminating them.<ref>{{Cite journal |last=Matern |first=Tyson S. |last2=DeCarlo |first2=Rebecca |last3=Ciliberto |first3=Michael A. |last4=Singh |first4=Rani K. |year=2021 |title=Palliative Epilepsy Surgery Procedures in Children |url=https://pubmed.ncbi.nlm.nih.gov/34620461 |journal=Seminars in Pediatric Neurology |volume=39 |pages=100912 |doi=10.1016/j.spen.2021.100912 |issn=1558-0776 |pmid=34620461 |via=PubMed}}</ref>

==== Other ====
Helmets may be used to provide protection to the head during a seizure. Some claim that [[seizure response dog]]s, a form of [[service dog]], can predict seizures.<ref name=Doh2007/> Evidence for this, however, is poor.<ref name=Doh2007>{{cite journal | vauthors = Doherty MJ, Haltiner AM | title = Wag the dog: skepticism on seizure alert canines | journal = Neurology | volume = 68 | issue = 4 | pages = 309 | date = January 2007 | pmid = 17242343 | doi = 10.1212/01.wnl.0000252369.82956.a3 | s2cid = 33328776 | citeseerx = 10.1.1.1003.1543 }}</ref> [[cannabis (drug)|Cannabis]] has also been used for the management of seizures that do not respond to anti-seizure medications. Research on its effectiveness is ongoing, but current research shows that it does reduce seizure frequency.<ref>{{Cite journal |last1=Lattanzi |first1=Simona |last2=Trinka |first2=Eugen |last3=Striano |first3=Pasquale |last4=Rocchi |first4=Chiara |last5=Salvemini |first5=Sergio |last6=Silvestrini |first6=Mauro |last7=Brigo |first7=Francesco |year=2021 |title=Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox–Gastaut Syndrome |journal=CNS Drugs |language=en |volume=35 |issue=3 |pages=265–281 |doi=10.1007/s40263-021-00807-y |pmc=8005394 |pmid=33754312 }}</ref><ref>{{Cite journal |last1=Elliott |first1=Jesse |last2=DeJean |first2=Deirdre |last3=Clifford |first3=Tammy |last4=Coyle |first4=Doug |last5=Potter |first5=Beth K. |last6=Skidmore |first6=Becky |last7=Alexander |first7=Christine |last8=Repetski |first8=Alexander E. |last9=Shukla |first9=Vijay |last10=McCoy |first10=Bláthnaid |last11=Wells |first11=George A. |year=2020 |title=Cannabis-based products for pediatric epilepsy: An updated systematic review |url=https://pubmed.ncbi.nlm.nih.gov/31865133 |journal=Seizure |volume=75 |pages=18–22 |doi=10.1016/j.seizure.2019.12.006 |issn=1532-2688 |pmid=31865133 |via=PubMed}}</ref> A [[ketogenic diet]] or [[modified Atkins diet]] may help in those who have epilepsy who do not improve following typical treatments, with evidence for its effectiveness growing.<ref>{{cite journal |last1=Martin-McGill |first1=Kirsty J. |last2=Bresnahan |first2=Rebecca |last3=Levy |first3=Robert G. |last4=Cooper |first4=Paul N. |title=Ketogenic diets for drug-resistant epilepsy |journal=The Cochrane Database of Systematic Reviews |date=24 June 2020 |volume=2020 |issue=6 |pages=CD001903 |doi=10.1002/14651858.CD001903.pub5 |pmid=32588435 |pmc=7387249 |issn=1469-493X}}</ref><ref>{{Cite journal |last1=Devi |first1=Nagita |last2=Madaan |first2=Priyanka |last3=Kandoth |first3=Nidhun |last4=Bansal |first4=Dipika |last5=Sahu |first5=Jitendra Kumar |year=2023 |title=Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis |journal=JAMA Pediatrics |language=en |volume=177 |issue=3 |pages=258–266 |doi=10.1001/jamapediatrics.2022.5648 |pmc=9887534 |pmid=36716045 }}</ref>