Editing Epilepsy (section)

===First aid and acute management of seizures===
During a generalized tonic–clonic seizure, the primary goals are to ensure safety and prevent injury. The following steps should be taken:<ref name="Mic2011">{{cite journal |vauthors=Michael GE, O'Connor RE |date=February 2011 |title=The diagnosis and management of seizures and status epilepticus in the prehospital setting |journal=Emergency Medicine Clinics of North America |volume=29 |issue=1 |pages=29–39 |doi=10.1016/j.emc.2010.08.003 |pmid=21109100}}</ref>

* Stay calm and remove any potential hazards from the area. Clear the space of sharp objects, furniture, or anything that might cause injury.
* If the person is standing, gently guide them to the ground to avoid a fall.
* Position the person on their side and into the [[recovery position]], which helps keep the airway clear and reduces the risk of choking. If possible, place something soft (e.g., a jacket or cushion) under their head to prevent injury.
* Do not restrain their movements or attempt to hold them down. Do not put anything in their mouth, as this may cause harm.<ref name="EB06" /><ref name="Mic2011" />

If the seizure lasts longer than 5 minutes or if multiple seizures occur without full recovery in between, it is important to call for emergency medical assistance immediately, as it is considered a [[medical emergency]] known as [[status epilepticus]].<ref>{{cite book |url=https://books.google.com/books?id=4W7UI-FPZmoC&pg=PA144 |title=Advanced therapy in epilepsy |vauthors=Wheless JW, Willmore J, Brumback RA |publisher=People's Medical Pub. House |year=2009 |isbn=978-1-60795-004-2 |location=Shelton, Conn. |page=144}}</ref> 

Convulsive status epilepticus requires immediate medical attention to prevent serious complications. In a community setting (such as at home or in the [[ambulance]]), first-line treatment includes the administration of [[Benzodiazepine|benzodiazepines]]. If the person has an individualized emergency management plan — which may have been developed with healthcare providers and outlines personalized treatment steps (such as the use of buccal [[midazolam]] or rectal [[diazepam]]) — this plan should be followed immediately.<ref name="NICE2022" /> In hospital, intravenous [[lorazepam]] is preferred.<ref name="NICE2022" />

If seizures continue after the first dose of benzodiazepine, emergency medical services should be contacted, and further doses can be given. For ongoing seizures, [[levetiracetam]], [[phenytoin]], or [[Valproate|sodium valproate]] may be used as second-line treatments, with levetiracetam preferred for its quicker action and fewer side effects.<ref name="NICE2022" />

Most institutions have a preferred pathway or protocol to be used in a seizure emergency like status epilepticus. These protocols have been found to be effective in reducing time to delivery of treatment.<ref name="NICE2022" />