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Why 5 minutes?
- Thread starter finalpoet
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A tonic-clonic seizure that lasts longer than 5 minutes is considered "status epilepticus". A seizure that doesn't resolve within that time can become become progressively difficult to stop, and the risk of brain damage due to loss of oxygen increases as well. You can read about status epilepticus in the article at this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824929/
Of particular note is the paragraph below which describes the evolution from a 30-minute cut-off to the current 5-minute one:
Of particular note is the paragraph below which describes the evolution from a 30-minute cut-off to the current 5-minute one:
In the past 10 years...the duration of what is accepted as Status Epilepticus (SE) has been shrinking progressively. From 30 min specified in the guidelines of the Epilepsy Foundation of America's Working Group on Status Epilepticus it was reduced to to 20 min; the Veterans Affairs Status Epilepticus Cooperation Study stipulated 10 min and, most recently, a length of 5 min has been proposed. Most seizures cease within a minute or two and if the seizure is prolonged beyond a few minutes, it is unlikely to stop by itself. Video-EEG analysis of 120 secondarily generalized tonic–clonic seizure (GTCS) in 47 patients has shown that the maximum duration was 108 s (range 16–108 s, mean 62 s). Primary generalized seizures were of shorter duration than secondarily generalized seizures. Spontaneous termination becomes less likely in seizures lasting >5 min, and the longer the seizure continues, the more difficult it is to control the seizure with antiepileptic drugs and the greater the degree of neuronal damage. It appears that in SE the innate inhibitory mechanisms in the brain that put a halt to the seizure are no longer effective. A duration of 5 min probably is a reasonable cutoff to distinguish isolated seizures from SE. Numerous clinical studies have demonstrated a relation between seizure duration and mortality. When confronted with a patient with continuous seizures, one cannot wait for 30 min, or for that matter even for 15 min, before initiating therapy. Further, there is evidence that seizures may become refractory and difficult to control if treatment is delayed. Lowenstein et al. have proposed that SE be defined as a continuous, generalized, convulsive seizure lasting >5 min, or two or more seizures during which the patient does not return to baseline consciousness. Probably any convulsive seizure that lasts more than 2 min deserves to be managed as SE.
Just as a note - a few weeks after I had my tonic/clonic seizure (first/only fingers crossed) I was on a plane and a man 2 rows in front of me had a seizure. For a few seconds I was terrified - not knowing if getting up to help would be something I could emotionally do. When the called for medical professionals I got up. There were two of us and I knew more about it than the ob/gyn. I remembered that someone told me that they just kept whispering in my ear "you're going to be fine, you're going to be all right." So that's what I did. I kept track and after 4-5 minutes I got worried. The issue was whether or not we should land. Finally, after about 8 minutes I said yes. It's a big deal. Only about an hour after take off to go 3000 miles - had to land a "heavy" plane. But we did. I was so impressed with the EMTs. They came on and had him off in about a minute. Had to sit on the runway for a long time for them to do whatever they needed to do. And then went off again. I didn't hear one word of complaint from anyone. At the end of the weekend, when I was flying home there were about 5 people who were flying back on the same plane that had been on the flight when the seizure occurred. I felt like a celebrity when they said, "Aren't you the one...." Anyway, I took the time seriously and am glad I did it. His daughter with him was only 11. I hope she did ok.