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Seizure Rescue FAQ
Ready, Set, Rescue: FAQ and Practical Answers to Seizure Emergencies

Released: January 29, 2026

Danielle Becker
Danielle Becker, MD, MS, FAES
Sarah Weatherspoon
Sarah Weatherspoon, MD
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Key Takeaways
  • Base rescue medication use on each patient's unique seizure pattern with clear, clear instructions, not rigid timing rules.
  • The risks of prolonged seizures far outweigh the potential mild to moderate adverse side effects of seizure rescue medications.
  • Specify when to give a second dose and when to call Emergency Medical Services so caregivers know the next steps.

In day-to-day practice, what gaps persist in available seizure rescue medications, and what advances would make the biggest difference for patients and caregivers?

Danielle Becker, MD, MS, FAES:
The gap that persists is that we only have benzodiazepines for seizure rescue medication, which carry the risk of abuse, misuse, addiction, concern for respiratory depression, and sedation. In addition, because of the risk of tachyphylaxis, they can only be administered once every 3-5 days; more frequent dosing would decrease the efficacy of the rescue medication precisely when it is most needed. An advance that could make a big difference would be a rescue medication that is not a benzodiazepine and could allow for more frequent use if needed. Also, using a rectal or nasal formulation typically cannot be given inconspicuously, and use in public can potentially add to the stigma associated with epilepsy. Although the advent of a nasal formulation has greatly reduced the associated embarrassment and/or stigma and improved access and utilization, a less conspicuous administration method, especially for self-administration, may also greatly help the patient and encourage increased use.

For an individual patient, how do you define the exact moment a seizure becomes a “seizure emergency” (especially when duration and recovery vary)?

Danielle Becker, MD, MS, FAES:
I ask the patient about their own individual pattern and characteristics of their seizures. I help them define the point at which their seizure deviates from their baseline or is more likely to progress or continue to impaired awareness or a convulsion. I also review what a cluster of seizures means and when to administer a seizure rescue medication if the patient has more than their typical baseline number of repetitive seizures. I review and document the seizure action plan, so the patient and caregiver know what to look for and what to do.

How do you reconcile the “status = 5 minutes” teaching with real-world counseling that sometimes supports earlier rescue use without confusing families?

Danielle Becker, MD, MS, FAES:
If they have been told to wait 5 minutes in the past, I explain where and why this definition likely came about and why it was defined as status = a seizure lasting 5 minutes or longer. I explain that when a seizure lasts 5 minutes or longer it is less likely to spontaneously stop on its own. However, I also explain that the longer a seizure persists, the harder it is to stop, and the longer the postictal recovery often lasts. I explain that depending on their individual seizure characteristics (severity/intensity, alteration of awareness, duration), and progression of seizure activity, I often will advise the patient/caregiver to take the rescue medication as soon as possible to try to stop the seizure faster and get them back to their baseline sooner, with quicker postictal recovery.

What’s your approach when caregivers can’t confidently time onset (eg, unwitnessed start, nocturnal events, evolving focal to bilateral tonic-clonic)?

Danielle Becker, MD, MS, FAES:
I do not ask caregivers to time from onset of the seizure as I think this adds more stress to an already stressful situation. I try to put myself in their shoes and figure out the priorities for keeping the patient safe as opposed to getting a timer or stopwatch and not administering the rescue medication until a specified time. I base the discussed seizure action plan on each patient’s individual characteristics. I tell patients and caregivers to administer the rescue medication as soon as the patient’s seizure is recognized to be different from their baseline, repetitive, or if they always have prolonged impaired awareness or convulsions to administer it as soon as they can. If a seizure is nocturnal or the onset wasn’t witnessed, I also tell them to administer the rescue medication as soon as they notice the patient is having a seizure.

For seizure clusters, what’s your practical threshold for rescue medication (number of seizures, incomplete return to baseline, pattern deviation), and how do you individualize it?

Sarah Weatherspoon, MD:
My practical threshold is to tell families that once a single seizure starts, they should locate and be ready to use the seizure rescue medication. If the seizure is still occurring by the time they have done so, then they should administer it. If the seizure has stopped by the time they had prepared to give the seizure rescue medication, then I tell them to give it for the following seizure if there’s a second seizure within 24-hours.  For an individual with frequent seizures, perhaps even daily seizures, I work with the caregivers and patient to establish what that baseline seizure pattern is so that any deviation from that pattern would be the indication to administer the seizure rescue medication. Asking detailed questions about typical seizure, frequency, duration, and semiology is essential to establishing the baseline.

What do you recommend for repeat dosing, and what are your simple, explicit criteria for when to call EMS or go to the ED?

Sarah Weatherspoon, MD:
There are recommendations provided by the manufacturers of the various seizure rescue medications as to when a second dose can be given. However, I have a discussion of risks and benefits with the family about administering a second dose at a particular time point and send them the typical recommendation on the medication instructions from the manufacturer. Most seizure rescue medication are effective within 2-5 minutes of administration so if seizure activity is still occurring after five minutes, this should prompt consideration of repeat dosing. If it is out of their norm to have to give a second dose, then I do recommend that they involve emergency services at that point. Also, if they were to give the instructed number of doses and seizures are still occurring or their loved one is not returning to baseline in the expected time, or if there are other factors going on such as illness, fever, potentially missed doses of medication, then directing them towards emergency services may also be indicated at that point.

What’s your “go-to” counseling to address caregiver concerns about oversedation/respiratory depression, while still encouraging timely use?

Sarah Weatherspoon, MD:
I review the data from the clinical trials regarding the seizure rescue medication and what the most common side effects were. It is more likely that oversedation and respiratory depression are secondary to the seizure itself. We know that particularly convulsive seizures place individuals at higher risk for sudden unexpected death in epilepsy or SUDEP which involves most likely respiratory depression. Therefore, terminating a seizure by administering seizure rescue medication sooner rather than later may help avoid excessive sedation/postictal phase as well as avoid respiratory depression.

If a seizure action plan must fit on a page, what are the must-have elements that make it usable under stress (and what do you intentionally leave out)?

Sarah Weatherspoon, MD:
The critical components include what type or types of seizures the patient has for which rescue medication may be needed. For instance, in an individual who has both brief absence seizures, which typically don’t require rescue medication, as well as convulsive or tonic-clonic seizures, both seizure types need to be addressed in the seizure action plan. There may be a scenario for an individual in which they have a prolonged absence seizure after awakening, which may occur in the genetic generalized epilepsies. For certain individuals, these progress to a convulsive seizure. Therefore, giving a specific time point at which to give rescue medication, even for absence seizures, is critical and may be different than the time I would give for administering rescue medication for a convulsive seizure. Finally, seizure first aid should be included. This includes placing the person on their side, not inserting anything into their mouth, and moving them away from any sharp or potentially dangerous surfaces.

How do you prevent confusion when patients have multiple benzodiazepines on their med list (daily use vs rescue, different routes, different names)?

Sarah Weatherspoon, MD:
It is rare that I give more than a single type of rescue medication; however, there are certain instances where that may be appropriate for a particular individual. This is why it is essential to list the form of seizure rescue medication, route of administration, etc, so that they can be clearly distinguished on the seizure action plan.

Where do you recommend storing rescue meds and seizure action plans across contexts (home, school nurse, workplace, college dorm), and how do you handle privacy and access tradeoffs?

Sarah Weatherspoon, MD:
Most schools require that seizure rescue medication be stored in a secure place, such as the school nurse's office. This prevents another student from inadvertently obtaining it and ensures that everyone knows where it is. The action plan should also be kept in a central location, such as the school nurse’s office. However, this may look different for an individual who keeps a seizure action plan and rescue medication at their place of work. They may keep it in their desk and educate their trusted colleagues about what the seizure action plan is and where their medication is stored. It is ultimately up to an adult individual with whom they want to share this information; it is their private information that they do not have to disclose.

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In your clinical practice, what is the primary factor that determines your threshold for recommending seizure rescue medication administration to patients and caregivers?

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