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Seizure management

Include in assessment


  • Capillary glucose
  • Venous blood gas (to measure lactate and acidosis) and venous bloods including FBC, LFTs, U&Es, Ca2+, PO43-, Mg2+ (look for electrolyte abnormalities), antiepileptic drug levels (if taking), clotting
  • ECG (look for prolonged QT interval)
  • Urine toxicology screen (if relevant)
  • Further investigations
    • CT/MRI brain (look for any focal lesions or bleed)
    • Electroencephalogram (EEG)
    • Lumbar puncture (if meningitis / encephalitis suspected)

Initial ABCDE approach

  • Airway
    • Recovery position
    • Maintain airway with jaw-thrust ± suction as required
    • Consider nasopharyngeal airway if airway concerns (not oropharyngeal airway due to trismus)
  • Breathing
    • 15L oxygen via non-rebreather mask
  • Circulation
    • Secure IV access
    • Attach monitoring (pulse oximetry, blood pressure, cardiac monitor)
  • Disability
    • Check capillary glucose
  • Everything else
    • Full examination
Recovery position

Pharmacological seizure management

Please note OSCEstop content is for educational purposes only and not intended to inform clinical practice. OSCEstop and authors take no responsibility for errors or the use of any information displayed. Drugs and doses are intended for non-pregnant adults, who are not breastfeeding, with normal renal and hepatic function.

If seizure ongoing, within:

  • 10 minutes: 4mg lorazepam IV OR 10mg diazepam PR
  • 20 minutes: repeat above
  • 30 minutes: levetiracetam (Keppra) 60mg/kg IV (max. 4.5g; over 15 minutes; unlicenced) or phenytoin 20mg/kg IV (max. 2g; at 50mg/minute with cardiac monitoring)
  • 60 minutes: general anaesthesia in intensive care unit


  • If hypoglycaemia: 50ml 50% glucose IV 
  • If any suggestion of alcohol dependence: Pabrinex I+II 2 pairs IV
  • Treatment for any obvious causes

After patient has recovered consciousness

  • Post-ictal period may last a few hours
  • Find cause
    • Full history 
    • Multi-system examination (including full neurological exam)
    • Complete any outstanding investigations above
  • Treat cause
  • Refer to medical team/neurology or seizure clinic
  • Give driving advice and instruct patient to inform DVLA 


What are three common causes of seizures?

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When are the usual indications for starting regular antiepileptics?

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How long is the DVLA driving restriction after a seizure?

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Try an OSCE station

  1. Status epilepticus
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