Status Epilepticus: When a Seizure Does Not Stop

By Dovy Paukstys, Founder, Komori Care

This article is educational and is not medical advice. It does not diagnose, treat, prevent, or cure any condition. Komori is not a medical device, is not FDA-cleared, does not detect seizures, and is not intended for people with epilepsy. Talk with a neurologist or epileptologist about personal medical decisions. Households living with epilepsy should use clinically validated seizure-detection devices as directed by their care team.

Most seizures stop. That's the part people forget when they're watching one.

Status epilepticus is the version that does not. A prolonged seizure, or seizures stacked so close the person never comes back in between. ILAE's 2015 task force called it a failure of the brain's "stop" mechanisms, or the start of mechanisms that keep the seizure going.

I am not a clinician. I read the definition papers so this page uses the same clocks a neurologist uses. If someone in front of you is still seizing, you do not need this page. You need 911.

The two clocks ILAE actually uses

Older textbooks used 30 minutes as the line. Useful for research. Late for a living person.

The ILAE Task Force on Classification of Status Epilepticus, led by Eugen Trinka, split the problem into two operational times.

t1 is the point where a seizure is abnormally prolonged and should be treated as continuous. For a convulsive (tonic-clonic) seizure, t1 is 5 minutes.

t2 is the point where ongoing activity starts carrying a risk of long-term consequences: neuronal death, injury, or a change in the networks. For that same convulsive seizure, t2 is 30 minutes.

Those times are "best estimates." The paper says the evidence is incomplete. For other forms, ILAE did not lock in times yet.

The practical reading is simple. Five minutes is when you treat it as status. Thirty minutes is the damage window you are trying not to enter. You do not sit at home waiting to see which clock wins.

What it looks like

Convulsive status is the one bystanders recognize. A tonic-clonic seizure that keeps going, or repeats without the person waking up in between. NINDS calls this a potentially life-threatening condition. CDC's first-aid page uses the same five-minute line: time the seizure, and if it lasts more than 5 minutes, call 911.

Nonconvulsive status is quieter. NINDS says it cannot be seen the same way and is diagnosed on EEG. It can look like a long stretch of confusion, agitation, loss of awareness, or something closer to coma. You are not going to sort that from the couch. A clinician will.

ILAE classifies status on four axes: how it looks, what caused it, what the EEG shows, and age. That is clinic language. Not a family checklist.

Call 911. That is the protocol.

There is not a second, secret home version.

CDC first aid for seizures is public and short. Stay with the person. Clear the space. If they are down, turn them gently onto one side with the mouth toward the ground so the airway stays clear. Put something soft and flat under the head. Loosen anything around the neck. Time it.

Do not hold them down. Do not put anything in the mouth. Do not give food, water, or oral medicine until they are fully alert. Do not start mouth-to-mouth during the seizure. CDC says people usually start breathing again on their own after it stops.

Call 911 if any of these are true, from the CDC list:

• The seizure lasts longer than 5 minutes.
• Another seizure starts soon after the first.
• They have trouble breathing or waking up after.
• They are injured.
• It happens in water.
• They have never had a seizure before.
• They have diabetes and lose consciousness.
• They are pregnant.

NINDS is blunt about the five-minute mark. Evidence has shown that five minutes is enough to damage neurons, and that seizures lasting that long are unlikely to end on their own. Seek medical care immediately.

Rescue medicine is a clinician plan, not a blog recipe

Some people with epilepsy have an emergency care plan. Epilepsy Action (UK) describes it as an agreement with the care team. The plan may include rescue medicine. You give that medicine only if you have been trained to give it, and only as the plan says.

I am not writing a home-treatment protocol. No drug names. No doses. No "if it hits X minutes, do Y." That is how people get hurt.

If there is no plan, or you are not the trained person, you do public first aid and you call 911. If there is a plan, you still call when the CDC criteria say to call. A written plan does not replace emergency services.

The Epilepsy Foundation runs free seizure first-aid training. CDC points people there. Take the class. Do not substitute a blog post for it.

What status is not

It is not "a bad seizure" as a vibe. It is a duration problem.

It is not something a consumer device detects or stops. Komori does not detect seizures. No wellness tracker does. Households living with epilepsy should use clinically validated seizure-detection devices only as their care team directs.

It is not the same thing as SUDEP. CDC treats status as an emergency you can often see. SUDEP is defined, in part, by the absence of another explained cause. Different pages. See what SUDEP is.

After the ambulance

Hospital teams treat status as a time-sensitive emergency. What they use, and in what order, is a clinician decision. This page does not walk that algorithm.

When the dust settles, the useful questions for the neurologist or epileptologist are ordinary. What was the cause. Was this convulsive or not. Does this person need a written seizure action plan. Who in the house is trained on rescue medicine, if it is prescribed.

If this was a first-known seizure, it still belongs in a clinic. One prolonged event is not a diagnosis of epilepsy by itself. See what epilepsy is versus a seizure.

Related reading

• Epilepsy: A Plain-English Guide
• Seizure first aid
• What SUDEP is
• Types of seizures

FAQ

How long does a seizure have to last before it is status epilepticus?

For a convulsive tonic-clonic seizure, ILAE's 2015 definition treats 5 minutes as t1, the point of abnormally prolonged activity. CDC first aid uses the same five-minute line for calling 911. t2, the longer-term injury window, is estimated at 30 minutes for that seizure type. Times for other forms are not locked in.

Should I try to treat status epilepticus at home?

No, beyond public first aid. Stay, protect, time, turn on the side, call 911. If the person has a clinician-written emergency plan and you are trained on their prescribed rescue medicine, follow that plan. This page is not that plan.

Is nonconvulsive status an emergency too?

NINDS treats both convulsive and nonconvulsive status as life-threatening conditions that need medical care. Nonconvulsive status is diagnosed on EEG. You cannot rule it in or out from a description.

Can a home monitor tell me this is status?

No. Status is a clinical emergency. Consumer wellness monitors, including Komori, do not detect seizures and are not for people with epilepsy.

Sources

• Trinka et al., A definition and classification of status epilepticus, Epilepsia (2015): https://onlinelibrary.wiley.com/doi/10.1111/epi.13121
• ILAE, What's new in status epilepticus (Trinka, 2025): https://www.ilae.org/journals/epigraph/epigraph-vol-27-issue-3-summer-2025/what-s-new-in-status-epilepticus-dr-eugen-trinka
• NINDS, Epilepsy and Seizures: https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures
• CDC, First Aid for Seizures: https://www.cdc.gov/epilepsy/first-aid-for-seizures/index.html
• Epilepsy Action, Status epilepticus and rescue medicine: https://www.epilepsy.org.uk/info/first-aid/emergency-treatment-seizures-last-long-time
• Epilepsy Foundation, First Aid for Seizures (resource): https://www.epilepsy.com/recognition/first-aid-resources