When to Go to the Doctor: Signs a Seizure Is an Emergency

It can be unnerving to see a coworker, friend, or loved one experience a seizure, especially if you’ve never seen one before. As you watch the sudden change in behavior, your first instinct might be to take the person to the ER — or even call 911. However, this isn’t always the case. 

“Not all seizures require emergency room treatment,” says Padmaja Kandula, MD, Neurologist at Weill Cornell Medicine and NewYork-Presbyterian. “If someone has a longstanding history of seizure disorder or epilepsy, not every seizure needs [a trip] to the emergency room.”

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When it’s not an emergency

The following examples of a seizure do not need emergency treatment:

• Aura: People with a seizure disorder sometimes experience an “aura,” which is itself a seizure, but is not an emergency. This is when the person experiences strange smells or tastes. These symptoms should be noted and relayed to a doctor later, but they do not require immediate medical treatment.

• Absence seizure: This is a type of seizure that involves a brief lapse in awareness. “People look absent. They stare and don’t pay attention,” says Dr. Kandula. “Keep them out of harm’s way so they don’t wander off, [but] that may not require going to the emergency room.”

• Seizure under two minutes: If a patient has a short seizure (under two minutes) and recovers fine — meaning they can talk and move around and have not injured themselves—they likely do not need to go to the ER.  

When it is an emergency

In some cases, a seizure may require emergency medical treatment, such as:

• First seizure: If this is someone’s very first seizure, getting emergency care is always recommended. “You do not know what is causing the seizure [and] you do not know how long the seizure may last,” says Dr. Kandula. (Here are health problems that can cause an isolated seizure.) 

• Seizure clusters: If someone experiences more than one seizure within 24 hours, emergency treatment is recommended. “The emergency room is the best place to assess whether you might need more monitoring or even a hospital stay just for observation,” says Dr. Kandula.

• Status epilepticus: This refers to a continuous seizure that lasts longer than five minutes, or two or more seizures without full recovery. “The chances are that it may not end on its own, and that is an emergency,” says Dr. Kandula. “It’s best to proceed to the emergency room. They’re best equipped to handle the problem.”

It is also important to seek emergency care if someone falls and hits their head during the seizure, if there's vomit or food entering the airways, or if they have an infection or fever when the seizuer occurs. Thankfully, many treatment options for epilepsy are available to prevent or reduce the frequency or severity of seizures. For many patients, these treatments (along with lifestyle tweaks to manage epilepsy) can significantly improve quality of life and keep them out of the emergency room altogether.