not enough oxygen to brain will cause seizures - could it be secondary to hypoxia or hypotension (especially if it was preceded by syncope without tonic/clonic movements)?
may be preferred as a non-sedating option for focal or myoclonic status, and is preferred over phenytoin for primary generalized epilepsies
may need higher dose if patient has been on enzyme inducing anticonvulsants
BUT risk of hepatic dysfunction and coagulopathy are important considerations in patients with active bleeding or those with liver disease or aminoacidopathies
the above can be given I/O at same doses if IV access not available
consider aetiology and possible specific therapies (see below)
3rd line
consider pyridoxine (100mg IV) in young infants with seizures refractory to standard anticonvulsants.
consider more phenytoin to 30mg/kg total dose if not C/I
in children, if 2 appropriate doses fail to terminate the seizure, further doses are unlikely to be effective and increase the risk of respiratory depression.
midazolam infusion 1 - 5 mcg/kg/min might be an alternative to RSI intubation with supervision by senior staff.
hopefully no-one gave a benzodiazepine antagonist to a polypharmacy OD which may precipitate a withdrawal seizure or remove the anticonvulsant benefits of benzodiapines from the cocktail.
Commercial drivers are required to be seizure free for 10 years
Private drivers may not be allowed to drive for various periods depending upon circumstances of the seizure but it is usually 12 months of seizure-free period
in patients with epilepsy, it seems that when the two hippocampi start communicating with each other then this raises the risk of a seizure within the next hours or day and this pattern can be detected with snapshot 90sec EEG analysis 1)