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Seizures


Probably not ideal for persons with questionable seizure history as obtaining and reading an EEG is often difficult



Inclusion Criteria

  • Past history of seizures with breakthrough seizure or subtherapeutic anticonvulsant level
  • No seizure in last 2 hours
  • New onset seizures with a normal neuro exam, normal head CT, and neurology agreement
  • Blood work: electrolytes, blood glucose, anticonvulsant levels (if appropriate), UDS / tox labs (as indicated).

Exclusion Criteria

  • Ongoing seizures or postictal state
  • Persistent focal neurological findings (e.g. Todd’s paralysis)
  • Clinical suspicion of meningitis or new CVA
  • Delirium of any etiology, including alcohol withdrawal syndrome / DTs
  • Seizures due to toxic exposure (e.g. theophyline or carbon monoxide toxicity) or hypoxemia
  • Pregnancy beyond first trimester / eclampsia
  • New findings on head CT
  • New EKG changes or significant arrhythmias

Potential Interventions

  • Appropriate anticonvulsant therapy
  • Seizure precautions
  • Cardiac and oximetry monitoring
  • Serial (q 2-4 hours) neuro checks and vital signs
  • Toxicological testing PRN
  • EEG or consultation as indicated
  • NPO or liquid diet as indicated
  • Neurology consult if new onset seizures

Discharge Criteria

Home

    • No deterioration in clinical status
    • Therapeutic levels of anticonvulsants PRN
    • Correction of abnormal labs
    • Resolution of post-ictal or benzodiazepine-related sedation
    • Appropriate home environment

Admit

    • Deterioration of clinical status, mentation, or neuro exam
    • Rule in for exclusionary causes
    • Inappropriate home environment
    • Recurrent seizures or status epilepticus
    • Not sufficiently alert for discharge after 18 hours observation


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