New onset seizures

16 Jul

Level B recommendations for labs:

  • Labs are very low yield in patients who returned to baseline
  • most frequent abnormality = hypoglycemia, hyponatremia
  • Important to identify pregnancy
  • Lumbar puncture if immunocompromised

Level B recommendations for head CT

  • Neuroimaging should be performed when feasible
  • 1996 study recommended head CT in the ED if:
    • acute intracranial process suspected,
    • acute head trauma,
    • h/o malignancy,
    • immunocompromise,
    • fever,
    • persistent HA,
    • new focal neuro exam,
    • focal onset before generalization
  • May defer outpatient neuroimaging if reliable follow-up

Level C recommendations for hospital admission and AED’s (anti-epileptic drugs)

  • If normal neuro exam can discharge with outpatient follow-up
  • If normal neuro exam, no comorbidities, no known structural intracranial disease, no need to start AED’s in ED
  • Patients with structural lesions on head CT or with focal seizures that secondarily generalize have highest risk of recurrence and probably benefit most from starting AED’s but may not change seizure recurrence

Submitted by F. DiFranco.

Reference(s): ACEP Clinical Policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg med. 2004;43:605-625.; picture

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