The Emergency Department Evaluation of the Adult Patient Who Presents with a First-Time Seizure
Section snippets
Laboratory Testing
Various studies have examined the usefulness of blood tests in evaluating a first-time seizure. The literature suggests the yield from laboratory tests is low, and their routine use is not recommended. The history and physical examination will normally predict most metabolic disturbances, with glucose abnormalities and hyponatremia being the most commonly identified.1, 2, 5, 6 A retrospective chart review by Henneman and colleagues,7 which excluded patients with trauma, drug ingestion, or
Hospital admission
The need for hospital admission is obvious in the critically ill patient. The dilemma arises when establishing disposition for the patient who has fully recovered without persistent neurologic symptoms in the setting of a first-time seizure. To determine which of these patients require hospitalization, it is necessary to identify a valid outcome measure that assesses the correctness of the decision. Useful measures would include seizure recurrence, morbidity, or mortality within a defined
Initiation of AED therapy
Preventing a seizure recurrence is the rationale behind starting an AED in the ED. Patients who have structural lesions on CT or patients with focal seizures that generalize secondarily have high risk (65%) of recurrence within 1 year, and are the group of patients that probably benefit from initiating AED therapy. However, identification of this subgroup requires laboratory testing, neuroimaging studies, and EEG, all of which are rarely immediately available in the ED. Moreover, AED treatment
Summary
In the evaluation of a first seizure, determination of serum glucose and electrolytes is recommended, as is a pregnancy test in women of child-bearing age. A head CT should be obtained in the ED whenever feasible, but when reliable follow-up is available, it is acceptable to discharge the stable patient with no comorbidities for deferred outpatient evaluation. The decision to initiate anticonvulsant therapy is based on the patient’s risk of recurrence, which is highest among patients with
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2022, American Journal of Emergency MedicineCitation Excerpt :Hospitalization is not always necessary for patients with first-time seizures if they have returned to their baseline mental status and have no abnormal neurological findings. The decision to hospitalize is not standardized and should be based on an assessment of each patient's background and risks [16,17]. Although this study included patients with non-first-episode seizures, all discharged patients returned to their baseline mental status and had no abnormal neurological findings.
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