Clinical Policy for the Initial Approach to Patients Presenting With a Chief Complaint of Seizure Who Are Not in Status Epilepticus☆
Section snippets
PREFACE
This clinical policy is a scheduled revision of the original seizure policy published in May 1993. The topic considered here, the initial approach to seizures, was selected for three reasons: (1) seizures are common, complex, clinical problems; (2) individuals who suffer from seizures frequently seek emergency care; and (3) timely, thoughtful diagnostic and therapeutic intervention may have a substantial impact on both short- and long-term morbidity.
This clinical policy was created after a
References (90)
- et al.
Placebo-controlled trial of intravenous dephenylhydantoin for short-term treatment of alcohol withdrawal seizures
Am J Med
(1989) - et al.
Compliance with a standard for the emergency department management of epileptics who present after an uncomplicated convulsion
Ann Emerg Med
(1990) - et al.
Combined ambulatory electroencephalographic and electrocardiographic recording for evaluation of syncope
Am J Cardiol
(1991) - et al.
Increases in serum prolactin levels associated with syncopal attacks
Am J Emerg Med
(1993) Hypoparathyroidism: An unusual cause of seizures
Ann Emerg Med
(1983)- et al.
Evaluation and outcome of emergency room patients with transient loss of consciousness
Am J Med
(1982) - et al.
Efficacy of a “standard” seizure workup in the emergency department
Ann Emerg Med
(1986) Structural causes of epilepsy. Tumors, cysts, stroke, and vascular malformations
Neurol Clin
(1994)- et al.
Alcohol related seizures, I: Clinical presentation and management
J Emerg Med
(1993) - et al.
Alcohol related seizures, II: Clinical presentation and management
J Emerg Med
(1993)
Magnesium physiology, clinical disorders, and therapy
Ann Emerg Med
Determining the need for admissions in patients with new-onset seizures
Ann Emerg Med
Long QT syndrome presenting as a seizure
Am J Emerg Med
New-onset seizures associated with human immunodeficiency virus infection: Causation and clinical features in 100 cases
Am J Med
The first seizure in adult life: Value of clinical features, electroencephalography, and computerized tomographic scanning in prediction of seizure recurrence
Lancet
Carotid sinus hypersensitivity in patients with unexplained syncope: Clinical, electrophysiologic, and long-term follow-up observations
Am Heart J
Emergency department approach to managing seizures in pregnancy
Ann Emerg Med
Cardiovascular causes of LOC in patients with presumed epilepsy: A cause of the increased sudden death rate in people with epilepsy?
Am J Med
Seizures as a manifestation of systemic disease
Neurol Clin
Seizures associated with poisoning and drug overdose
Am J Emerg Med
Single dose oral phenytoin loading
Ann Emerg Med
Serum chemistry abnormalities in adult patients with seizures
Ann Emerg Med
Seizure patient selection for emergency computed tomography
Ann Emerg Med
First time major motor seizures in an emergency department
Ann Emerg Med
Adult first generalized seizure: Etiology, biological tests, EEG, CT scan, in an ED
Am J Emerg Med
Utility of laboratory studies in the emergency department patient with a new-onset seizure
Ann Emerg Med
Epilepsy and pregnancy. New issues for an old disorder
Neurol Clin
Seizures associated with recreational drug abuse
Neurology
Consensus statements, sample statutory provisions, and model regulations regarding licensing and epilepsy
Epilepsia
Appropriate interhospital patient transfer
Ann Emerg Med
Practice parameter: Neuroimaging in the emergency patient presenting with seizure (summary statement)
Ann Emerg Med
Magnetic resonance imaging of the brain and spine: A revised statement
Ann Intern Med
Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias
Ann Intern Med
Seizures after head trauma: A population study
Neurology
Neurological manifestations and morbidity of hyponatremia: Correlation with brain water and electrolytes
Medicine
Pregnancy and epilepsy
J Neurol
The risk of seizure recurrence following a first unprovoked seizure: A quantitative review
Neurology
Seizures after stroke
Stroke Clinical Updates
Drug interactions in epilepsy
Epilepsia
Seizure disorders and pregnancy
N Engl J Med
Epileptogenic properties of cocaine in humans
Neurotoxicology
Cardiogenic syncope: Seizures versus syncope
Neurol Clin
Intracranial lesions shown by CT in 159 cases of first alcohol-related seizures
Neurology
How often does a CSF pleocytosis follow generalized convulsions
Ann Neurol
Prolonged confusion following convulsions due to generalized nonconvulsive status epilepticus
Neurology
Cited by (27)
How do doctors in training react to seizures?
2016, Epilepsy and BehaviorCitation Excerpt :Following the suggestions of Hosmer and Lemeshow, we classified diagnostic accuracy based on the AUC of 0.5 as no better than by chance, 0.6 to 0.69 as poor, 0.7 to 0.79 as fair, 0.8 to 0.89 as good, and 0.9 to 1 as outstanding [13]. When a patient presents with an acute seizure, life-threatening emergencies such as apnea, hypoxia, and hypotension should be treated urgently [14]. Benzodiazepines are commonly used to terminate seizures [15].
Risk for developing epilepsy and epileptiform discharges on EEG in patients with febrile seizures
2013, Brain and DevelopmentCitation Excerpt :However, slowing of the EEG is found to be more prevalent in the early postictal period after febrile seizure episodes [3,15,16]. Several studies have reported that approximately 33% of patients have EEG abnormalities within the first week after a complex febrile seizure [4,17]. In a recent study, patients whose EEGs, which were obtained later than 11 days after a seizure episode, showed epileptiform discharges on an had a higher incidence of epilepsy.
Specificity of epileptic seizures in the elderly: A proposed electro-clinical scale
2009, Revue NeurologiqueHypoparathyroidism-induced epilepsy: an overlooked cause
2006, American Journal of Emergency MedicineManagement of patients after a first seizure
2004, Journal of NeuroradiologyClinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Seizures
2004, Annals of Emergency Medicine
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This clinical policy was developed by the ACEP Clinical Policies Committee and the Clinical Policies Subcommittee on Seizure.