Seizure - Revision history

Danbot: Add to Category:Symptoms - common EM chief complaint

2026-03-22T09:41:39Z

Add to Category:Symptoms - common EM chief complaint

← Revisión anterior		Revisión del 09:41 22 mar 2026
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	<references/>		<references/>

			[[Category:Symptoms]]
	[[Category:Neurology]]		[[Category:Neurology]]

Rossdonaldson1: /* Physical */

2022-05-12T22:18:54Z

Physical

← Revisión anterior		Revisión del 22:18 12 may 2022
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	**[[focal neuro deficit\|Focal deficit]] (Todd paralysis vs [[CVA]])		**[[focal neuro deficit\|Focal deficit]] (Todd paralysis vs [[CVA]])
	*** If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.		*** If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.
	**Nuchal rigidity		**Nuchal rigidity (concern for [[meningitis]])

	===Work-Up===		===Work-Up===

Beren85: /* Background */

2022-05-11T21:28:12Z

Background

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	==Background==		==Background==
	*Caused by a pathologic pattern of brain cortex activity → involuntary movement or change in level of consciousness<ref name="Martindale">Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am. 2011 Feb;29(1):15-27.</ref>		*Caused by a pathologic pattern of brain cortex activity (time-limited paroxysmal events from abnormal rhythmic neuronal discharges) → involuntary movement or change in level of consciousness<ref name="Martindale">Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am. 2011 Feb;29(1):15-27.</ref>
	**11% of people will have at least one seizure in their lifetime		**11% of people will have at least one seizure in their lifetime
	**3% will have epilepsy (at least 2 unprovoked seizures)		**3% will have epilepsy (at least 2 unprovoked seizures)

Beren85: /* Physical */

2022-05-11T21:15:43Z

Physical

← Revisión anterior		Revisión del 21:15 11 may 2022
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	**[[focal neuro deficit\|Focal deficit]] (Todd paralysis vs [[CVA]])		**[[focal neuro deficit\|Focal deficit]] (Todd paralysis vs [[CVA]])
	*** If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.		*** If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.
			**Nuchal rigidity

	===Work-Up===		===Work-Up===

Beren85: /* Background */

2022-05-11T21:14:20Z

Background

← Revisión anterior		Revisión del 21:14 11 may 2022
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	*In pregnancy >20 WGA or <4wks postpartum, need to consider [[eclampsia]]		*In pregnancy >20 WGA or <4wks postpartum, need to consider [[eclampsia]]
	**Most seizures in pregnancy are not first-time seizures, but rather are due to medication noncompliance or pharmacokinetic drug changes as result of pregnancy		**Most seizures in pregnancy are not first-time seizures, but rather are due to medication noncompliance or pharmacokinetic drug changes as result of pregnancy
			*The most common etiology of seizure is noncompliance with medication

	{{Seizure types}}		{{Seizure types}}

Elcatracho: /* External Links */

2021-01-13T17:55:04Z

External Links

← Revisión anterior		Revisión del 17:55 13 ene 2021
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	==External Links==		==External Links==
	*[http://ddxof.com/seizure-2/ DDxOf: Differential Diagnosis of Seizures]		*[http://ddxof.com/seizure-2/ DDxOf: Differential Diagnosis of Seizures]
	*[https://www.acep.org/patient-care/clinical-policies/seizure/ ACEP Clinical ~~Policy Statement~~ Policy on Seizure]		*[https://www.acep.org/patient-care/clinical-policies/seizure/ ACEP Clinical Policy on Seizure]

	==References==		==References==

Elcatracho: /* External Links */

2021-01-13T17:53:56Z

External Links

← Revisión anterior		Revisión del 17:53 13 ene 2021
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	==External Links==		==External Links==
	*[http://ddxof.com/seizure-2/ DDxOf: Differential Diagnosis of Seizures]		*[http://ddxof.com/seizure-2/ DDxOf: Differential Diagnosis of Seizures]
			*[https://www.acep.org/patient-care/clinical-policies/seizure/ ACEP Clinical Policy Statement Policy on Seizure]

	==References==		==References==

Elcatracho: /* First-Time Seizure */

2021-01-13T17:50:49Z

First-Time Seizure

← Revisión anterior		Revisión del 17:50 13 ene 2021
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	==Disposition==		==Disposition==
	===[[First-time seizure\|First-Time Seizure]]===		===[[First-time seizure\|First-Time Seizure]]===
	*Those with single generalized seizure and otherwise normal history and physical can be discharged home with close follow-up		*Those with single generalized seizure and otherwise normal history and physical can be discharged home with close follow-up<ref>Huff JS, Melnick ER, Tomaszewski CA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures [published correction appears in Ann Emerg Med. 2017 Nov;70(5):758]. Ann Emerg Med. 2014;63(4):437-47.e15. doi:10.1016/j.annemergmed.2014.01.018</ref>
	**Observation is not unreasonable for those that look ill or have a complicating history/physical (comorbidities, age > 60y, cancer, immunocompromise, cardiovascular disease)		**Observation is not unreasonable for those that look ill or have a complicating history/physical (comorbidities, age > 60y, cancer, immunocompromise, cardiovascular disease)
	**24-hr recurrence of seizures in this group is about 9% when alcohol-related events are excluded<ref>Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007; 69(21):1996-2007.</ref>		**24-hr recurrence of seizures in this group is about 9% when alcohol-related events are excluded<ref>Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007; 69(21):1996-2007.</ref>

ClaireLewis at 14:16, 19 October 2019

2019-10-19T14:16:11Z

← Revisión anterior		Revisión del 14:16 19 oct 2019
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	===Work-Up===		===Work-Up===
	====[[First-Time Seizure]] or Change in Baseline Seizures====		====[[First-time seizure\|First-Time Seizure]] or Change in Baseline Seizures====
	*Non-contrast [[head CT]] in ED (or advanced imaging arranged as outpatient)		*Non-contrast [[head CT]] in ED (or advanced imaging arranged as outpatient)
	**First time seizures in setting of EtOH or [[Alcohol withdrawal seizures\|EtOH-withdrawal]]: 6.2% had clinical significant lesion.<ref>Earnest MP, et al. Neurology 1988;38:1561–5.</ref>		**First time seizures in setting of EtOH or [[Alcohol withdrawal seizures\|EtOH-withdrawal]]: 6.2% had clinical significant lesion.<ref>Earnest MP, et al. Neurology 1988;38:1561–5.</ref>
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	*CBC & chemistry		*CBC & chemistry
	*[[ECG]] ([[prolonged QT]] and [[torsades]] can cause shaking after intermittent runs}		*[[ECG]] ([[prolonged QT]] and [[torsades]] can cause shaking after intermittent runs}
	*~~Prolactin may be useful~~ in differentiating seizures from psychogenic nonepileptic ~~seizures~~		*Consider prolactin<ref>Fisher RS. Serum prolactin in seizure diagnosis: Glass half-full or half-empty?. Neurol Clin Pract. 2016;6(2):100-101.</ref> or [[lactate]] to assist in differentiating seizures from [[psychogenic nonepileptic seizure]] or volitional seizure activity (lactate may be detectable for up to 1 hour post-seizure)
	*Lactate which may help distinguish from volitional ~~etiology~~ (~~Lactate~~ may be detectable for up to 1 hour post-seizure)
	*Consider: [[Utox]], RPR, [[HIV]], [[UA]], EEG, [[lumbar puncture]], EtOH level, CK		*Consider: [[Utox]], RPR, [[HIV]], [[UA]], EEG, [[lumbar puncture]], EtOH level, CK

Bigshits at 05:39, 7 October 2019

2019-10-07T05:39:29Z

← Revisión anterior		Revisión del 05:39 7 oct 2019
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	*CBC & chemistry		*CBC & chemistry
	*[[ECG]] ([[prolonged QT]] and [[torsades]] can cause shaking after intermittent runs}		*[[ECG]] ([[prolonged QT]] and [[torsades]] can cause shaking after intermittent runs}
	*Consider: [[Utox]], RPR, [[HIV]], [[UA]], EEG, [[lumbar puncture]]		*Prolactin may be useful in differentiating seizures from psychogenic nonepileptic seizures
			*Lactate which may help distinguish from volitional etiology (Lactate may be detectable for up to 1 hour post-seizure)
			*Consider: [[Utox]], RPR, [[HIV]], [[UA]], EEG, [[lumbar puncture]], EtOH level, CK

	====Known Epileptic with NO Change in Baseline Seizures====		====Known Epileptic with NO Change in Baseline Seizures====