A seizure is an episode of neurologic dysfunction resulting in change in motor activity or sensory perception caused by abnormal firing of neurons. Seizures can be generalized, with abnormal activity in both hemispheres of the brain and a change in mental status, or partial, involving only certain parts of the brain.
Simple partial seizures cause no change in mental status, while complex partial seizures do result in some degree of altered consciousness. Status epilepticus is defined as 5 minutes of continuous seizing or two or more episodes of seizures without a return to baseline between episodes.1
Seizures are a common presentation in the emergency department and account for 1%-2% of all emergency department visits. Epilepsy affects more than 3 million people in the United States, with more than 200,000 new cases of seizure each year.2 The most commonly affected are those at the extremes of age (younger than 2 years and older than 65 years old). Of the affected patients, approximately 100,000 will be in status epilepticus.
The work-up necessary for a complaint of seizure is dependent on several factors. When evaluating a patient with the complaint of seizures, the emergency physician should consider a few questions to guide management:
- Is the patient presenting with a true seizure, or is there a seizure mimic?
- Are there any underlying causes of the seizure, or is it secondary to a seizure disorder?
- Is this a first-time seizure, or does the patient have an established seizure history?
- Is the patient in status epilepticus?
This article will review the current evaluation, management, and disposition of patients presenting to the emergency department with seizures.
History and Physical Exam
Patients presenting with seizures often have a history of seizure disorder. Other key history to obtain includes compliance with medications, alcohol or barbiturate use, illicit substance abuse, recent fall or trauma, pregnancy, intracranial pathology, or travel outside of the United States. EMS is frequently a source of history for these patients as well, as the patient’s mental status may make it difficult to obtain history directly from the patient.