> Seizure

Seizure

Official guideline from the American College of Emergency Physicians.

summary by Eric Steinberg, DO

Recommendations

Anti-Epileptic Drugs (AEDs) for First-Time Seizure

Emergency physicians need not initiate antiepileptic medication* in the emergency department for patients who have had a first provoked seizure. Precipitating medical conditions should be identified and treated. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.

Level C

Emergency physicians need not initiate antiepileptic medication* in the emergency department for patients who have had a first unprovoked seizure without evidence of brain disease or injury. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.

Level C

Emergency physicians may initiate antiepileptic medication* in the emergency department, or defer in coordination with other providers, for patients who experienced a first unprovoked seizure with a remote history of brain disease or injury. *Antiepileptic medication in this document refers to medications prescribed for seizure prevention.

Level C

Disposition

Emergency physicians need not admit patients with a first unprovoked seizure who have returned to their clinical baseline in the emergency department.

Level C

AED Route of Administration

When resuming antiepileptic medication in the emergency department is deemed appropriate, the emergency physician may administer intravenous (IV) or oral medication at their discretion.

Level C

What do the icons mean?

Level A

Generally accepted principles for patient care that reflect a high degree of clinical certainty (ie, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).

Level B

Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (ie, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).

Level C

Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.

Literature

Original/Primary Reference

Huff JS, Melnick ER, Tomaszewski CA, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Seizures. Ann Emerg Med. 2014;63(4):437-47.e15.

Calc Function

Recommendations