Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures
Official 2024 guideline from the American College of Emergency Physicians.
summary by Eric Steinberg, DO, MEHP
Recommendations
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 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 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 refers to medications prescribed for seizure prevention.
Level C
Emergency physicians should treat seizures refractory to appropriately dosed benzodiazepines with a second-line agent. Fosphenytoin, levetiracetam, or valproate may be used with similar efficacy.
Level A
Emergency physicians need not admit patients with a first unprovoked seizure who have returned to their clinical baseline in the emergency department.
Level C
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
