Adult Patients Presenting to the Emergency Department With Seizures

Publication Date: January 1, 2014
Last Updated: March 14, 2022

Recommendations

Patient Management

Emergency physicians need not initiate antiepileptic medication in the ED for patients who have had a first provoked seizure. Precipitating medical conditions should be identified and treated. (C)
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Emergency physicians need not initiate antiepileptic medication in the ED for patients who have had a first unprovoked seizure without evidence of brain disease or injury. (C)
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Emergency physicians may initiate antiepileptic medication in the ED, or defer in coordination with other providers, for patients who experienced a first unprovoked seizure with a remote history of brain disease or injury. (C)
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* Antiepileptic medication in this document refers to medications prescribed for seizure prevention.
Emergency physicians need not admit patients with a first unprovoked seizure who have returned to their clinical baseline in the ED. (C)
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When resuming antiepileptic medication in the ED is deemed appropriate, the emergency physicians may administer IV or oral medication at their discretion. (C)
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Emergency physicians should administer an additional antiepileptic medication in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines. (A)
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Emergency physicians may administer intravenous levetiracetam, propofol, or barbiturates in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines. (C)
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Emergency physicians may administer intravenous phenytoin, fosphenytoin, or valproate in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines. (B)
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Recommendation Grading

Disclaimer

Overview

Title

Adult Patients Presenting to the Emergency Department With Seizures

Authoring Organization

Publication Month/Year

January 1, 2014

Last Updated Month/Year

June 26, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians is the revision of a 2004 policy on critical issues in the evaluation and management of adult patients with seizures in the emergency department.

Target Patient Population

Patients with seizures

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Emergency care

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D012640 - Seizures, D004635 - Emergency Medicine, D020270 - Alcohol Withdrawal Seizures, D003294 - Seizures, Febrile, D003295 - Convulsive Therapy, D003292 - Convulsants

Keywords

seizure, adult seizure, unprovoked first seizure

Source Citation

Ann Emerg Med. 2014;63:437-447.

Methodology

Number of Source Documents
55
Literature Search Start Date
January 1, 2000
Literature Search End Date
September 1, 2011