Last updated March 14, 2022
Adult Patients Presenting to the Emergency Department With Seizures
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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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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Title
Adult Patients Presenting to the Emergency Department With Seizures
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
January 1, 2014
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