1. Seizure, new onset
OutpatientHistory of: Aura, LLOC, Abnormal
movements/sensation, incontinence,
injury, confusion, focal paralysis, muscle
soreness, headache, tongue bite,
predisposing factors (family history of
seizure disorder, perinatal issues, prior
CNS infection, stroke, head injury)
Was seizure provoked
(metabolic disorders,
stress, insomnia,
substance
abuse/withdrawal)
Treat
underlying
condition
Is the patient
stable?
CT Brain, serum electrolytes, glucose,
calcium, magnesium, hematology studies,
renal and liver function tests , toxicology
If abnormal,
treat as
indicated
Normal
Fever , signs of
infection
Obtain lumbar
puncture
Consistent with
infection treat
accordingly
Unlikely to be seizure: consider evaluation for
other causes: ECG holter monitor, carotid
Doopler, echocardiogram, psychiatric
evaluation, etc
Outpatient evaluation
Treat if Increased
risk of recurrence of
seizure:
- Abnormal neurological exam/focal seizure
- Epileptiform abnormalities on EEG
- CT Brain abnormalities
- Strong family history of seizures
-More than 1 seizure/Status epileptic
Initiate anti-seizure
medication based upon
seizure type
Review state driving
requirements in patients
with known seizure
Yes
No
Yes
No
No Yes
Yes