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Episode Info: Take Home Points When approaching the patient with uspected seizure, focus on questions that matter in determining if the event was a seizure or not Extensive lab work after a first time seizure is not necessary in patients who are back to baseline.  Focus on serum glucose, determining pregnancy/postpartum status, and in patients who continue to seize, check that sodium! Get a CT of the Head on First-time seizure patients High-risk groups (alcoholics, immunocompromised, infants < 6 months of age) Those with an abnormal neuro exam Those presenting with focal seizures Psychogenic non-epileptic seizures are difficulty to distinguish from true epilepsy and there is significant overlap between the two conditions.  Take all seizure activity seriously. Give clear discharge instructions to your first-time seizure patients and close the loop on close neurology follow-up. REBEL Core Cast 36.0 – Seizures Click here for Direct Download of Podcast Seizures: Definition – an episode of disturbed cerebral functions characterized by excessive and synchronous discharges by cortical neurons 2 types Provoked – attributable to an apparent cause (electrolyte disturbance, drug/EtOH withdrawal, eclampsia) Unprovoked – no identifiable cause Convulsions – the motor manifestations of the abnormal brain activity No single ED test or information from the history is 100% diagnostic of a seizure Seizure mimics: Syncope (20% will be convulsive syncope) Convulsive concussion Posturing Psychogenic non-epileptic spells (PNES) certain TIAs other neurologic movement disorders Characteristics that are non-diagnostic of seizure: urinary incontinence lightheadedness prior to the event paresthesias activity prior to the event headache after sustaining an injury Characteristics that are helpful (make seizure more likely) lateral tongue biting eyes open during the episode post-event confusion a forward or unilateral gaze during the episode First-time seizure ED work-up: POC glucose! Most common cause of provoked seizure ECG (to rule out dangerous mimics) FULL vital signs! temperature, blood pressure, oxygen saturation Pregnancy/Postpartum status up to 6 weeks postpartum at risk for eclampsia Sodium level especially if seizure is not resolved CT of the head may change management in the ED up to 17% of the time Let the patient’s medical, social, and medication history dictate any further workup High-risk groups in which to always get a CTH: Those not back to baseline Chronic alcohol use Immunocompromised Infants < 6 months of age Those with an abnormal neuro exam Those with focal seizures Recent neurosurgical intervention/instrumentation Psychogenic Non-Epileptic Seizures (PNES) Involuntary episodes NOT associated with abnormal cerebral discharges Often associated with a history of PTSD, abuse Triggering event is not usually readily identifiable Between 5-60% of patients diagnosed with PNES will ALSO have a concurrent diagnosis of epilepsy PNES does not equa...
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