Emergency Department Clinical Pathway for Management
of Suspected New Unprovoked Seizure(s)
Related Pathways
- Abuse Physical, ED
- EEG Monitoring, PICU, NICU, CICU
- Febrile Seizures, ED and Inpatient
- Head Trauma, Acute, ED
- Meningitis, Suspected, ED, Inpatient, ICU
- Somatic Symptom and Related Disorders (SSRD), ED and Inpatient
- Status Epilepticus, ED
- Stroke, ED
- Traumatic Brain Injury, ED and ICU
- Ventricular Shunt Obstruction/Infection, ED, ICU, Inpatient
ED Team Assessment
- VS, mental status, neurologic exam
- History and Physical Exam
- Consider POC glucose if altered mental status
Review
Concern for Provoked Seizure
Evaluation, treatment, Neurology Consult as clinically indicated
- Mental status not improving after 15 mins from seizure cessation or ED presentation
- Post-seizure (Todd’s) paralysis lasting > 15 mins
- Seizure duration > 5 mins
- Medication used to stop seizure
- > 1 seizure in 24 hrs
- Focal seizure
- Developmental regression
- Age < 2 yrs
Consider Discharge
Return to baseline
mental status and exam
Return to baseline
mental status and exam
Consider Admission
Persistently altered mental status
and/or abnormal neurologic exam
Persistently altered mental status
and/or abnormal neurologic exam
- Expedited Neurology follow-up w/in 2 wks
- Consider rescue medications for seizure > 5 mins
- Seizure Discharge Instructions
- Neurology arranges EEG with appointment
- Need for urgent MRI (< 48 hrs)
- ED places MRI order, if indicated
- Additional care coordination to arrange
management and follow-up
Posted: April 2021
Last Revised: March 2024 Editors: Clinical Pathways Team
Last Revised: March 2024 Editors: Clinical Pathways Team
Evidence
- Practice Parameter: Evaluating a First Nonfebrile Seizure in Children
- The Role of Emergent Neuroimaging in Children with New-Onset Afebrile Seizures
- The Role of Brain Computed Tomography in Evaluating Children with New Onset of Seizures in the Emergency Department
- Utility of Laboratory Testing for Infants with Seizures
- Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures
- Utility of Obtaining a Serum Basic Metabolic Panel in the Setting of a First-Time Nonfebrile Seizure
- Diagnostic Value of Lumbar Puncture in Afebrile Infants with Suspected New-Onset Seizures
CHOP Programs
Related Links