What are the discharge instructions for a patient hospitalized for seizures?

Discharge Instructions for Patients Hospitalized for Seizures

Patients with a normal neurologic examination who have returned to their clinical baseline can be safely discharged from the hospital with appropriate outpatient follow-up. 1

Assessment Prior to Discharge

• Ensure patient has returned to neurological baseline with a Glasgow Coma Scale (GCS) score of 15 1
• Verify completion of appropriate diagnostic workup to identify underlying cause of seizures 1
• Confirm that any acute intracranial processes or metabolic abnormalities have been addressed 1
• Assess risk factors for seizure recurrence, including age ≥40 years, alcoholism, hyperglycemia, and abnormal neuroimaging 1

Medication Management

For First-Time Seizures:

• Patients with a normal neurologic examination, no comorbidities, and no known structural brain disease do not need to be started on an antiepileptic drug (AED) before discharge 1
• Delaying therapy until a second seizure does not affect one-to-two-year remission rates 2
• For patients with remote symptomatic seizures (history of stroke, trauma, tumor, or other CNS disease), treatment after first seizure may be appropriate due to higher recurrence risk 1

For Patients Already on AEDs:

• If medication non-adherence caused breakthrough seizure, restart previous effective AED regimen 3
• Ensure therapeutic drug levels before discharge if applicable 1
• If medication adjustment is needed, consider consulting with neurology before making changes 3
• Serum drug levels do not need to be rechecked before discharge, but follow-up monitoring is important 1

Follow-Up Instructions

• Schedule neurology follow-up appointment at time of discharge 3
• Arrange for outpatient EEG if not performed during hospitalization 4
• If neuroimaging was deferred during hospitalization, ensure reliable outpatient follow-up for this study 1
• Approximately half of providers recommend driving restrictions for 6 months after discharge 4

Seizure Precautions and Safety

• Advise patients to refrain from driving and high-risk activities for at least 3 months if seizures occurred within past 3 months or are poorly controlled 2
• Educate patients about seizure triggers to avoid (sleep deprivation, alcohol, recreational drugs) 1
• Instruct on proper seizure first aid for family members/caregivers 3
• Recommend home safety modifications to prevent injury during seizures 3

When to Seek Emergency Care

• Return to emergency department for:
  • Seizures lasting >5 minutes 1
  • Multiple seizures without returning to baseline between episodes 1
  • New focal neurological deficits 1
  • Persistent altered mental status 1
  • Fever or signs of infection 1

Special Considerations

• For women of childbearing potential, discuss potential teratogenic effects of AEDs and importance of planned pregnancy 2
• For patients with alcohol-related seizures, provide resources for substance abuse treatment 1
• For elderly patients, consider potential drug interactions with existing medications 5

Follow-up Duration of Antiepileptic Medication

• Most common recommended durations for outpatient AED use after acute symptomatic seizures:
  • 1-3 months (36% of providers) 4
  • 3-6 months (30% of providers) 4
  • 6-12 months (13% of providers) 4

  • 12 months (11% of providers) 4

Communication with Primary Care

• Ensure detailed communication between emergency physician, neurologist, and primary care physician regarding hospitalization details and follow-up plan 3
• Provide patient with written discharge instructions including medication details, follow-up appointments, and when to seek emergency care 3