From the Guidelines
The basic workup for potential seizure activity should begin with a thorough history and physical examination, followed by an electroencephalogram (EEG) to detect abnormal electrical activity in the brain, and neuroimaging of the brain, as recommended by the most recent guidelines 1. When evaluating a patient with potential seizure activity, it is essential to consider the latest clinical policies and guidelines. According to the 2024 clinical policy on critical issues in the management of adult patients presenting to the emergency department with seizures, published in the Annals of Emergency Medicine 1, the management of seizures can be clinically challenging.
Key Components of the Workup
- A thorough history and physical examination to identify potential causes of seizures
- An electroencephalogram (EEG) to detect abnormal electrical activity in the brain
- Blood tests, including complete blood count, comprehensive metabolic panel, glucose, electrolytes, and toxicology screening
- Neuroimaging with either CT or preferably MRI of the brain, as recommended by the 2004 clinical policy 1, which suggests that when feasible, perform a neuroimaging of the brain in the ED on patients with a first-time seizure
Additional Considerations
- If the initial EEG is normal but seizures are still suspected, a prolonged EEG monitoring for 24-72 hours may be necessary
- Additional tests might include lumbar puncture if infection or autoimmune causes are suspected
- For first-time seizures in adults, consider starting with an anticonvulsant, and patients should be counseled about seizure precautions, including avoiding driving until cleared by a physician and taking medications consistently, as seizures are symptoms of an underlying condition rather than a disease itself.
From the Research
Basic Workup for Potential Seizure Activity
The following steps can be taken for a basic workup:
- Medical history: A thorough medical history is essential to identify any underlying conditions that may be contributing to the seizure activity 2, 3, 4, 5, 6.
- Physical examination: A physical examination can help identify any physical abnormalities that may be related to the seizure activity 2, 3, 4, 5, 6.
- Electroencephalogram (EEG): An EEG can help diagnose and monitor seizure activity by measuring the electrical activity of the brain 2, 3, 4, 5, 6.
- Imaging studies: Imaging studies such as MRI or CT scans can help identify any structural abnormalities in the brain that may be contributing to the seizure activity 3, 4.
Treatment Options
The following treatment options are available for seizure activity:
- Levetiracetam: Levetiracetam is an antiepileptic drug that has been shown to be effective in controlling seizures in patients with epilepsy 2, 3, 4, 5, 6.
- Lamotrigine: Lamotrigine is an antiepileptic drug that has been shown to be effective in controlling seizures in patients with epilepsy, but may not be suitable for patients with juvenile myoclonic epilepsy 2, 6.
- Sodium valproate: Sodium valproate is an antiepileptic drug that has been shown to be effective in controlling seizures in patients with epilepsy, but may have adverse effects and may not be suitable for all patients 2, 6.
Key Findings
- Levetiracetam has been shown to be effective in controlling seizures in patients with epilepsy and may be a good alternative to sodium valproate, especially in women of childbearing age 3, 4, 5, 6.
- Lamotrigine may not be suitable for patients with juvenile myoclonic epilepsy due to its lower efficacy and higher rate of adverse effects 6.
- Sodium valproate has been shown to be effective in controlling seizures in patients with epilepsy, but may have adverse effects and may not be suitable for all patients 2, 6.