Apr 25, 2021
Written By: Chris Cochrane, FM Resident in Medicine Hat
Peer Review By: Kevin Duncan, EM Resident in Kelowna
Objective
One:
a) In a patient having a seizure:
Ensure proper airway control (e.g., oropharyngeal airway or nasal
trumpet, lateral decubitus to prevent aspiration).
b) Use drugs (e.g., benzodiazepines, phenytoin) promptly to stop
the seizure, even before the etiology is confirmed.
c) Rule out reversible metabolic causes in a timely fashion (e.g.,
hypoglycemia, hypoxia, heat stroke, electrolytes
abnormalities).
Objective
Two:
In a patient presenting with an ill-defined episode (e.g., fits,
spells, turns), take a history to distinguish a seizure from other
events.
Objective
Three:
In a patient presenting with a seizure, take an appropriate history
to direct the investigation (e.g., do not over investigate; a
stable known disorder may require only a drug-level measurement,
while new or changing seizures may require an extensive
work-up).
Objective
Four:
In all patients presenting with a seizure, examine carefully for
focal neurologic findings.
Objective
Five:
In a patient with a previously known seizure disorder, who presents
with a seizure or a change in the pattern of seizures:
a) Assess by history the factors that may affect the primary
seizure disorder (e.g., medication compliance, alcohol use,
lifestyle, recent changes in medications [not just antiepileptic
medications], other illnesses).
b) Include other causes of seizure in the differential diagnosis.
(Not all seizures are caused by epilepsy.)
Objective
Six:
In the ongoing care of a patient with a stable seizure
disorder:
a) Regularly inquire about compliance (with medication and
lifestyle measures). side effects of anticonvulsant medication, and
the impact of the disorder and its treatment on the patient’s life
(e.g., on driving, when seizures occur at work or with
friends).
b) Monitor for complications of the anticonvulsant medication
(e.g., hematologic complications, osteoporosis).
c) Modify management of other health issues taking into account the
anticonvulsant medication (e.g., in prescribing antibiotics,
pregnancy).