Neurology Book

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Single Seizure EvaluationAka: Seizure Evaluation, First Seizure Evaluation

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  1. See Also
    1. Seizure
    2. Status Epilepticus
  2. History of event
    1. Careful review of events leading up to Seizure
    2. Presence of prodromes or auras
    3. Description of Seizure by reliable witness
    4. Postictal observations
    5. Time to complete recovery
  3. Medical History
    1. Febrile Convulsions
    2. Head Injury
    3. Vascular disease
      1. Cerebrovascular Accidents
      2. Coronary Artery Disease
    4. Cancer
    5. Infectious disease
    6. Sleep Disorder
    7. Medications (including over the counter, and herbals)
  4. Family History
    1. Febrile Convulsions
    2. Epilepsy in siblings, parents, or close relatives
    3. History of neurogenic disorders
  5. Social History
    1. Travel
    2. Occupation
    3. Substance Abuse
  6. Physical Exam
    1. Injury pattern
    2. Cardiovascular exam
    3. Skin exam
    4. Neurologic Exam
      1. Focal postictal deficits
      2. Focal neurologic deficits after recovery
      3. Neuropsychological evaluation
  7. Labs
    1. Complete Blood Count
    2. Serum electrolytes, calcium, magnesium, and phosphorus
    3. Serum Glucose
    4. Renal Function tests
      1. Creatinine
      2. Blood Urea Nitrogen
    5. Liver Function Tests
    6. Erythrocyte Sedimentation Rate (ESR)
    7. Urine Toxicology Screening
    8. Serum drug levels (as indicated)
    9. Serum Prolactin is not typically helpful
      1. Increased in 40-60% within 20 minutes of Seizure
  8. Diagnostic Testing
    1. Electroencephalogram (EEG) Indications
      1. Emergent EEG if Status Epilepticus (even if treated)
      2. Routine EEG (preferably within 48 hours)
        1. Recommended for most cases of new onset Seizures
    2. Lumbar Puncture indications
      1. CNS Infection suspected (fever, Meningitis)
      2. Immunocompromised patient
      3. Age under 6 months
    3. Consider cardiovascular evaluation in older patients
      1. Chest XRay
      2. Electrocardiogram
      3. Echocardiogram
      4. Holter Monitor
      5. Carotid Ultrasound
  9. Radiology: Structural study
    1. See Seizure Indications for Neuroimaging
  10. Differential Diagnosis
    1. See Seizure Causes
  11. Management
    1. See Status Epilepticus for acute Seizure management
    2. See Seizure Prophylaxis
  12. Driving restriction after Seizure
    1. Epilepsy foundation
      1. http://www.efa.org
  13. References
    1. Adams (2007) Am Fam Physician 75:1342

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