Emergency Department Clinical Pathway for Management
of Suspected New Unprovoked Seizure(s)

ED Team Assessment
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
Consider Admission
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